Is this something serious?

[HP44]

Hey,

I am 18-year-old male and I'm concerned about heart palpitations. These palpitations feel like my heart skips a beat. I have had these kinds of feelings on and off for about 4-5 months. I use to be anxious person but not anymore to be honest. After I got fine with my anxiety, I started to get these palpitations. It's really distressing and scary. I'm stressed that I have something in my heart and that may be one reason why I'm having these.
Yesterday I checked my resting pulse and it was 50. I don't drink energy drinks, caffeine like coffee or coke and I don't smoke. I'm in pretty good shape because I play two sports. About two months ago I went to the doctor to check out my heart and there wasn't anything.
I get these palpitations every day 1-6 times I'd say. They don't give me any other symptoms but I get scared and small anxiety which goes away.

So are these palpitations normal or do I have some kind of heart arrhythmia? How can I get rid of these palpitations? What are your thoughts?

Thank you!

[JPstone]

I was 17 when I first started having Palpitations I have had them on and off ever since. I’m 33 now. I went to docs then and had a Cardio work up all normal. They chalked it up to anxiety. My doc tells me no my heart is structurally fine. I did have an episode of A fib but I was doing a lot of things I shouldent have been. Namely drinking a lot of alcohol. If your worried about your heart the worst thing you can do is use any kind of mind altering substance. I had to  learn that the hard way so if you steer clear of that now your doing yourself a favor. Trust me.

The answer to your question is maybe. I only say that because there are many thing you feel in your heart could be benign and may be not even your heart at all.  Probably more likely the case than a serious medical problem. Especially at your age. The only way to know for sure is to get a work up. Best of luck and feel better

[2210485]

You too! All the interesting heart stuff coming out of the woodwork in these comments..

You are just too young for someone to consider afib normal.. Especially at 17.. Even if youre absolutely plastered.. Afib that early is a bit ominous..

Normally afib is to be expected in a much older population with sick sinus syndrome.. It accompanies conduction system disease often.

Did they tell you how it conducted? Did you have a rapid heart rate at the time? The first priority is ensuring the afib isnt traveling down a pathway thats not the av node.

Priority 2 is closely tracking it (regular followups every year) to ensure it doesnt become more frequent.. Especially as you age the team responsible for your care should be looking for any sort of trends that would indicate a progression of an underlying disease process.

That or nip it in the bud and start treating it now... Given the technical obstacles and risks associated with ablation, pulmonary vein isolation is the last line of treatment here, reserved for severe or hemodynamically unstable cases, however prophylactic medical management could be justified in some cases.. Particuarly if the episode is prolonged.

[tom_h]

When i was experiencing a period of days of PVC's (skips), my cardiologist told me that he considers 4 normal beats in a row to ve a normal heart rhythm, and while increasing my beta blocker, did nothing else except monitor me further.  Indeed, there are people here on the forum who experience upwards of a confirmed 25,000 PVC's per day and who go basically untreated.

[2210485]

Err.. Ehh.. Ok..

4 beats is when a rhythm stops being 'pvcs' and is officially ventricular tachycardia..

However.. 2 or 3 beats in a row is still slightly more concerning.. As is bigeminy.

The reason for this being couplets and triplets along with bigeminy have a higher probability of originating from reentrsnt substrate.

If i recall correctly you got an svt ablation so you should be familiar with the concept here..

2 pathways exist.. A fast and a slow with different refractory periods.. In avnrt the 'substrate' is the fast slow av nodal pathways..

In couplets and triplets similar substrate exists in the ventricle.. A pvc fires off and reenters a slow pathway, where it gets hung up and emerges out the other side, generating a pvc.

If it is able to reenter the loop 4 times its vtach.

Same principle applies to bigeminy.. An intrinsic impulse gets stuck in slow pathway, emerging as a ventricular "echo". In bigeminy what we often see is that echo being blocked from retrogradely entering the atria, allowing another sinus impulse to travel outside the refractoriness of the atria.

In any case it becomes more important to aggressively manage folks with couplets or triplets, usually with medicine.. If the medicine however isnt effective at eliminating the episodes entirely more invasive techniques can be considered, such as ablation or even icd implantation in certain high risk populations.

[2210485]

Of course exceptional irritability (a normal pvc randomly,firing off twice without reentry) is a possibility as well..

Similar phenomenon can be observed in bigeminy.. The pvcs just happen to occur at the right time...

Distinguishing which is which however is difficult.. If not impossible (cant think of a foolproof method off the top of my head) without an ep study.

As for structurally normal hearts, that is one method of determining probability but it isnt conclusive.. People without cardiomyopathy/heart failure, congeinital abnormalities or prior surgeries certainly are at lower risk for developing the sort of scar tissue that allows these things to propagate.. Its just the risks associated with reentry are not worth taking the risk.. Gotta trial meds till theyre eradicated or do an Ep study

[2210485]

All you need to do to get a holter monitor btw is just approach your doctor and tell him the following:

"I am experiencing forceful palpitations in pairs of 2 or 3. Id like to wear a holter to assess my pvc burden and to rule out the presence of triplets and non sustained vtach"

100% guaranteed to get a cardiac workup. :)

[2210485]

Sounds normal.. Usually these feelings are caused by pvc's.

They come and go at different points in life, sometines they have triggers, sometimes not.

Skipped beats followed by periods of mildly elevated heart rate are pretty standard with them.

Everyone gets pvcs from time to time, so they are normal.. However some individuals become more sensitive in terms of actually feeling them. Most folks might actually feel 1 out of 100 pvcs they have.. Others might feel all 100. Unfortunately theres really no way to predict who experiences the sensations associated with then and who does not.. And scientists are largely in the dark as to why some folks get so symptomatic.

Anxiety after a pvc is natural.. I think its easy to blame anxiety for everything, but we tend to forget that our brains are hardwired to freak out when something isnt right with our vital organs.

Its definately more common for pvc's to create anxiety then for anxiety to create pvc's

They dont become dangerous untill you start having large amounts of 'skipped beats' (at least 1 out of every 10 heart beats), or if you were born with certain forms of congenital heart disease.

Unfortunately for you they are very hard to control.. And the best results come from invasive cardiac procedures. Medicines such as beta blockers can be effective at reducing the amount of pvc's but its literally like a 50/50 chance with any given med.

The best course of action for you is to visit your doctor and reauest a referral to a cardiologist to get a 'holter monitor'. This monitor takes and saves an ecg for 24 hours while you go about your day (its the size of an old ipod, and is worn around the neck).. The results will tell the doctor just what percentage of beats are pvcs or pacs (we call this your burden), along with any other issues that may be going on electrically.

This data is what will guide your treatment options moving forward.

[HP44]

Thank you for answering so quickly! I got to still say and ask one thing. Sometimes when I get palpitation, it can be like 2-3 palpitations at one time/in a row. It can comeback once after 10 beats or so but after that they stop, so is this also normal? Sorry for asking so much but I just want to be sure.

[2210485]

If theyre back to back forceful contractions that take your breath away or cause pain then it can be a little "less normal".

Getting a monitor to verify that it is in fact 2 or 3 beats back to back (referred to as a "couplet" or "triplet" respectively) and not just 2 or 3 that are seperated by normal beats but feel back to back is beneficial here.

Such a phenomenon could indicate a higher risk for a more significant or dangerous problem like vtach.

Unfortunately theres no way to verify this without the monitor as theres no way to know if youre actually feeling the beats as theyre occuring, or if theres any sort of delay or distortion between what you feel and the corresponding electrical activity.