Heart Palpitations: When to Seek Medical Help

The heartbeat is so strong that I can feel my body shaking (unsure if it's a heart issue)?

Hello, Director Wu.
I would like to ask about a concern I've been experiencing over the past week.
I often feel like my heart skips a beat, and then suddenly beats very hard, causing significant palpitations.
Whenever my heart beats strongly, my body also shakes a bit.
I really want to see a doctor, but I'm afraid to go out due to psychological factors, fearing I might faint (I have fainted before).
I have been resting at home for a year, and since I've been staying indoors, I haven't exercised much.
I'm afraid that any intense activity might be too much for my heart, which makes me hesitant to seek medical attention.
In January 2020, I felt my heart racing and went to the emergency room.
The doctor only mentioned that my heart was beating fast, but I showed some signs of high blood pressure and was advised to monitor my blood pressure.
I have a history of autonomic nervous system dysfunction (accompanied by panic disorder, worrying that I might suddenly die on the way to the hospital).
Given my fear of seeking medical care, I'm unsure whether I should first visit a cardiologist or another specialist.
(I am extremely anxious every time I go out, fearing something might happen.) What kind of help can I seek?

Wang Xiaoting, 30~39 year old female. Ask Date: 2020/12/16

Dr. Wu Xueming reply Cardiology

Many factors in daily life can contribute to this condition, such as emotions, stress, irregular sleep patterns, or excessive intake of caffeinated beverages.
It is recommended to adjust your lifestyle and engage in regular exercise.
However, if symptoms persist, it is advisable to visit a hospital for a 24-hour Holter monitor test.

Reply Date: 2020/12/16

More Info

Heart palpitations can be concerning, especially when accompanied by feelings of anxiety or fear of fainting. It's important to understand that palpitations are often benign, but they can sometimes indicate underlying heart conditions that require medical attention. Given your symptoms and history, it is advisable to seek medical help, particularly from a cardiologist, to ensure a thorough evaluation of your heart health.

Understanding Heart Palpitations
Heart palpitations are sensations that feel like your heart is pounding, fluttering, or beating irregularly. They can occur due to various reasons, including stress, anxiety, caffeine intake, certain medications, or underlying heart conditions. In your case, the combination of palpitations, a history of high blood pressure, and autonomic nervous system dysregulation (which can lead to panic attacks) suggests that a comprehensive evaluation is warranted.

When to Seek Medical Help
You should seek medical help if you experience any of the following:
1. Frequent or Persistent Palpitations: If your palpitations occur often or last for an extended period, it’s essential to consult a healthcare provider.

2. Associated Symptoms: If your palpitations are accompanied by dizziness, fainting, chest pain, or shortness of breath, you should seek immediate medical attention.

3. History of Heart Disease: Given your high blood pressure and previous episodes of rapid heart rate, it’s crucial to have a cardiologist assess your heart function.

4. Anxiety and Panic Attacks: Since you have a history of anxiety and panic disorders, it’s important to address these issues as they can exacerbate your perception of palpitations and overall heart health.

Steps to Take
1. Consult a Cardiologist: Given your symptoms and history, the first step should be to schedule an appointment with a cardiologist. They may perform tests such as an electrocardiogram (ECG), echocardiogram, or Holter monitor to assess your heart's rhythm and function.

2. Manage Anxiety: Since anxiety can contribute to palpitations, consider seeking help from a mental health professional. Cognitive-behavioral therapy (CBT) or other therapeutic approaches can help manage anxiety and improve your overall well-being.

3. Lifestyle Modifications: Incorporate gentle physical activity into your routine, as tolerated. Regular exercise can help reduce anxiety and improve cardiovascular health. However, consult your doctor before starting any new exercise regimen, especially given your concerns about your heart.

4. Monitor Blood Pressure: Keep track of your blood pressure at home. If you notice significant fluctuations or consistently high readings, report these to your healthcare provider.

5. Educate Yourself: Understanding your condition can alleviate some fears. Learn about palpitations, anxiety, and how they can interact. Knowledge can empower you to manage your symptoms better.

Conclusion
Your symptoms warrant a thorough evaluation by a healthcare professional, particularly a cardiologist. While it’s understandable to feel anxious about seeking medical help, addressing your heart health is crucial. Remember, many people experience palpitations, and with the right support and treatment, you can manage your symptoms effectively. Don’t hesitate to reach out for help; your health and peace of mind are worth it.

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