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Dr. Natasha
Dr. Natasha, Board Certified Physician
Category: Cardiology
Satisfied Customers: 12910
Experience:  Training in cardiology emergencies.
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Madam, I have been having regular palpitations

Customer Question

Dear Sir/Madam, I have been having regular palpitations for the last few months and have been very concerned. I get regular flutters in my chest, i can feel my heart pounding and i sometimes get added beats. I can feel an uneasy irregular sensation in my chest and i can feel that my heart is unusual. I have had lots of ECGs conducted, an Echocardiogram of my heart, Two 24 hour ECG tapes and a Event recorder. All very reassuringly have come back normal and especially my heart scan this came back as a normal study. The only thing that has come back is one ECG caught the heartbeat more abnormally irregular and the baseline is more chaotic. This has been diagnosed as ectopics or added beats, i have never had any symptoms of dizziness or shortness of breath. This is very reassuringly for me and i have been told i can come to no harm from these episodes but even now the palpitations are very bad and make my feel very uneasy and they are spoiling my quality of life, i really am struggling to cope. I know i am not in any danger but the palpitations are so forceful and the flutters in my chest make me feel very uneasy. If i am trying to relax or read a book i cannot concentrate and i focus on the heart rhythm i just lye down and try to forget them. I really want some help on what i can do from here to try and find a solution or at least a way to limit these episodes. If anyone knows if i should have a blood test to check my vitamin and mineral levels would this be beneficial? I have been fit and well since birth and these are really getting me down. I cannot leave the situation and i really want to find out more and try to limit these symptoms or find better ways of coping. Where do i go from here i am so depressed. I have noted that exercise helps and when i am walking these episodes get less, but as you can imagine i cannot walk all day everyday there must be something else i can do, should i go back and see my GP to discuss managing this condition? Yours faithfully, John XXXXXX

Submitted: 2 years ago.
Category: Cardiology
Expert:  Dr. Natasha replied 2 years ago.
Hi
Thank you for your question.
The one lab test that should be checked is TSH and T4- for thyroid disease.
That being said, if walking reduces these episodes, that is exceedingly reassuring- because true cardiac disease gets WORSE not better with exercise. This implies that your palpitations are more related to stress- because the exercise reduces stress levels and takes your mind off of the symptoms.

The cornerstone management for stress related symptoms is cognitive behavioral therapy (CBT) by a psychologist. This can also be helped with medication for stress and anxiety. Other things you can do are avoid caffeine, alcohol, spicy food and acidic foods. Yoga and meditation and even acupuncture are helpful.

But I would not worry about these symptoms- they are NOT concerning for any significant disease as you had a broad negative workup.

Thank you for your question.
I hope that this helped
Please leave positive feedback for my time and expertise :-)
Dr. Natasha and other Cardiology Specialists are ready to help you
Customer: replied 2 years ago.

Dear Dr Natasha,

Thank you for your prompt response.

Although reassuring that i have nothing wrong the main concern was trying to find extra tests to try and find what could be causing this. I will go back to my GP and request a TSH and T4 blood test for thyroid disease i think this was checked, this was normal. Would you suggest having a complete mineral and vitamin blood test, to check if i am missing something from my diet would this be beneficial?

Even though you say these symptoms are stress related they appear as soon as i wake up and i am very relaxed, a stressful event does not seem to trigger these episodes. Importantly when these symptoms occur what should i do, is there anything that may be able to limit them when they occur, at the moment i am having a very difficult time coping?

The only thing i can think of is i do work on the computer for my work and get neck pain. Do you think this could cause the palpitations, would it be wise to see a physiotherapist to try and calm the neck pain down and see if the palpitations ease off? As i really am struggling on what else to do, the symptoms are very unpleasant and do not seem to ease off at all.

Yours sincerely,

John XXXXXX

Expert:  Dr. Natasha replied 2 years ago.
Eating a well balanced diet rich in fiber and omega-3 oils is the best.

I am a big fan of the mediterranean diet- it is recommended by the Mayo Clinic in the USA and is heart healthy

http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

There is something that is stressful about you waking up- even if you feel relaxed, your body is telling you that it is not. If you have these symptoms and they get better with exercise, then when you wake up, do about 15 minutes worth of yoga.
This will help you wake up, stretch you and is great for mind/body balance.

Here is a great link:
http://greatist.com/move/morning-yoga-for-beginners

Sure you can see a physiotherapist for your neck pain- but do make sure your workstation is ergonomically fitted for you ;-)
Customer: replied 2 years ago.

Dear Dr Natasha,

My diet is fairly good but i will try the diet you have recommended. Do you think i should try have any certain supplements that may help limit these ectopic beats that i can try. Some people have tried small doses of magnesium and this has helped them, is this worth a try?

I appreciate you telling me about exercise when i wake up, however after the exercise the palpitations will return for the rest of the day. Like i explained with walking, once the exercise has ended the palpitations return stronger than before and i really find it difficult.

Talking gulps of cold water or splashing cold water on the face may help change the rhythm back to normal, i have read this on a health forum. Is this worth a try or is this not really a good solution?

Even when i am relaxed in the bath with lavender oil, i can feel a pulse in my head which is going fast and my heart palpitations are ongoing. This is when i am very relaxed, so wouldn't you say this is quite concerning?

Yours sincerely,

John XXXXX

Expert:  Dr. Natasha replied 2 years ago.
why don't you work on the measures that I recommended first and if you need additional tweaking, we can do that.

You can take a multivitamin with magnesium- sure

Water is fine.

You may also want to take an antacid- like zantac- sometimes reflux can worsen palpitations.
Customer: replied 2 years ago.

Dear Dr Natasha,

I will try what you have suggested and see if these make any improvements.

I do have a slight medical problem diagnosed before and it was symptoms similar to reactive hypoglycemia, but low blood sugar was not diagnosed. The condition never was actually found to be an illness, but i did used to have a diet high in sugar. I find now that when i do eat something high in sugar i go weak and dizzy. I have been advised to have a healthy diet to limit these episodes and got advice from a dietitian.

Do you think this previous condition may have any impact on the palpitations or do you still think this is more stress related? Sometimes i still get these episodes as i have not yet perfected my diet or i go too long between meals and go slightly irritable and tired.

Yours sincerely,

John XXXXXX

Expert:  Dr. Natasha replied 2 years ago.
yes, reactive hypoglycemia can certainly worsen palpitations!
Customer: replied 2 years ago.

Relist: Answer quality. The answer was very brief and not detailed enough to help me. Towards the end of the conversation the answers to my questions where getting very brief. I am very depressed about my symptoms and the answers i have received are very poor. I want my question to be passed to a very experienced Cardiologist who i can have a proper conversation with. These are symptoms which are making me depressed and the answers have not given me any viable solution. I have also noted some questions asked have been ignored, i am very unhappy, i want another answer immediately.

Expert:  Dr. Natasha replied 2 years ago.

I apologize. I was in a meeting and I wanted to give you an immediate reply. Specifically which questions would you like an answer to and I will address them in a more length and satisfactory manner later this evening.

Expert:  Dr. Natasha replied 2 years ago.
John- please keep in mind that you can always post back here.
So if you try any of the above measure which I suggested:

1. yoga
2. mediterranean diet
3. antacid
4. thyroid test

And they are not helping, then let me know and we can try something else. It is difficult to come up with a number of different suggestions and really find out what works for you

Reactive hypoglycemia (or post prandial hypoglycemia) can make palpitations worse- because the body releases adrenaline in response to the drop in blood sugar. Your sugar drops because of the over release of the insulin. So, eating a diet with less refined sugar will be really helpful- even if you have not been formally diagnosed, you may still have the condition. It can be quite elusive.

I still think that it is stress related.
In regards ***** ***** bath, a pounding which was concerning would have been picked up on echocardiogram- such as aortic insufficiency. So this is most likely related to the fact that you are not distracted and all you can feel is the pounding. As mentioned before, cardiac related conditions get worse with exertion. Because you are stressing the heart and that is when the wheels come off the cart.
That being said, try monitoring your blood pressure when this happens. You can buy the device at the chemist. You may be having bouts of hypertension during these episodes. If this is the case, then they may want to check your adrenal glands to see if you are over producing the adrenal hormones (adrenaline type).

I hope that you find this to be a more satisfactory answer. I do appreciate your patience and your business. Once again, I apologize for the brevity, as we are physicians, we do have practices and meetings to attend to and we are not online constantly for hours. As it appeared you were quite anxious about your symptoms, I felt it was better to give you a reply (albiet brief) than have you waiting for an hour worried about your symptoms.

Cheers :-)
Customer: replied 2 years ago.

Dear Dr Natasha,

I have had a thyroid test at my Doctors and i phoned them later today and this was normal. I asked before but i did not get a response from you, do you think is it worth asking for a A-Z vitamin and mineral blood test to check to see if i am lacking anything in my diet? As i was informed that diet could help with these ectopic beats, so do you think this is worth looking into?

I have tried the Yoga in a morning and while it does relieve the symptoms for the 20 minutes while i am doing this. As soon as i stop and i can be quite relaxed the symptoms reoccur. Do you really think it is anxiety related. I have been very stressed at times and had no palpitations before i got diagnosed with ectopic beats. Do you think it is possibly something else causing these strange irregular heartbeats? Further is there any other exercised i can do besides yoga?

What about deep breathing exercises, my doctor informed me to lay down and breath in and out very slowly, is this a good option?

I have also been advised of these supplements, coenzyme Q10 which helps keep your heart rhythm regular. Take 2 to 3 grams of cold-pressed marine fish oil, which is high in beneficial omega-3 fatty acids. The amino acid taurine helps quell irregular electrical impulses in the heart. Can you confirm if these supplements could be okay to trial are these safe suggestions? Not altogether but one at once for a period of time.

As i am going through a trial and error stage i really wanted your input to try get my quality of life back. I will update you on the diet and antacid which you have suggested and get back to you.

Yours sincerely,

John XXXXX

Expert:  Dr. Natasha replied 2 years ago.

I have had a thyroid test at my Doctors and i phoned them later today and this was normal. I asked before but i did not get a response from you, do you think is it worth asking for a A-Z vitamin and mineral blood test to check to see if i am lacking anything in my diet? As i was informed that diet could help with these ectopic beats, so do you think this is worth looking into?


>An a-z mineral blood test would be of minimal utility. But I would make sure you had your calcium, magnesium and phosphate level checked


I have tried the Yoga in a morning and while it does relieve the symptoms for the 20 minutes while i am doing this. As soon as i stop and i can be quite relaxed the symptoms reoccur. Do you really think it is anxiety related. I have been very stressed at times and had no palpitations before i got diagnosed with ectopic beats. Do you think it is possibly something else causing these strange irregular heartbeats? Further is there any other exercised i can do besides yoga?

>You can do swimming or walking. Try meditation and see if that helps with the heartbeats.


What about deep breathing exercises, my doctor informed me to lay down and breath in and out very slowly, is this a good option?

Yes, this is a form of meditation. I would also ask for a referral to a psychologist- they can help you with biofeedback techniques


I have also been advised of these supplements, coenzyme Q10 which helps keep your heart rhythm regular. Take 2 to 3 grams of cold-pressed marine fish oil, which is high in beneficial omega-3 fatty acids. The amino acid taurine helps quell irregular electrical impulses in the heart. Can you confirm if these supplements could be okay to trial are these safe suggestions? Not altogether but one at once for a period of time.

Yes, you can take ALL of these supplements and at the same time- often coenzyme Q10 is bundled with omega-3
http://www.icelandhealth.com/


As i am going through a trial and error stage i really wanted your input to try get my quality of life back. I will update you on the diet and antacid which you have suggested and get back to you.


Customer: replied 2 years ago.

Dear Dr Natasha,

I have had a further blood test for Calcium, Magnesium and Phosphate levels checked and this was also normal. Do you know of any further blood tests linked to ectopic beats or irregular heartbeats that may be necessary? My GP advised me that he would be willing to conduct any further blood tests that may be useful. He noted in his surgery that the palpitations were quite regular and fast and although there is no significant arrhythmia he does feel that something maybe slightly abnormal to cause such rapid palpitations in a young adult in good health.

I have tried swimming and walking and although this helps for the period of time while the activity is ongoing this comes back as soon as i have stopped. I sometimes do get a few added beats or palpitations through these exercises but not as many so it does help. Can you recommend any exercises apart from meditation and yoga i could do at work or home when they come on? For instance would pres-sups, sit-ups and squats may be useful. This can be done more or less anywhere and keeps the body active. Do you know any other easy exercises to do or any positions i can put my body into that may relieve these palpitations please?

Meditations and Yoga along with breathing exercises really have minimal effect. I only get relief from these palpitations with exercise that gets the heart beating. Relaxing technique are of no use apart from making myself more aware of the palpitations, despite being very relaxed.

I have tried the coenzyme Q10 with omega-3 and taurine and this is not having any good effect. I have also been on a strict diet you recommended earlier the mediterranean diet but so far i am not seeing any effects on the palpitations.

I really need you further input on adding some further suggestions to limit these palpitations. I hope you can please provide a detailed answer to help me cope with these symptoms.

Yours sincerely,

John XXXXXX

Expert:  Dr. Natasha replied 2 years ago.
Are you seeing a cardiologist?
Customer: replied 2 years ago.

Dear Dr Natasha,

I have seen two and had an extensive amount of investigations the GP advised i do not need to see a third Cardiologist. No significant arrhythmia has been found and i have had no significant symptoms during exercise or episodes of palpitations. This is why i am asking questions on a trial and error basis to see what may limit and help the palpitations. I would appreciate if you could answer my questions to the above and kindly provide any further suggestions.

Yours sincerely,

John XXXXXX

Expert:  Dr. Natasha replied 2 years ago.
There are no other labs to be done
There are no other exercises I would suggest other than yoga and meditation. Press up and etc will not help
At this point, I would suggest that you see a psychologist. Because your palpitations are not caused from a cardiac reason and you have seen 2 cardiologists
This is something that you need to undergo cognitive behavioural therapy to deal with
Customer: replied 2 years ago.

Dear Dr Natasha,

You have suggested walking and swimming earlier in the conversation and press ups, sit ups get the heart going similar to walking and swimming. Do you not think these exercises are worth a try at all?

Do you think my life is already over and that these palpitations will plague me for the rest of my life with no known cause? How can the heart suddenly go so abnormal from being so healthy?

Can you recommend any further vitamins or supplements to try please, this would be appreciated?

Yours sincerely,

John XXXXXX

Expert:  Dr. Natasha replied 2 years ago.
You need to see a psychologist
Customer: replied 2 years ago.

Dear Dr Natasha,

I will ask my GP for a referral to a psychologist as recommended.

Can you recommend any further vitamins or supplements to try please, this would be appreciated?

You have suggested walking and swimming earlier in the conversation and press ups, sit ups get the heart going similar to walking and swimming. Do you not think these exercises are worth a try at all?

Yours sincerely,

John XXXXXX