Occasional Palpitations and Sleep Disruption: A Cardiac Perspective

Q: Occasional Palpitations and Sleep Disruption: A Cardiac Perspective

Hello Wayne： Generally, if there are no significant abnormalities in the electrocardiogram (ECG), exercise stress test, or echocardiogram, there is no need for regular follow-ups. <br>Given your current age, a follow-up every two to three years should be sufficient unless new sym

In the past six months, I have occasionally experienced palpitations at night that affect my sleep?

Hello Dr.
Huang,
In the first half of this year, my company's health check revealed a normal chest X-ray.
The physical examination indicated "rapid heart rate with heart murmurs" during cardiac auscultation.
My total cholesterol was 226, high-density lipoprotein (HDL) was 62, and low-density lipoprotein cholesterol (LDL-C) was 152.
Everything else was normal, with a BMI of 20.2.
I consider my stress levels to be manageable (though there are always concerns), and I consistently sleep 6 to 6.5 hours each night.
Last year, my high-sensitivity C-reactive protein (HS-CRP) level was slightly over 0.1, and this year it is slightly over 0.7.

Starting around June of this year, I began experiencing occasional discomfort in my chest.
In July and August, I went to the hospital for an examination, where I underwent an echocardiogram and a resting electrocardiogram, both of which were largely normal, although I was diagnosed with mitral valve prolapse.
However, I still experience occasional discomfort, and I would like to list my symptoms for your assessment.
While these symptoms are not severe, they have persisted intermittently for six months and are bothersome.
The discomfort does not occur during intense exercise but rather when I am lying down, sitting, or walking.
1.
Sometimes I experience chest tightness, and occasionally my breathing feels less smooth than before.
2.
If I feel discomfort in my chest (or heart) during the day, I experience more pronounced palpitations at night, and I may wake up several times.
(It's hard to describe the discomfort; it feels like something is touching my heart area—it's not painful, but it's a sensation.)
3.
In June or July, I experienced radiating pain in my back while walking (this has only happened once in the past six months).
4.
While walking, I have experienced a floating sensation (or what is referred to as positional vertigo) once or twice.
5.
I had a cold about six months ago, and after taking cold medication before bed, my heart rate suddenly exceeded 100 beats per minute for about one to two hours, although I had not experienced this with the same medication in the past.
6.
Previously, sleeping on my left side did not cause discomfort, but in the last six months, I have noticed a significant feeling of pressure on my heart when I sleep on my left side.
I would like to ask Dr.
Huang whether it is necessary to switch hospitals for another echocardiogram or to add a stress test.
How often should a stress test be performed? Based on the symptoms described, what is the likelihood of a connection to heart issues? Thank you, Dr.
Huang.

Wayne, 40~49 year old female. Ask Date: 2020/11/27

Dr. Huang Yinghe reply Cardiology

Hello Wayne: Generally, if there are no significant abnormalities in the electrocardiogram (ECG), exercise stress test, or echocardiogram, there is no need for regular follow-ups.
Given your current age, a follow-up every two to three years should be sufficient unless new symptoms arise.
Based on your description, the chest tightness occurs more often at rest and is not typical of cardiovascular obstruction symptoms.
Chest tightness can also be caused by non-cardiac issues such as gastroesophageal reflux, pulmonary problems, or musculoskeletal issues in the chest wall.
Common cardiovascular risk factors include age, hypertension, high cholesterol, diabetes, and smoking.
For high cholesterol, lifestyle modifications including exercise and dietary control are recommended, with follow-up blood tests in three to six months.
If levels remain high and meet the criteria for insurance coverage, medication may be prescribed.
Some cold medications or bronchodilators can cause palpitations by stimulating the sympathetic nervous system, leading to increased heart rate.
Other non-pharmacological factors such as stress, smoking, alcohol, and even temperature changes can also trigger palpitations.
Certain conditions, such as arrhythmias, mitral valve prolapse, or hyperthyroidism, are also commonly associated with palpitations.
It is advisable to start with lifestyle adjustments, manage stress, maintain a regular schedule with exercise, and avoid stimulants like tobacco, alcohol, and coffee.
I recommend returning to discuss further treatment options with your physician.
Wishing you all the best.

Reply Date: 2020/11/27

More Info

Understanding occasional palpitations and sleep disruption from a cardiac perspective involves a multifaceted approach, considering both the physiological and psychological aspects of heart health. Based on the symptoms you've described, it seems there are several factors at play that could be contributing to your discomfort and sleep disturbances.

Firstly, you mentioned experiencing occasional chest discomfort, palpitations, and a sensation of pressure in the heart area. These symptoms can be concerning, especially when they are persistent or recurrent. The fact that you have been diagnosed with mitral valve prolapse (MVP) is significant, as this condition can sometimes lead to palpitations and a feeling of discomfort in the chest. MVP is generally considered benign, but it can be associated with arrhythmias, which may explain your experiences of heart palpitations, especially during periods of stress or discomfort.

Your recent health assessments, including a normal chest X-ray and echocardiogram, are reassuring. However, the presence of a heart murmur and the elevated levels of LDL cholesterol (152 mg/dL) warrant attention. Elevated LDL cholesterol can increase the risk of cardiovascular disease, and it may be beneficial to discuss lifestyle modifications or medications with your healthcare provider to manage your cholesterol levels effectively.

The relationship between sleep and heart health is also crucial. You mentioned that your sleep duration is around 6 to 6.5 hours per night, which is on the lower end of the recommended amount for adults. Sleep deprivation can exacerbate feelings of anxiety and stress, potentially leading to increased heart rate and palpitations. Additionally, sleep disorders such as sleep apnea can significantly impact cardiovascular health, leading to increased blood pressure and heart rate variability. If you suspect that your sleep quality is poor, it may be worthwhile to explore sleep studies or consultations with a sleep specialist.

Your symptoms of feeling lightheaded or experiencing a floating sensation while walking could also be related to anxiety or stress, particularly if they occur during periods of discomfort. Anxiety can manifest physically, leading to palpitations, chest tightness, and even dizziness. It may be beneficial to incorporate stress management techniques such as mindfulness, yoga, or cognitive behavioral therapy into your routine.

Regarding your question about whether to seek further cardiac evaluation, it is always prudent to follow up with your healthcare provider if you have ongoing symptoms that concern you. A repeat echocardiogram or an exercise stress test could provide additional insights into your heart's function under physical stress, especially if you have experienced changes in your symptoms or if they have become more frequent or severe.

In terms of frequency for exercise stress tests, it generally depends on individual risk factors and symptoms. For someone with a history of palpitations or known heart conditions, it might be reasonable to have this test every 1-2 years, or more frequently if symptoms change.

In summary, while your symptoms may be related to your mitral valve prolapse and possibly exacerbated by anxiety or sleep issues, it is essential to maintain open communication with your healthcare provider. Regular monitoring of your heart health, lifestyle modifications to manage cholesterol, and addressing sleep quality can all contribute to better overall cardiovascular health. If your symptoms persist or worsen, do not hesitate to seek further evaluation. Your health and peace of mind are paramount.

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