Palpitations: When to Seek Further Medical Advice

Regarding palpitations?

Hello, Doctor.
I apologize for the lengthy message and appreciate your understanding.
Thank you.
Last year, in December 2015, I suddenly felt some difficulty in breathing and a sense of weakness in my heart while sitting in a chair.
After resting for a while, I felt better and did not seek medical attention at that time.
Then, in May 2016, one night around 1 AM, I experienced a tightening sensation in my heart, accompanied by chest tightness, shortness of breath, weakness, and cold sweats.
Three days later, I visited the cardiology department at Taoyuan Saint X Hospital.
The initial examination by the doctor found nothing significant.
Subsequently, I underwent an echocardiogram and a 24-hour Holter monitor, which did not reveal any abnormalities.
However, after a stress test, some issues were detected.
The doctor mentioned that my heart seemed to have reduced elasticity.
To be honest, I was quite confused by the explanation at that moment.

After that, I occasionally experienced palpitations in my daily life, but since they were not accompanied by chest tightness or cold sweats, I did not seek further medical attention.
Until October of this year, at around 12:30 AM, I experienced palpitations again, along with chest tightness, cold sweats, slight dizziness, weakness, and slightly labored breathing.
This episode occurred a second time, and I considered going to the emergency room but ultimately decided against it.
Due to the late hour, I couldn't get an appointment, so I saw a doctor two days after the episode.
The second doctor (also at Saint X Hospital) initially suspected a thyroid issue, but blood tests ruled that out, as well as autonomic nervous system disorders.
While waiting for the report, I kept a handwritten record of each palpitation episode, noting the time and symptoms.
Over the course of a week, I experienced palpitations about three times, and I also felt vague pain in my left rib cage and even had headaches.
I had never experienced such frequent episodes before.

The doctor, noticing my discomfort, asked me to wear a 24-hour Holter monitor again.
The results showed no issues, which I was relieved and reassured about.
However, the recurring palpitations were quite distressing.
In November, I experienced palpitations again, and my family suggested I visit a larger hospital for further evaluation.
I went to the cardiology department at Linkou Chang Gung Memorial Hospital, and my symptoms were similar to the previous two episodes.
The doctor arranged for a 24-hour Holter monitor, a stress test, X-rays, and blood tests.
During my second follow-up visit to discuss the results, the doctor said the 24-hour Holter monitor and other test results looked good (without specifying the values) and advised me to stay calm.
He also mentioned that if I experienced any discomfort, I could go to a nearby hospital instead of traveling far for care.

At that time, I forgot to ask whether blood tests for myocardial infarction could provide preliminary indications of any issues.
My life stress is not significant, and stress-related factors have been initially ruled out.
Doctor, I still experience occasional palpitations.
Should I seek another doctor for further evaluation? Do I need to have regular follow-up examinations? I feel quite confused by these symptoms; even though the results show no problems, I still feel unwell.

Yunwu, 20~29 year old female. Ask Date: 2016/12/08

Dr. He Dongjin reply Cardiology

Hello, Yunwu.
Your heart has been thoroughly checked and is fine, so there's no need to worry.
What you're experiencing may resemble symptoms of autonomic nervous system dysfunction.
Changhua Hospital is concerned about you.

Reply Date: 2016/12/08

More Info

Palpitations can be a concerning symptom, especially when accompanied by other symptoms such as chest tightness, shortness of breath, and sweating. Based on your detailed account, it seems you have experienced episodes of palpitations that have prompted you to seek medical attention multiple times. While it is reassuring that various tests, including echocardiograms and 24-hour Holter monitors, have not indicated any significant abnormalities, your ongoing symptoms warrant further consideration.

First, it is important to understand what palpitations are. They are often described as the sensation of a racing, fluttering, or pounding heart. While they can be benign and related to anxiety, stress, or caffeine intake, they can also indicate underlying cardiac issues. Given your history of episodes, it is crucial to monitor your symptoms closely.

The fact that you have experienced palpitations along with symptoms like chest discomfort, weakness, and dizziness raises some flags. Although your tests have returned normal results, it is essential to continue to communicate with your healthcare provider about these episodes, especially since they seem to be increasing in frequency. It is not uncommon for patients to feel anxious or confused when they experience symptoms that do not correlate with test results. This is where a thorough discussion with your doctor can be beneficial.

You mentioned that one physician suggested a potential thyroid issue, which is a valid consideration. Thyroid dysfunction can lead to palpitations and other symptoms. If you have not already, it may be worthwhile to have a comprehensive thyroid panel done, including TSH, Free T4, and Free T3 levels, to rule out any thyroid-related issues.

Additionally, you should consider the possibility of other non-cardiac causes for your symptoms. Conditions such as anxiety disorders, panic attacks, or even gastrointestinal issues like acid reflux can manifest as palpitations. Keeping a detailed diary of your symptoms, including when they occur, their duration, and any associated factors (like food intake, stress levels, or physical activity), can provide valuable information for your healthcare provider.

Regarding your question about whether to seek another opinion or continue monitoring, it is always within your rights as a patient to seek a second opinion, especially if you feel that your concerns are not being fully addressed. A fresh perspective from another cardiologist or even a specialist in electrophysiology (a cardiologist who specializes in the electrical activities of the heart) may provide additional insights or testing options.

In terms of follow-up, regular check-ups may be beneficial, especially if your symptoms persist or worsen. Your healthcare provider may recommend periodic monitoring or additional tests, such as an event monitor, which records your heart's activity over a longer period and may capture episodes that a 24-hour monitor might miss.

Lastly, it is essential to address lifestyle factors that could contribute to palpitations. Reducing caffeine and alcohol intake, managing stress through relaxation techniques, and ensuring adequate hydration can all help mitigate symptoms. Regular physical activity, within your comfort level, can also improve overall cardiovascular health.

In conclusion, while your test results have been reassuring, your ongoing symptoms deserve attention. Continue to communicate openly with your healthcare providers, consider seeking a second opinion if necessary, and keep track of your symptoms to help guide your care. Your health and peace of mind are paramount, and it is essential to advocate for yourself in the healthcare system.

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