My heart is playing tricks on me

July 31, 2018 8:36 PM

For the last two weeks, I've often noticed the sensation of my heart skipping beats. I'll be seeing my doctor soon, but in the meantime, how can I relax?

I'm a 33 year old lady, generally healthy. I have asthma and take a longterm steroid (Qvar) to treat it. Family history wise, my maternal grandma passed away in her mid 70s from a heart attack. I consider myself a generally anxious person.

About 3-4 years ago, I went to see my doctor for occasional heart palpitations; these would happen mainly when I'd lie in bed before falling asleep, and occasionally during sex. It would feel like a flutter, and would happen a couple of times maximum. The doctor had me get an ECG which came up normal.

Two weeks ago, the day before leaving for vacation in Europe, I noticed a similar sensation happening, but I was able to "catch" the feeling by touching my neck and focusing on my pulse; I could feel a pause between beats, and the following beat would be harder/stronger (I guess this is actually considered a double beat). During these last two weeks traveling, this sensation happened countless times. Parts of the trip involved staying up late for music/dance events, consuming a small amount of alcohol (I tend to take it easy, but did so especially to not worsen the heart thing), lots of sun, recovering from jet lag etc. I did my best to stay well-fed and hydrated throughout. I also tried a few of the tricks that are recommended to normalize a heartbeat, such as doing the Valsalva maneuver, bearing down, coughing, or splashing my face with cold water (I even tried jumping into the freezing cold Atlantic in Portugal). It wasn't clear if any of these had an effect.

At some points, I would feel my pulse and notice the "skipped" beats happening after every 5 or 6 normal beats. Other times I'd count 50 normal beats and then a skip, and sometimes I felt completely fine. I didn't notice any other symptoms during these times (dizziness, chest pain, etc.). In my mind, I was sort of hoping this would resolve after getting home from the trip. I'm home now (slept 13 hours last night!) and am feeling a little fluttering here and there today, but have only been able to "catch" one skip. I'm still pretty groggy and foggy from jet lag.

I'm planning to call my doctor tomorrow to make an appointment, but I'm wondering if any of you have a similar issue that you've been able to resolve.

posted by sucre to Health & Fitness (27 answers total)

Best answer: I've had that happen off and on since I was 22. I'm 41 now and still alive. The doctors ran a bunch of tests: echo, EKG, holter monitor three times since then and my tests all come back fine. They told me to cut out caffiene. I get an occassional check up. But they come and go. Sometimes I'll have a lot of them for a few weeks, and then it won't happen again for months.
posted by ilovewinter at 8:42 PM on July 31, 2018 [4 favorites]

Best answer: I have very similar symptoms, though not as frequently -- usually only a couple within a couple of hours and then they go away for months. Like ilovewinter, doctors have run the battery of tests -- echo, EKG, holter -- and found nothing, because it's an intermittent problem. It scares the shit out of me, but doesn't seem to cause lasting damage or concern medical professionals.
posted by jacquilynne at 8:47 PM on July 31, 2018

Best answer: Most likely it is either PVCs or atrial fibrillation, probably PVCs based on the extra hard beat. Neither are immediately life threatening and can be managed. I’ve had both at different times in my life (in my 40s now)and they are usually related to stress and anxiety and/ or overindulgence in food, caffeine or booze. The symptoms usually resolve themselves. I have anxiety and the first time I had PVCs and then later a-fib, both times I freaked out thinking I was having a heart attack. But there was no pain or shortness of breath etc, and after seeing a doctor they assured me that it would be ok. Both go away, and just come back occasionally. You will be ok.
posted by banishedimmortal at 9:00 PM on July 31, 2018 [3 favorites]

I have had this problem. For me it was brought on by stress but also potassium? Like I was taking a multivitamin and also eating a shitton of carrots and maybe not drinking enough water (this according to the doc who checked me out, I was very freaked out about it). So look at whether there's some high in potassium thing you are eating, and drink more water.
posted by jessamyn at 9:03 PM on July 31, 2018 [1 favorite]

Holiday heart syndrome. Not necessarily what you had, but I'm guessing you slept less and partied a wee bit harder than normal. I'd suggest getting a few more nights of really good sleep.
posted by RobotVoodooPower at 9:14 PM on July 31, 2018

Best answer: Seconding maybe PVCs. That 'double beat' is a premature beat. So ba-DUM...ba-DUM...ba-DUMbaDUM. Every second beat is called bigeminy, every third trigeminy, and every fourth quadrigeminy (I've got that one).

Mine was diagnosed a couple of years ago the day before I left for an overseas vacation, and so was also put down to 'holiday heart'. Turned out it wasn't, but what I do have is exceedingly rare. Multiple GPs in the intervening period listened to my heart, noted the quadrigeminy, and commented that so long as the beat was 'regularly irregular' - they showed me how they could line a ruler up along the premature beats - then it was just something that most people got at some stage in their life, that it was usually temporary, and was definitely nothing to worry about.

So don't worry! See that last line in the first para of the Wikipedia article: "Single beat PVC abnormal heart rhythms do not usually pose a danger."

Non-harmful heart things are common. Freaky heart conditions in otherwise healthy young people are rare. You're doing the right thing, which is seeing a doctor. Even if you do win the lottery there, you have a lot of treatment options that can stop whatever it is becoming a problem. I have a freaky thing, and I'll almost certainly be just fine. It's when they're not detected early and you only find out after you've had a heart attack that there's a real issue. You're way ahead of the game here.
posted by some little punk in a rocket at 9:36 PM on July 31, 2018 [1 favorite]

I had heart palpitations, went through a full cardiology workup, and they didn't find anything out of order. I mean, they found that I had atrial fibrillation but no obvious cause.

Then I went to a endocrinologist and he found I had hyperthyroidism. That's managed now and I feel much better

Could be anything of course, just something to keep in mind
posted by RustyBrooks at 9:41 PM on July 31, 2018 [1 favorite]

Best answer: These sound like my PVCs - I also have POTS/chronic illness and anxiety so they get worse when I'm over-tired, active, anxious, or really sick.

I've done 2 holters and an echocardiogram with a bubble (because they couldn't figure out I had POTS) in addition to multiple EKGs both in office settings and ERs. Every time they say, "You're having a lot of PVCs... do you feel that?" Even the cardiologist nurse was surprised. I said, "Uh, yeah... I feel them. I just get used to them." My results were within "normal" but on the higher end.

I personally feel like I get 2 types. Overall palpitations - again often with activity or anxiety or POTS so the increased heart rate almost masks it. Or I get the flutters and thumps and skipping feeling. That second one is worse.

Things that helped for me - I NEVER have caffeine beyond chocolate. It makes me feel like my heart will explode. I avoid stimulants whenever possible (epinephrine at the dentist can trigger it for me. I made a mistake trying it for a cosmetic laser procedure. Big nope.) If it's really bad (and with my other illnesses) I use Ativan to help calm down my symptoms. Breathing exercises and overall trying to calm your body helps.

Overall treatment of my underlying illnesses has helped more than anything.
posted by Crystalinne at 11:26 PM on July 31, 2018 [1 favorite]

Best answer: Do you have a smartphone and $99 to spend on an AliveCOR? It's basically a mini ECG the size of a credit card that you can use whenever you feel something strange. You just press it against your chest and it will record the ECG and save it as a PDF and send it to you by email. That way the doctor can review the heart events as they happened. It's a super nifty device and made just for situations like this.
posted by dum spiro spero at 12:05 AM on August 1, 2018 [5 favorites]

Do you use an albuterol inhaler for your asthma? That can provoke PVCs (assuming that's what these are). So can stress/anxiety/anything that ramps up your sympathetic "fight-or-flight" nervous system.

That also means that you can potentially suppress PVCs by ramping up your parasympathetic "rest and digest" nervous system. Coughing, or the Valsalva maneuver is a pretty decent way to bump up your vagal tone during a run of PVCs. Note that this only applies to "benign" PVCs where underlying serious heart conditions have been ruled out, and that I am most definitely not a cardiologist.
posted by basalganglia at 4:01 AM on August 1, 2018 [1 favorite]

I’m not a Dr/I’m not your Dr—but just another reassurance that this is most likely nothing to worry about. I also experience this on occasion and my dr is not even remotely concerned about it.

Hearts are busy organs and there are many different levels of normal heart activity. I had to have a routine EKG last year before (non-heart-related) surgery and the report came back as “abnormal EKG.” Of course I freaked out and saw my dr—he said it was a very common “abnormality” that was absolutely normal for me and absolutely no cause for concern.
By all means get this checked out for your peace of mind but it is extremely likely that you are just fine!
posted by bookmammal at 5:03 AM on August 1, 2018

Also 30s generally anxious female. Getting my iron levels up has significantly lessened the frequency for me. Maybe get that checked?
posted by platypus of the universe at 5:12 AM on August 1, 2018 [1 favorite]

Nth-ing the PVC experience. I was lucky in that they caught one on a short EKG and so could verify that's what it was. I think I've basically sorted out that mine are anxiety-related, but exacerbated by booze, caffeine, and lack of sleep. If I can keep at least 2 of those things managed, they tend to go away.
posted by Medley at 5:13 AM on August 1, 2018 [1 favorite]

I had this in the year following chemo for breast cancer and Dr Google told me it can be caused by a thousand things and most of them are not serious. My oncologist thought in my case it was most likely anxiety (and he is probably right).
posted by something something at 5:34 AM on August 1, 2018

I have this happen to me sometimes. The cardiologist ran a bunch of tests, came up with nothing, and labelled it benign. We never caught it on the EKG/holter. Overeating or drinking can trigger it, but for me, I think it was mostly anxiety related. I say that because the thing that helped the most (I went from having it happen every other day or so to having one every few months), and I am 100% serious about this, was that I cut way back on reading about Donald Trump on the internet.
posted by Bulgaroktonos at 5:34 AM on August 1, 2018 [2 favorites]

Best answer: Nthing everyone saying PVCs. I have them and I also have asthma. I was taking Advair until the PVCs got so bad they switched me to a non-steroidal med. I also pretty much quit caffeine and heavy, fatty foods.

Good luck!
posted by cooker girl at 5:43 AM on August 1, 2018

Best answer: I have had the same thing since my early 20s. It got significantly worse one time while on vacation. My doctor said it was "holiday heart" and not to worry. I happened to mention it to a friend who said she thought it was low magnesium. Turns out I was on a medication that depletes magnesium, but was never warned about this side effect. I started taking a supplement of calcium (which I need anyway), zinc, and magnesium. Problem went away within days and has never re-occurred. IANAD.
posted by eleslie at 6:09 AM on August 1, 2018 [1 favorite]

Best answer: I have this sometimes! I was able to identify patterns - stress, large meals, low magnesium. Magnesium really helps, even though I'm not on anything that impedes absorption!

I've found that telling myself, "of course you're having palpitations, you went out for dim sum with your family so you ate a bunch of salty fatty food, it will go away" is not only soothing but also cuts down on the palpitations themselves.
posted by Frowner at 6:27 AM on August 1, 2018

While everyone is telling you not to worry, I’m here to tell you that you are right to take this seriously. I ended up in the hospital for a week, with IV punctures everywhere, and after week of various meds not working, I ended up having to be zapped with the paddles (cardio conversion). So definitely get this checked out. In the meantime, if you feel palpitations, take some slow, deep breaths and will yourself to calm down. Just keep taking slow, deep breaths, and you’ll get there. The first time it may take a while to work, but after a few times your brain realizes that it DOES work, and it should start working faster.

Also, try listening to some Tibetan gong recordings. My understanding is that the randomness of the sounds means your brain can’t predict what’s coming next, and it alters your brain waves and puts you into a state of deep relaxation. (They’re great for helping you fall asleep, too!)
posted by MexicanYenta at 6:59 AM on August 1, 2018 [1 favorite]

Have you been taking antihistamines or decongestants? I get the same thing happen on sudafed if I take them less than 8 hours apart.
posted by wwax at 7:09 AM on August 1, 2018

IANAD Do not diagnose yourself based on the Internet, seriously.

I have tachycardia(specifically SVT), it was only correctly diagnosed when I had an episode that I couldn't get under control, went to the ER. It does not show up in any other tests, only when it is occurring. It's not great for your heart, but not really a crisis. My doc says I should go to the ER if I have it for over an hour.

I have an app on my phone that monitors my heart rate. I use it as a kind of biofeedback, consciously relaxing and breathing to reduce stress.
Stress/ anxiety makes it worse.
Being at all dehydrated makes it worse, you should be drinking enough water so your pee no darker than apple juice.
Coffee and ADHD meds like Ritalin, Adderal, etc., can affect it. I am able to drink 2 cups of coffee a day.
I carry a prescription beta blocker. Beta blockers can also help with anxiety, talk to your doctor about having propanolol or xanax available on an as-needed, very infrequent basis. I seldom use meds, maybe 2 xanax a year, and the most I take is half.

There are 2 methods I use to manage my heart rate. Cold water on the face prompts the mammalian dive reflex. I carry a wash cloth in my purse, and get it quite wet with cold water, and put it on my face. This helps with panic attacks, too.

The 2nd method is non-trivial, so talk to a health care professional. The Valsalva maneuver affects the vagus nerve, and slows heart rate. Psychology Today has had a bunch of articles on using it to manage anxiety. There is recent research that mild vagus nerve stimulation may help with anxiety, depression, auto-immune disorders. You can make yourself pass out, so use common sense.

Take good care of yourself.
posted by theora55 at 7:41 AM on August 1, 2018

Seconding lots of the good info up above.

I have AFIB, and some of the things that can help when in the middle of an AFIB interval :

drink plenty of water (and then drink more) ice water if you can
really make sure you don't get dehydrated, that's a biggie for me

eat a banana for potassium, cashews for magnesium

meditate or read

alternately, try mild exercise--gentle yoga or walking while swinging your arms can help some folks

try a cold washcloth or dunk your head in cold water

listen to a normal heart beat

try belly breathing

try the valsalva maneuver (after you talk to your doctor first)
posted by BlueHorse at 2:01 PM on August 1, 2018

It's hard to do a vagal maneuver on yourself to lower heart rate. Sometimes it doesn't work if the maneuver is intentional or you know it's coming.

A vagal maneuver isn't necessary for a normal heart rate with a few extra beats -- PACs or PVCs which are pretty much benign if you have no cardiac history and even if you did they don't really worry about them unless symptomatic.

Cardio exercise. I would aim for 45-60 minutes of getting your heart rate up for 3-5 days per week. Cardio decreases the number of ectopic beats and helps manage anxiety.

Go very light on the caffeine, booze, and sodium and maybe try some meditation or yoga along with cardio. Even if you sit up against a wall and do some mindful breathing. Try to manage your emotional stress and take very good care of your sleep, hydration, exericse, and nutrition.
posted by loveandhappiness at 3:02 PM on August 1, 2018

Response by poster: Y’all are the best. THANK YOU. I’m still going to see the doc, just to make sure everything is all good, but your comments have reassured my anxiety about the issue. Today I feel so much better. I do think anxiety makes it worse. Thanks so much to all of you for taking the time to respond!
posted by sucre at 8:03 PM on August 1, 2018 [1 favorite]

Best answer: Another minor note: hyperthyroidism increases anxiety and also causes sleeplessness. I had huge sleep problems when I had hyperthyroidism.
posted by RustyBrooks at 6:33 AM on August 2, 2018

Best answer: I tried Qvar also a while back and had the same problem. Stopped the Qvar and the palpitations went away.
posted by Justin Case at 11:34 AM on August 2, 2018

Best answer: You can get a similar sensation with acid reflux. Some doctors associate acid reflux with PVCs. IF you suffer from heartburn or acid reflux, getting that under control may be the answer.
posted by Foam Pants at 7:01 PM on August 2, 2018