Persistent Palpitations and Dizziness: What Tests to Consider

Long-term palpitations and dizziness for a year?

Hello Doctor, I have been experiencing palpitations daily for the past year, often accompanied by dizziness.
These symptoms do not occur when sitting or lying down, but only when walking, where I feel my heart racing and a bit short of breath.
I also experience a sense of unsteadiness (not to the extent of vertigo, and there are no sudden blackouts in my vision).
I feel a heaviness in my head that lessens (but there is no vomiting or cold sweats).
My heart rate is approximately 80-100 beats per minute.
I have undergone a resting electrocardiogram, and the doctor suspects mild arrhythmia; I am still waiting for the report.
Could you please suggest what tests I should undergo? I am very concerned that it might be related to heart issues.

He Zhengyan, 20~29 year old female. Ask Date: 2021/03/08

Dr. He Dongjin reply Cardiology

Hello, please don't be too anxious.
Let's wait for the report; it may not necessarily be a heart-related issue.
If needed, let's schedule a 24-hour Holter monitor.
Changhua Hospital cares about you.

Reply Date: 2021/03/08

More Info

Persistent palpitations and dizziness can be concerning symptoms, especially when they occur frequently and are accompanied by changes in heart rate. It’s good that you have already undergone a resting electrocardiogram (ECG), as this is a fundamental first step in evaluating heart rhythm issues. Given your symptoms and the preliminary findings of possible mild arrhythmia, there are several additional tests and evaluations that can help clarify the situation.

1. Holter Monitor: This is a portable ECG device that you wear for 24 to 48 hours. It continuously records your heart's electrical activity, allowing your doctor to see how your heart behaves during your normal daily activities. This can help identify any intermittent arrhythmias that may not have been captured during your resting ECG.

2. Echocardiogram: An echocardiogram uses sound waves to create images of your heart. This test can assess the structure and function of your heart, including the size of the chambers, the condition of the heart valves, and the overall pumping ability of the heart. It can help rule out structural heart disease that might be contributing to your symptoms.

3. Exercise Stress Test: This test involves monitoring your heart while you exercise, typically on a treadmill or stationary bike. It can help determine how your heart responds to physical stress and whether exercise triggers any abnormal heart rhythms.

4. Blood Tests: Certain blood tests can provide valuable information about your heart health. These may include tests for thyroid function (as hyperthyroidism can cause palpitations), electrolyte levels (such as potassium and magnesium), and cardiac biomarkers (to rule out any heart muscle damage).

5. Tilt Table Test: If your dizziness is suspected to be related to blood pressure changes, a tilt table test can help assess how your body responds to changes in position. This test can help diagnose conditions like orthostatic hypotension or vasovagal syncope.

6. Electrophysiological Study (EPS): If your symptoms persist and the above tests do not provide a clear diagnosis, an EPS may be considered. This invasive procedure involves threading catheters through your blood vessels to the heart to study its electrical activity in more detail.

In addition to these tests, it’s essential to consider your overall health and lifestyle factors. Stress, anxiety, dehydration, and caffeine intake can all contribute to palpitations and dizziness. Keeping a symptom diary may help identify any triggers related to your activities, diet, or emotional state.

It’s also crucial to communicate openly with your healthcare provider about your symptoms, including their frequency, duration, and any associated factors. This information can guide your doctor in determining the most appropriate tests and treatment options.

Lastly, while it’s natural to feel anxious about these symptoms, many cases of palpitations and dizziness are benign and can be managed effectively. However, it’s essential to follow up with your healthcare provider to ensure that any underlying issues are addressed promptly.

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