Heart Palpitations: Causes and When to Seek Help

Cardiac issues

Hello Doctor, I have recently been experiencing strong heartbeats while lying down at night, accompanied by a feeling of chest tightness.
I also feel a pulling sensation in my chest that is somewhat painful, which seems to coincide with my heartbeat, and I can hear my heart beating (not just from pressing my ear).
This has been going on for five days.
I visited a clinic yesterday where the doctor listened to my heartbeat, checked my blood pressure, and performed an electrocardiogram.
The doctor said everything was normal, but we are unsure about the cause of these symptoms.
Do you have any insights?

Yin, 10~19 year old female. Ask Date: 2020/04/05

Dr. Wu Xueming reply Cardiology

Chest pain can be classified as either cardiac or non-cardiac.
Cardiac chest pain, commonly known as angina, typically has the following characteristics: 1.
It lasts for several minutes (2-10 minutes), is described as pressure or tightness, and may cause shortness of breath (like an elephant sitting on the chest).
2.
It may radiate to the jaw, left arm, or other areas.
3.
It is usually triggered by physical activity or emotional stress and improves with rest.
4.
It is more common in patients with risk factors for coronary artery disease, such as: age (men >45 years or women >55 years or postmenopausal), hypertension, hyperlipidemia, diabetes, smoking, family history of early-onset coronary artery disease, and a sedentary lifestyle.
Based on your symptom description, it does not align with typical angina, so you can be reassured.
However, if symptoms persist, it is still recommended that you visit a cardiology clinic for a thorough evaluation.

Reply Date: 2020/04/05

More Info

Heart palpitations can be a concerning symptom, especially when accompanied by chest discomfort or pain. Based on your description, it seems you are experiencing a combination of sensations that include a strong heartbeat, chest tightness, and pain that feels like pulling or tugging. This has been ongoing for five days, which understandably raises concerns.

First, it’s important to recognize that heart palpitations can arise from a variety of causes. Common triggers include anxiety, stress, caffeine consumption, dehydration, and lack of sleep. Given your recent experiences, it’s possible that emotional stressors or lifestyle factors may be contributing to your symptoms. For instance, if you have been under significant stress or have had changes in your sleep patterns, these could lead to heightened awareness of your heartbeat and sensations of discomfort.

In your case, the fact that you have already consulted a physician and had normal results from an electrocardiogram (ECG), blood pressure measurement, and heart auscultation is reassuring. These tests are crucial in ruling out serious cardiac conditions. However, if your symptoms persist or worsen, it may be beneficial to seek further evaluation, possibly including a Holter monitor, which records your heart's activity over a longer period, or an echocardiogram to assess the structure and function of your heart.

Another potential cause of your symptoms could be related to gastrointestinal issues, such as gastroesophageal reflux disease (GERD), which can mimic heart-related symptoms. The sensation of tightness or pain in the chest can sometimes be attributed to acid reflux, especially if it occurs after eating or when lying down.
Additionally, consider lifestyle modifications that may alleviate your symptoms. Reducing caffeine intake, ensuring adequate hydration, managing stress through relaxation techniques (such as deep breathing, yoga, or meditation), and maintaining a regular sleep schedule can all be beneficial. Regular physical activity is also important, but it should be balanced with rest, especially if you are feeling fatigued or stressed.

If you notice any alarming symptoms such as severe chest pain, shortness of breath, dizziness, or fainting, it is crucial to seek immediate medical attention. These could be signs of a more serious condition that requires prompt evaluation.

In summary, while your initial tests are normal, ongoing symptoms warrant further investigation and lifestyle adjustments. Keep track of your symptoms, noting any patterns or triggers, and maintain open communication with your healthcare provider. If necessary, don’t hesitate to seek a second opinion or further testing to ensure your peace of mind and health.

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