signifiance of heart palpitations

[maddy]

Could you please tell me if there is any signifance to the amount and hardness of heart palpitations.  

I am a 38 year old female who suffers from heart palpitations almost daily.  I usually have between 10 - 20 skips or strange sensations in my heart per day.  Sometimes the skips are REALLY hard.  I have no heart disease and a completely normal heart so I am told not to worry.  

My question is 10 - 20 abnormal beats a lot during one day and is there any significance to how hard the skips are.  I am told a lot of people just ignore the skips but I can't believe they can do that when they are so intense.

Thank you for your time.

[Cleveland Clinic, MD]

Dear Maddy,

In general there is no medical significance as far as the type of extra heart beat associated with the strength of the sensation.  However, in extreme circumstances where the patient is very bothered by what are otherwise normal beats beta-blockers can be used to decrease the sensation.  10-20 extra beats a day is not very much and personally I wouldn't take medication for so few beats but for some people it may be worth it.

[Robert]

Dear Maddy,

I am a 41 year old male.  I too suffer from "palpitations" diagnosed by my cardiologist as Premature Ventricular Contractions (PVCs) over 7 years ago.  The sensations that I feel sometimes take my breath away and result in light-headedness and also can sometimes be very severe in the sensations that are produced.  I have seen several cardiologists for this...had echocardiogram, stress test, wore a holter monitor etc...  It can be very frightening at times.  I have periods of months when I do not notice them and other times when they are so prevalent that they are all I can think about.  Fortunately, these intense periods usually are short lived (few weeks at a stretch).  When I first experienced strong PVCs, I was like you and didn't think that I could live with these symptoms so I asked my doctor for beta blockers (Corgard).  It did lessen the sensations, but all the doctors said the same thing, "Beta Blockers do not correct the condition, therefore do you really want to take the medication for the rest of your life?"  I stopped taking Corgard 2 weeks after initially prescribed and haven't used it since.  My suggestion to you is to have all the necessary tests to grant you peace of mind that nothing is physically wrong with your heart and stay away from the medication.  You don't want to become unnecessarily dependent on them or subjected to the expense.

[Xtian]

Robert,

I am a 34 yr old male and also have bad pvcs and what "appear to be occassional runs of atrial fibrillation" according to the cardio. I have had a cardiolite stress test which was negative along with stress echos, numerous exercise stress tests, MRI's, Holters, CAT scan of heart etc.. All negative except for the pvcs and occassional afib. I'm still bothered by this because I have been experience spasm-like chest pain on and off for a few years but more frequently lately with exercise and also at rest. The pain is crushing, in the center of the chest and very fast (seconds). My cardio doesn't believe it is angina because of it's short duration. He put me on 240mg of Cardizem CD to see if it might eliminate the problem which it did for a month until today when I had another spasm. I had an endoscopy yesterday to rule out esophageal problems which was negative. What's interesting is that I took the cardizem at 5:00PM yesterday instead of in the AM as usual because of the procedure. So today I took the cardizem at 3:00PM and one hour later I had the spasm. It's strange that I haven't had the pain in a month and the one day I screw with the medication it returns. This leads me to believe it is a coronary artery spasm or esophageal spasm. Have you, or anyone else out there, experienced fast chest pain like this as a result of arrythmias or otherwise? This morning I had a strange irregular rhythm for about 10seconds. My pvcs are usually shorter, so I'm not sure what the longer arrythmias are or whether I should associate this with the chest spasms i'm having. I'm frustrated because the doctors no longer listen to me due to all of the negative tests and my cardio doesn't even believe I'm having coronary artery spasms because the pain doesn't last long enough (he said coronary spasms are usually minutes, not seconds). The cardio also says I can get off the cardizem (which scares me because the pain is not diagnosed, and believe me I hate all meds!) My health is good otherwise and I have very low cholesterol. Anyone out there ever experience this? Should I push for an angiogram even though I had a negative cardiolite test and a negative CAT scan of the heart showing 0 calcium. I could use some good feedback. Thanks all.

[Xtian]

Robert,

I am a 34 yr old male and also have bad pvcs and what "appear to be occassional runs of atrial fibrillation" according to the cardio. I have had a cardiolite stress test which was negative along with stress echos, numerous exercise stress tests, MRI's, Holters, CAT scan of heart etc.. All negative except for the pvcs and occassional afib. I'm still bothered by this because I have been experience spasm-like chest pain on and off for a few years but more frequently lately with exercise and also at rest. The pain is crushing, in the center of the chest and very fast (seconds). My cardio doesn't believe it is angina because of it's short duration. He put me on 240mg of Cardizem CD to see if it might eliminate the problem which it did for a month until today when I had another spasm. I had an endoscopy yesterday to rule out esophageal problems which was negative. What's interesting is that I took the cardizem at 5:00PM yesterday instead of in the AM as usual because of the procedure. So today I took the cardizem at 3:00PM and one hour later I had the spasm. It's strange that I haven't had the pain in a month and the one day I screw with the medication it returns. This leads me to believe it is a coronary artery spasm or esophageal spasm. Have you, or anyone else out there, experienced fast chest pain like this as a result of arrythmias or otherwise? This morning I had a strange irregular rhythm for about 10seconds. My pvcs are usually shorter, so I'm not sure what the longer arrythmias are or whether I should associate this with the chest spasms i'm having. I'm frustrated because the doctors no longer listen to me due to all of the negative tests and my cardio doesn't even believe I'm having coronary artery spasms because the pain doesn't last long enough (he said coronary spasms are usually minutes, not seconds). The cardio also says I can get off the cardizem (which scares me because the pain is not diagnosed, and believe me I hate all meds!) My health is good otherwise and I have very low cholesterol. Anyone out there ever experience this? Should I push for an angiogram even though I had a negative cardiolite test and a negative CAT scan of the heart showing 0 calcium. I could use some good feedback. Thanks all.

[Xtian]

Robert,

I am a 34 yr old male and also have bad pvcs and what "appear to be occassional runs of atrial fibrillation" according to the cardio. I have had a cardiolite stress test which was negative along with stress echos, numerous exercise stress tests, MRI's, Holters, CAT scan of heart etc.. All negative except for the pvcs and occassional afib. I'm still bothered by this because I have been experience spasm-like chest pain on and off for a few years but more frequently lately with exercise and also at rest. The pain is crushing, in the center of the chest and very fast (seconds). My cardio doesn't believe it is angina because of it's short duration. He put me on 240mg of Cardizem CD to see if it might eliminate the problem which it did for a month until today when I had another spasm. I had an endoscopy yesterday to rule out esophageal problems which was negative. What's interesting is that I took the cardizem at 5:00PM yesterday instead of in the AM as usual because of the procedure. So today I took the cardizem at 3:00PM and one hour later I had the spasm. It's strange that I haven't had the pain in a month and the one day I screw with the medication it returns. This leads me to believe it is a coronary artery spasm or esophageal spasm. Have you, or anyone else out there, experienced fast chest pain like this as a result of arrythmias or otherwise? This morning I had a strange irregular rhythm for about 10seconds. My pvcs are usually shorter, so I'm not sure what the longer arrythmias are or whether I should associate this with the chest spasms i'm having. I'm frustrated because the doctors no longer listen to me due to all of the negative tests and my cardio doesn't even believe I'm having coronary artery spasms because the pain doesn't last long enough (he said coronary spasms are usually minutes, not seconds). The cardio also says I can get off the cardizem (which scares me because the pain is not diagnosed, and believe me I hate all meds!) My health is good otherwise and I have very low cholesterol. Anyone out there ever experience this? Should I push for an angiogram even though I had a negative cardiolite test and a negative CAT scan of the heart showing 0 calcium. I could use some good feedback. Thanks all.

[samantha]

To Chris,
After suffering from periodic episodes of chest pain with EKG
changes(ST segment depression)on two different occasions, I had
a cardiac cath. I was only 24 at the time, but I had already had
open heart at 21 for arrhythmias, and still suffered from them at that time. I was given a drug called ergonovine which helps
to stimulate spasms during the heart cath. I did experience pain
with the medication but no EKG changes. The cath showed no occulsions or spasms of the main arteries but I did have total
obliteration of a small distal branch (off of one of the main arteries). My cardiologist speculated that this could be contributing to my chest pain but it was not what one would expect with classic coronary artery spasms. Also the fact that EKG changes were not always present with the pain made it difficult to diagnose. Except for arrhythmias all other tests came back normal. I was given nitroglycerin spray and put on a
calcium channel blocker. I tried several different meds finally settling with Cardiazem SR-90 (3xday). This pretty much relieved the pain. I continue to have some chest pain but this usually only occurs with arrhythmias (SVT, Atrial Flutter, Sick Sinus Syndrome, frequent PVC's{5000 per day}). Of course it is you and your doctor's decision but I would consider having the cardiac cath with dye and the ergonovine. At least you could finally rest knowing you have exhausted all possibilites. Good luck!

[Xtian]

Dear Samantha,

Thankyou for your reply. Did you have open heart for arrythmias? I thought catheter ablations were usually the solution. Did you have any blocked arteries? Also was your chest pain like mine; crushing and lasting only seconds? I'm trying to get a sense of your symptoms in relation to mine. I noticed an arrythmia this morning which was longer than the usual PVC, but had the chest pain later in the day. I'm a little hesitant to do the catheter because I don't have any evidence of angina yet and know their are risks involved with the catheter. I really appreciate the input as I desperately need to put my mind at rest.
My e-mail is: ***@**** if you or anyone else have any suggestions.

[Robert]

Chris....
Not sure what I can add to Samantha's comment.  My PVCs have never resulted in any severe pain such as you have discribed.  Mine are limited to what I believe would be similar to a hiatus hernia, pressure forming in the upper chest and throat.  I do have runs of PVCs lasting 5-10 seconds at times, but the sensations are limited to breathlessness and dizziness.  I think alot of people suffering from PVCs are frustrated with some of the medical advise and the seemingly apothetic response from the medical profession in general.  I guess from the doctor's point of view, since PVCs by themselves are benign, the bedside manor is often tested by what the doctor's view as unwarranted concern by those experiencing them. As I have found, the only thing reasurring me of my otherwise excellent health was to have all the requisite tests and accept that the cummulative diagnoses of 3 cardiologists.  Tough call on your part.  Don't know of the risks involved in the cath procedure, but if that is what it takes to provide you peace of mind, it may be worth it!  Good Luck!

[aaron]

To Robert - I get the same thing.  My cardio also thinks I am having short periods of Afib.  I had a EP study done in January and the only thing we found was PVC's and SVT.  I don't believe the 10 to 30 seconds runs are SVT becuase the beats are very irregular and irratic.  Just thought you might want to know that there are others in the same boat.  Take care (I'm 31 to by the way).

[Susan]

I was diagnosed with idopathic atrial fibrillation 10 years ago.
I have been treated with a wide variety of drugs.. each sort of controlling the episodes, but not totally.
In Oct.1998 I was referred to a cardiac research program.. the drug they were researching/studying is called Azimilide. for 18 months i was on the drug.. completely free of side effects and episodes of atrial fib!!!
The study was such a success, that the company, Proctor & Gamble have now stopped it. period. No more drug for us that are so completely symptom free.
Today i started on Rhythmol.. but i am sure not happy.
We are hoping the drug will be approved very soon for retail use.. watch for this drug and ask your doctors when it comes out.. it just may be the drug for you! I sure improved my life!!

[samantha]

Chris,
I had open heart in 1983. Radiofrequency ablations had not yet been discovered. Some ablations were being done with DC current but the risks were very high depending on what area needed to be ablated. The chances of blowing a hole in the wall of the heart were great, and also the accuracy of what area the current would actually destroy was not perfected at that time. It is amazing to see how far technology has actually come in 20 years. Most likely I would have avoided open heart today. Gee, how I wish I could have. The surgery did more harm than good in the long term. I had my SA node totally excised. It and all of the excitable tissue surrounding it was not gotten. I continued to have arrythmias and eventually developed 5 different pacemaker sites alternating my rhythms. Getting back to the chest pain, I only had 2 EKG's that were taken during 2 different episodes of pain that showed any changes. All other tests were negative. During the heart cath I did not show any EKG change which is not usually the norm. All of my major ateries were clear but when I was given the ergonovine to stimulate any types of spasms, I had one distal branch off of the main artery that totally closed up.
This is not "typical" coronary artery spasm but my cardiologist
said it was certainly enough to cause pain. Even though the distal branch was small, the oxygen supply was cut off which could cause pain. He said this was his first experience involving the total obliteration of a distal branch in relation to pain. Since this was not a case of classic coronary artery spasm it was difficult to diagnose, and as I said all of my other tests were negative except for arrhythmia. Pain during the arrhythmias differed from the other chest pain. My pain with spasm was crushing like an elephant standing on my chest. Sometimes it went through to my back and I became nauseated at times. However, mine usually lasted minutes or hours, not just seconds. I hope this helps in some way. Good luck!

[Nick]

I am a 50 year old male with type 2 diabetes and asthma.Recently I developed heart palpitations after my doctor added a new diabetes med to my oral meds.About 15 years ago my doctor told me that I have the beginning of a hiates hernia.My doctor didn't seem concerned when I informed him of the palpitations. He just changed my med again.But the palpitations continue.They seem to be worse after a meal and don,t seem to be present when I sleep.Could these palpitations be due to the hiates hernia and have nothing to do with my heart? I have never had heart problems.Also will they go away after awhile? Should I be concerned?

[Linda]

Nick - what diabetes drug were you put on?  i am having the same sort of problem and my doc just put me on avandia.  i don't see palpitations listed as a side effect though.  thanks.

[Wayne]

I have had pvc's on and off for many years and my Dr's always thought it was simply anxiety and stress related. I find them pesky especially when they last for hours on end-svery few beats or so. Lopressor seems to have cuth them way down and I only have them on ocassion and briefly..but they still scare me! Like.."is this gonna be it!??" Anxiety can make it so much worse. My other problem is waking at night with rapid hard pulse. happens only whil sleeping and my EKG show a strong normal heart. I hate it.

[Sherry]

I don't know what I can really add to everyones experiences except I have had skipped beats every single day for the past 6 years..I'm not dead yet! Sometimes I'll only have 3 or 4 skips a day...other days I'll have them every few seconds..like when I'm really tired or stressed..The doctor tells me mine are called PAC'S.....they tell me to cut down on smoking and coffee..which I haven't done yet!I know when it  is happening every few seconds all day long...for days on end I tend to panic and I think it makes it worse.I try to relax and listen to tapes for relaxation..it helps..I don't know what triggered it to start skipping on that day 6 years ago but I haven't had a day without them yet..maybe one of these days they will stop ..just as quickly as they started..thanks for being my sounding boards..it's nice to have someone to tell your problems to.....Sherry

[Frank]

Palpitation!!! Six weeks ago I started having palpitations. They started after jogging 2miles which I have been doing every other day for twenty years. I had EKGs, 24 hr. monitor and echogardiogram. The cardiologists do not seem concerned and I have been placed on Beta Blocker (supposedly mildest form) and blood pressure pills. Plapitations are substantially reduced (24 hr. monitor detected  approximately 2,000 palpitations in 89,000 beats. I have not had the stress test.
Dr. said to maintain exercise schedule so I did. I had palpitations during evening and night after last jog. I have stopped it. I now notice tightness in chest and tingling/discomfort in left arm after walking. The funny thing is that I do not notice these problems when actually working, exercising. The echo showed normal heart, except for borderline enlarged Left Atrial. Again DR. says do not worry.
Does anyone experience chest discomfort without shortness of breath even though they are taking medication?

[Sherry]

Hi...sherry here again..since I last wrote I hav efound out the results of the holtor monitor....Since I don't have a family doctor at this time I signed a medical release to receive the report myself...WHAT A MISTAKE.....I really don't understand what it means but here is part of what it says.......1.sinus rhythm normal iv and av conduction time of no higher degrees of av block...2. no major repolorization changes......3. isolated pvc's and pac's...there was a 7 beat run of atrial fib flutter with heartblock being evident with a maximum RR interval of 1.4 seconds....4.  there were no sustained atrial or ventrical tachyarrhythmias........5.   severity of pvc's this falls into a grade 1a on theLOWNS GRADING SYSTEM with infrequent unifocal pvc's..........6.there is nothing consistant with a syncpal spell or acute or silent myocardial ischemia...7...it is not clear whether the patient could have had more sustained run of SVT at sometime in the past..........there you go..this is my holtor monitor report..I have no idea what it means. If someone out there could please tell me I would greatly appreciate it...I'm really worried..What are svt's?..thank you.

[Barbara]

I am a member of the same club as all of you.  I have palpitations of every description including atrial fibs, PVCs, etc. for no known reason. I am 52 and have had occasional or once-in-while skips since my late 20's when I was diagnosed with MVP and later panic attacks. Now I guess old age has set it because with Hashimoto's Disease (hypothyroidism)and with the introduction of Thyroid meds (Synthroid)and Armour Thryoid, I have had more problems than not. When TSH's go below or above normal, atrial fibs can occur and they did with me. I got that regulated and once again my TSH came way too close to the edge ( the norm is .4-5.0 ) and the first time mine was <.1 and the 2nd time my TSH was .7. I have noticed that the more I am at the edge of the norm or closer to .4 I get worse with my heart palpitations.
One of the reasons for my note is that I have been reading where some of your doctors do not believe what heart palps and chest pains you all are having and naturally when you are being monitored with a Holtor Monitor, nothing much happens. It is rather like taking your car to the shop and no problems! Have you all heard of the Event Recorder? It records the event as it is happening. If you ask the doctor for this, you can catch most of the palps as they occur......it is always in a backtracking mode by about 10 seconds so when you feel the pain or the skip, when you press "record" it has backtracked 10 seconds and it "catches" the palpitations and then continues on for maybe 20 seconds. You then send it in to the lab via the phone and a mouthpiece on the recorder....you push "send" on your event recorder after you match up the phone mouthpiece with the tiny recorder's mouthpiece and it goes over the phone to a computer lab which transcribes the noise you hear to an EKG. I did not read of many of you using this or being asked to use it so I thought I would tell you about this because I had to be told about it. I love this machine!
    I am also wondering about this drug called Azimilide. Is it out yet? Thanks, Barbara. My email is ***@****.

[Kristi]

Sherry-I am in almost the exact situation that you have described.  About 7 years ago, I started getting panic attacks where my heart would palpitate for several minutes at a time.  Then, after the panic attacks had ceased, I began to notice irregular heartbeats more often....especially in the past few years.  Like you described, sometimes they seem to occur several times a day, and other times every few seconds.  The doctor had me wear a heart monitor, and told me after several weeks that what I had were "PVCs" and not "PACs."  I don't really understand the difference but he did say that PACs are always benign. This made me feel better temporarily, and the skipped heartbeat sensation seeded to fade, but now, about 7 months later, I am sensing them very often.  I have developed a habit of feeling my pulse every few minutes, almost unconsciously, to see if I can sense any irregularity.  It is extremely annoying, uncomfortable, and sometimes downright frightening.  I can tell you that yoga and completely eliminating caffeine from my diet has helped in the past.  If you eliminate caffeine completely, yours may dissapear, because that seems to be the most common cause.  Other things that may contribute to heartbeat irregularity that I've read about are red wine, cold medicine, and chocolate.  Thanks for letting me vent!  Let me know if you have any ideas or input.

[Jack]

I'm 23 years old and I have been having palpitations for the last 3 months.  I've gone to the hospital and the doctor told me that these were pvc's and not to worry about them.  Easy for him to say!  Well, I've noticed that some days they are very frequent and other days not frequent at all.  Some days, I never have them.  I've been experiencing anxiety, and a few panic attacks about 6 months prior to having my first palpitations.  The doctor seems to think this has alot to do with my palpitations.  I don't have panic attacks anymore, but my anxiety revolves around my palpitations.  I've also noticed that when I drink alcohol, I don't have them during, or a few days after drinking.  Thats weird because they recomend not drinking alcohol if you have palps.  It's also caused me to drink more frequently than I ever had.  Just wondering if anyone my age is experiencing the same thing.

[Jack]

I'm 23 years old and I have been having palpitations for the last 3 months.  I've gone to the hospital and the doctor told me that these were pvc's and not to worry about them.  Easy for him to say!  Well, I've noticed that some days they are very frequent and other days not frequent at all.  Some days, I never have them.  I've been experiencing anxiety, and a few panic attacks about 6 months prior to having my first palpitations.  The doctor seems to think this has alot to do with my palpitations.  I don't have panic attacks anymore, but my anxiety revolves around my palpitations.  I've also noticed that when I drink alcohol, I don't have them during, or a few days after drinking.  Thats weird because they recomend not drinking alcohol if you have palps.  It's also caused me to drink more frequently than I ever had.  Just wondering if anyone my age is experiencing the same thing.

[tom]

I am a 40 year old male who started having palp's 8 years ago. the cardiologist advised me to cut down an cafeine, chocolates etc. which helped.

Now 8 years later, I have developed the palp's again and they last all day long ( 1 or 2 per minute sometimes more.) I notice them the most when I am at my desk or lying in bed totaly relaxed.

I went in recently for a stress echo and of course everything looked fine. I blew through the stress test without a problem.
Does anyone else get these when at rest? It is starting to drive me crazy!

[Lynn]

I am 53 years old.  On June, 20, the morning after I had just had a routine check-up, I felt as if I were really nervous.  I thought that I had forgotten to take my blood pressure medicine, but no shot.  That night, I woke up with a pounding heart, some palpitations, and pain at the base of my breastbone.  This went on periodically.  While on vacation the second week of July, I was aware of the pain quite a bit.  I was never short of breath, no nausea, no pain while walking on the beach.  It mainly happened at suppertime when things were hectic.
I made an appt. with a cardiologist but not until 9/12. In the meantime, I went to my internist, who did an ekg, which was normal.  I have a lot of stress in my life right now, so he put me on Paxil, which worked for awhile.  My mother-in-law was very sick, so I gave her my appt., thinking I was okay.  Now the pain and palps have returned, and I have an appt. with the cardiologist Oct. 3.  The pain feels like spasms, but I'm not sure.  I am very nervous today, because I was awake most of the night, and the more I think about what it could be, the worse I become.  I have walked three miles at least four days a week for 20 years.  I never feel any pain while walking.  Also, I bicycle.  Again, no pain.  I usually go to bed feeling fine, then wake about 2 am.  I feel as if my breastbone is sore and my bra is pressing on it!  Does anyone have any advice for me?  I would like to know if anyone is having the same symptoms.
Lynn

[Cindy]

For months now I have noticed skipped beats or a fluttering of my heart which did not concern me a great deal at first but recently I have had irregular and pounding heart beats which then in turn makes me very anxious.I have taken to drinking a glass of warm milk, taking a hot bath or doing Yoga like breathing to calm myself down so it doesn't make it worse.I've noticed coffee & alcohol increase my bouts so I have been advised to cut that out and see if any improvement. My doctor doesn't seem concerned, she just takes my blood pressure (which reads just fine). Of course I don't have any trouble with my heart when I finally get to see the doctor and she finds no reason to do any other tests until we rule out caffeine & alcohol (I do drink 2-3 drinks a day). I do have anxiety which I take Rivitrol occasionaly so she thinks it's all part and parcel.