Quit playing' games with my heart... seriously, that's enough
November 6, 2018 4:39 PM   Subscribe

I'm dealing with constant heart palpitations, after tests came back normal. What are my next steps?

Hi all. I hate to do this, but I'm following up on my previous question about heart palpitations.

After posting that question, I went in to see a resident doctor in a local clinic (my favorite GP is not covered under my current insurance plan). An ECG was completed at that time and showed normal heart function. The doctor suggested wearing a Ziopatch for two weeks to see if any of the palpitations could be picked up. During those two weeks, I had 6 instances of feeling a palpitation (but it was more like, wait, was that something? Well, I'll click the button just in case). Nothing like what's happening now; it's much more intense now.

These were the Ziopatch results:

Preliminary Findings
Patient had a min HR of 44 bpm, max HR of 177 bpm, and avg HR of 80 bpm.
Predominant underlying rhythm was Sinus Rhythm.

Isolated SVEs were rare (<1.0%), SVE Couplets were rare (<1.0%), and no SVE Triplets were present.
Isolated VEs were rare (<1.0%), and no VE Couplets or VE Triplets were present.

Comment: Zio is unremarkable. Symptoms mostly occurred in association with sinus rhythm w/o ectopy; once a PAC was present.

So, normal. However, this past week or two, the palpitations have been back with a vengeance. My primary sensation is a skipped beat. Beat / Beat / Beat / Pause / THUD / Beat / Beat / Beat / Beat / Beat / Pause / THUD etc. It looks like this is a PAC, as the patch results say, I think?

The palps were so bad yesterday that I ended up visiting urgent care last night. Another ECG came up normal (though the palps seem to dissipate when lying down, and the ECG was taken while lying down). The doctor on duty was fairly unhelpful. "We used to worry about skipped beats 20 years ago. We don't worry about them anymore." She suggested stopping caffeine consumption (I have about 6-8 oz of coffee per day, but it's worth a shot). She said I didn't need to go to the ER. She listened to my heart and heard one skip but again said it was nothing to worry about.

I also have a slight cold or something that has been developing, but the constant palps started before I became sick. I walked to my polling place today and just felt awful. Exhausted, somewhat lightheaded, and "skipped" beats every 5 - 10 seconds.

I will go back to the doctor, but I am flying to Seattle tomorrow morning for 6 days (seriously, I've been sick on 3 different trips to Seattle... sheesh). I will have my favorite GP back on Jan 1. As it stands now, my bill for the Ziopatch is over $700 so I'm hesitant to keep racking up the medical bills, but this is also driving me crazy.

I've been staying hydrated, getting enough sleep, upping my potassium (but not too much) and taking a magnesium supplement. I know that anxiety is a big factor here. I have health-related anxiety so I'm sure that's not helping.

Is there anything I can do right now to chill out about this? What should my next step be, doctor wise? If this is just my life now, that's okay, but I need to find some ways to deal with it, if so.

Oh! I also ordered an AliveCOR yesterday, as someone suggested in my previous question.
posted by sucre to Health & Fitness (17 answers total) 5 users marked this as a favorite
I answered your last question and mentioned that I have POTS. It can be difficult to diagnose. I'm not saying you do have it since IANYD - but your heart rate and symptoms going down when you are reclining is a symptom. I did a poor man's tilt table checking results at 5 mins for about 20-30 mins, saw my GP, then saw a specialist. It's often misdiagnosed as anxiety as your body floods with adrenaline to compensate for the lack of blood flow. Feel free to message me if you think you may have it. ETA: I wear compression socks and ativan helps. Talk to your doctor about those options.
posted by Crystalinne at 4:48 PM on November 6, 2018 [2 favorites]

Are you treating your anxiety in any way? I would start with that, since your doctors are not worried about your heart.
posted by pinochiette at 4:54 PM on November 6, 2018 [1 favorite]

Requisite Mefi disclaimer: I'm not a cardiologist, this is not medical advice, etc etc.

PAC (premature atrial complex) is a extra quick beat. What you describe, with the pause and THUD, sounds like a ventricular escape beat. Something prevents normal transmission of electricity from the sinoatrial node/atria down to the ventricles (the part that actually pumps out the blood to the rest of your body). After a second or two, your ventricle takes matters into its own anthropomorphized hands and beats on its own. But I'd think that would show up on the Ziopatch.

Have you seen a cardiologist? Will your current insurance cover a specialty visit, or will you need a referral first? I would push for a referral if I were you, because ventricular ectopy happening with just 1 cup of coffee and minor illness/exercise seems excessive to my (totally not a cardiologist!) mind.
posted by basalganglia at 5:25 PM on November 6, 2018 [1 favorite]

I had something similar and this is what I was told:

If these are routine PVCs (the pause/THUD), the reason medical folk are not freaking out is that everyone gets them to one extent or another. Anxiety can trigger them, caffeine, chocolate, drinking, working out, dehydration, etc. They can go away entirely, or show up now and then, and according to my cardiologist, no one really knows why. But all agree they are benign. Some people feel them, some don't, some can be painful, some are very mild.

My cardiologist put me on a beta blocker to chill things out, and then weaned me off it. The PVCs have not come back.

Short term: work on the anxiety, start taking Magnesium Glycinate and up your potassium levels, do lots of reading on PVCs (so many message boards. so. many), and switch to decaf. Stop drinking alcohol. You may be able to start drinking coffee (and alcohol) again once your heart calms down.

Longer term: For your peace of mind, get a full cardio check, including stress test.
posted by Ink-stained wretch at 5:34 PM on November 6, 2018 [3 favorites]

I am not your doctor. Go ahead and make an appointment to see a cardiologist. Specialists exist to provide an expert opinion as to whether there is, or is not, something the matter with you that falls within their domain area. You are not getting the reassurance you seek from urgent care and PCP visits (FWIW, I'm an emergency doc, I see patients sent for very normal "abnormal EKGs" from urgent cares all the time, and I would not trust an urgent care provider to rule out subtle EKG badness). A clinic appointment with a general cardiologist will go a long way towards easing your mind.
posted by killdevil at 5:40 PM on November 6, 2018 [5 favorites]

Has your doctor checked your hemoglobin? Heart palpitations were one of my symptoms for severe anemia, which was totally missed by my doctors.

I had other symptoms too (shortness of breath, whooshing noises in my ear, fast heart rate), so I’d be surprised if this were it, but my doctors (four of them!) really dropped the ball not doing basic blood tests, so I thought I’d mention it.
posted by FencingGal at 5:52 PM on November 6, 2018 [1 favorite]

I am a doctor but not your doctor; however, I have had a similar issue. There are many reasons PVCs/VPBs/VEs can become more frequent and symptomatic. Some of these have been covered above. It’s not clear if you have had basic lab testing (electrolytes/metabolic panel, CBC, thyroid tests). This would be part of the initial evaluation. Reduction in alcohol and caffeine helped my symptoms. It’s likely benign but there’s no reason not to see an internist or cardiologist for evaluation and, hopefully, reassurance.
posted by sudogeek at 6:42 PM on November 6, 2018 [2 favorites]

Seconding FencingGal. My severe palpitations all but went away when I got my severe anemia (and anxiety!) under control. I was also dizzy, weak, lightheaded and frequently out of breath, but none of my doctors would allow that it was anything except the anxiety. Then lo and behold, one finally listened to me and checked my hemoglobin and ferritin stores and it was BAD NEWS. Some months of heavy duty iron treatments later and I haven't had a palpitation in ages.
posted by Cloudberry Sky at 6:44 PM on November 6, 2018 [1 favorite]

I'm an emergency physician.


Another ECG came up normal

Normal ECG = no structural heart disease = no congenital or acquired problems with any parts of your heart

The doctor suggested wearing a Ziopatch for two weeks

Since normal resting ECG does not exclude arrhythmic causes (more below), ambulatory ECG monitoring (a ziopatch) over a longer period of time is required.

There are two broad classes of cardiac (heart-specific) causes of palp's:

Structural: (see above)
Arrythmic: a disruption of the electrical impulse that act as a natural pacemaker

Your resting ECG ruled out structural cardiac causes. You ambulatory ECG ruled out arrythmic cardiac causes (it's what "sinus rhythm w/o ectopy" means)

Despite the 6 palp's you felt during two week of mobile monitoring, you're "asymptomatic" in medical terms. The ER doctor was "unhelpful" because you don't require immediate medical help, which is a GOOD thing


43 percent of palp's have a cardiac cause, but your's don't About 35 percent have a psychiatric cause, 10 percent have a miscellaneous physical cause, about 10 percent have no identifiable cause

I believe your palp's have a psychiatric cause. This doesn't mean they're not physically real--when you say you can feel when your heart is out of synch, you're describing a physical sensation--it just means they don't have a biophysical cause or solution

Do you have any history of panic attacks, generalized anxiety disorder, or somatization disorder?
posted by BadgerDoctor at 6:55 PM on November 6, 2018 [5 favorites]

I had very similar symptoms as in your other post, and it was driving me nuts. I was able to get into a cardiologist and had an EKG (which was fine) and wore a Holter monitor for 24 hours (which also didn't show anything). I then had an echocardiogram and and a stress test and it was determined that the cause was premature ventricular contractions (which my mom and aunt both have). The doctor upped my existing blood pressure medication (amlodipine) and also prescribed metoprolol. Even though he said it could take a week or so to notice the difference, I noticed the difference that night, which leads me to believe a lot of it was caused by a little stress at work (which is thankfully rarely stressful at all), and the stress of the PVCs themselves (I'd get worried about what the problem was, which would cause more of the problem!).

So, I don't have any advice other than what has already been given here (by people far more qualified than I!), but just wanted to say that my solution was pretty simple, and hopefully yours will be, too. Good luck!
posted by jonathanhughes at 7:18 PM on November 6, 2018 [1 favorite]

In the meantime, you could check out stuff to calm your vagus nerve. I have a hiatal hernia and was told by my dr that it can irritate the vagus nerve, which can cause the palpitation feelings. So if I start getting palpitations I will make sure to do exercises that supposedly drop my stomach down into it’s rightful place. That helps. You can find hiatal hernia exercises online - they are simple and not dangerous, maybe worth a shot?
posted by fleecy socks at 8:13 PM on November 6, 2018

You need some hard reassurance to help that anxiety, and that's fine. See a cardiologist, ask for an echocardiogram, go from there. You'll have the comfort of knowing they've looked at your heart, live, in 3D, watched it pumping, measured the flow in and out, checked the diameter of arteries, the volume of ventricles and so on. If there's something there, they'll find it. At the same time, if there isn't something there, you'll have positive assurance about that (we've checked for [bad thing] and it's definitely not there) vs negative assurance (nothing weird came up, but we haven't ruled anything out). I feel like you need the first one.
posted by some little punk in a rocket at 8:54 PM on November 6, 2018

I've has similar palpitations before and it matched a serious spike in anxiety due to life things. I fell into the anxiety spiral where I'd have trouble sleeping and then overdo the caffeine to make up. It seriously freaked me out the first time it happened because I was on my bike when I felt my heart skip. Then I noticed it tended to skip when I was bike commuting (lots of adrenaline and anxiety spikes there from dodging errant drivers). Eventually I put 2 and 2 together and realized I had pretty bad anxiety, which is pretty rare for me.

It took a few months to go away on its own (and thankfully hasn't happened since). What helped was absolutely no caffeine, minimal booze, lots of exercise, and getting back into a meditation routine every night before bed. I started doing some calming breathing exercises I learned from diving throughout the day too. Basically did a lot of self care to reign the anxiety back in.
posted by astapasta24 at 9:15 PM on November 6, 2018

The beat beat beat pause thud sounds exactly like my PVCs.
What makes it worse: not eating for long periods of time (6-8h) with moderate (walking) exercise, then suddenly eating. Thinking anxious thoughts. Too much food from the broccoli family.
posted by St. Peepsburg at 9:50 PM on November 6, 2018

I've had heart palpitations on and off for the past like... decade. They get worse when I am stressed, not getting enough sleep or drinking too much caffeine. At one point, I quit coffee for a while and it helped. I started drinking coffee again eventually. When I first got them, it was due to a thyroid disorder that was doing other things to my body, including making my heart race and beat very fast. At the time, I went on Toprol but eventually went off it. Most recently, I started getting them again last year and I was getting lots in a row and it freaked me out. I knew it was because it was a very stressful time in my life, but they still scared me. Yet, I've been tested many times and my heart is fine. What has worked for me is taking an extremely low dose of extended release metoprolol (half of a 25 mg tablet) every day. Since they got bad last year and I went back on metoprolol, it hasn't been a problem. It doesn't eliminate them entirely, but they happen way less and I don't have any on most days now.
posted by AppleTurnover at 1:33 AM on November 7, 2018 [1 favorite]

My heart palpitations were also related to vitamin deficiency. In my case it was Vitamin D and Magnesium shortage. I've had anemia but it mostly caused ear-whooshing.
posted by Ms. Moonlight at 5:08 AM on November 7, 2018

Just popping in here to say thank you for the feedback. I’m still trying to identify the palpitation triggers, but I’m getting there. The anxiety wake up call is really helpful- I need to target this. Thank you all for responding! I love you guys.
posted by sucre at 7:16 PM on November 13, 2018

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