Abnormal Heartbeats: Symptoms, Causes, and When to Seek Help

The heart is beating very irregularly?

Hello Doctor, I often feel my heart beating strongly two to three times in a row, and I can feel this pulsation without touching my chest.
Occasionally, I also experience chest pain and tightness.
I have had three frightening experiences where I suddenly had tinnitus, my vision gradually darkened, and I became unable to see, accompanied by severe dizziness.
The first incident occurred in a basement restaurant, the second while waiting in line for a midnight movie, and the third after a car accident when I returned home about an hour after being examined at the hospital.
Each episode lasted about 3 to 5 minutes before I recovered.
I previously underwent a 24-hour Holter monitor test at the hospital, and the doctor noted that my heart rate peaked at 170 beats per minute but found no significant abnormalities.
I was prescribed a month’s supply of antiarrhythmic medication to take once in the morning and once at night.
During a follow-up visit with a different doctor, I requested an echocardiogram to explore other potential issues.
However, the doctor informed me that my Holter monitor results showed 39 instances of arrhythmia in a day, and that having fewer than 100 instances of arrhythmia per day is considered normal.
The doctor explained that if there were a serious heart issue, the arrhythmia would exceed 100 instances even when not symptomatic.
Ultimately, I was prescribed a two-week supply of antiarrhythmic medication to take as needed.
I would like to ask you, Doctor, if I need to return for a follow-up visit given my situation? Is it normal for my heart to beat this strongly? Are the near-fainting episodes related to my heart condition? What could be causing the episodes of my vision going dark? Thank you for your guidance.

Xiao Xiaojie, 20~29 year old female. Ask Date: 2021/02/20

Dr. He Dongjin reply Cardiology

Hello, a 24-hour ECG can only provide information about your condition on the day of the test.
Do you experience palpitations before feeling faint? It is difficult to determine if there are any arrhythmias when you feel faint.
It is advisable to return for a follow-up appointment and discuss this with your attending physician.
Changhua Hospital cares about your well-being.

Reply Date: 2021/02/20

More Info

Understanding abnormal heartbeats can be quite complex, especially when accompanied by symptoms like chest pain, dizziness, and fainting. Your experiences of feeling your heart racing or pounding, along with episodes of tinnitus and visual disturbances, are concerning and warrant a thorough understanding.

Firstly, it’s essential to recognize that the sensation of your heart beating forcefully or irregularly is often referred to as palpitations. These can be caused by various factors, including anxiety, stress, caffeine intake, or underlying heart conditions. Given your history of episodes where you felt faint and experienced tinnitus, it’s crucial to consider the possibility of arrhythmias, which are irregular heartbeats that can sometimes lead to more severe symptoms.

The fact that you have experienced episodes of dizziness and near-fainting could indicate that your heart is not pumping effectively during those moments, potentially leading to decreased blood flow to the brain. This can happen if your heart rate becomes excessively fast (tachycardia) or if there are significant pauses in your heartbeat. The episodes you described, particularly the ones that occurred in stressful situations or after a traumatic event, could be related to both physical and emotional stressors.

Regarding your previous evaluations, it’s reassuring that your 24-hour Holter monitor showed that your heart rhythm was not excessively abnormal, with only 39 instances of irregular beats noted. The threshold of 100 irregular beats per day is often considered within the normal range for many individuals, especially if they are asymptomatic. However, your symptoms of dizziness and near-fainting are significant and should not be overlooked, even if the Holter monitor did not indicate severe abnormalities.

The recommendation to take heart rhythm medication (likely a beta-blocker) is common in managing palpitations and anxiety-related symptoms. These medications can help regulate your heart rate and reduce the frequency of palpitations. It’s important to follow your doctor’s advice regarding medication and to communicate any concerns you have about side effects or the need for long-term use.

As for whether you need to return for further evaluation, it would be prudent to do so, especially if your symptoms persist or worsen. A follow-up visit can provide an opportunity to reassess your condition, discuss your symptoms in detail, and potentially conduct further tests, such as an echocardiogram or stress test, to evaluate your heart's structure and function more comprehensively.

In summary, while your heart's forceful beating and episodes of dizziness may not indicate a severe underlying condition based on your previous tests, they are symptoms that should be monitored closely. It’s essential to maintain open communication with your healthcare provider about your experiences and any changes in your symptoms. If you experience any new or worsening symptoms, such as increased frequency of palpitations, prolonged dizziness, or chest pain, seek medical attention promptly. Your health and well-being are paramount, and addressing these concerns with your physician will help ensure you receive the appropriate care and reassurance.

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