Arrhythmia: Symptoms, Concerns, and Treatment Options

Arrhythmia-related issues

Hello, doctor.
I have some questions regarding heart-related issues.
I previously underwent a 24-hour Holter monitor test, which showed only a few PACs (about 50-100 times) and around 1-10 PVCs.
My previous experiences included occasional sensations of my heart skipping a beat or suddenly beating forcefully.
However, this week, I have been experiencing irregular sensations of my heart skipping beats consistently for a week.
Sometimes it feels like it beats once and then stops, or beats 2-3 times and then stops, often accompanied by dizziness, chest tightness, and mild shortness of breath.
Each episode tends to follow this pattern for about 3-4 cycles before returning to normal, although sometimes it’s just a single skipped beat.

Additionally, my heart rate varies significantly; at rest, it can drop to 60-70 beats per minute, and during sleep, it can go as low as 40-60 beats per minute (I have a smartwatch that measures my heart rate).
However, it can also spike suddenly to 90-130 beats per minute.
When my heart rate reached 120 beats per minute while I was at the hospital for a cardiac evaluation, an ECG was performed, but by the time it was done, my heart rate had returned to 99 beats per minute with no abnormalities detected.
The doctor prescribed Inderal for me.

I would like to ask:
1.
Could the sudden changes in my condition indicate a worsening of my arrhythmia? Is there a need to schedule another 24-hour Holter monitor test? (However, these symptoms often do not occur during scheduled tests.)
2.
Sometimes my heart rate spikes to around 110-130 beats per minute.
A previous doctor suspected paroxysmal supraventricular tachycardia (PSVT), and during the 24-hour Holter test, my heart rate did reach over 150 beats per minute, but the report indicated no PSVT.
Is this simply a case of tachycardia? I often feel uncomfortable when my heart rate exceeds 100 beats per minute (accompanied by dizziness and shortness of breath).
However, when I stop the medication, the symptoms return, although sometimes I can have normal periods for a long time.
A previous doctor mentioned that if this continues, I might need a pacemaker.
Is that really necessary? Could this continuous elevated heart rate lead to heart failure?
3.
Since I am already taking Inderal, which lowers my heart rate, but the skipped beat symptoms have not improved, are there other treatment options? (Currently, I take 10 mg daily, either one pill or half a pill, as taking it with meals causes my blood pressure to drop too low, around 70/40, which makes me feel dizzy and short of breath.
Should I return to the hospital to change my medication, or is this dosage insufficient?)
4.
These issues are really affecting my daily life, and I often feel frightened.
Is there any risk to my life due to these symptoms?
5.
Additionally, I have mild mitral valve prolapse and mild mitral and tricuspid regurgitation.
Could these conditions make me more sensitive to these issues?
I apologize for the numerous questions, and I hope you can help answer them.
Thank you for taking the time to read and respond.

shin, 20~29 year old female. Ask Date: 2021/06/22

Dr. Wu Xueming reply Cardiology

1.
Many factors in daily life can contribute to this condition, such as emotions, stress, irregular sleep patterns, or excessive consumption 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 an electrocardiogram (ECG) examination.

2.
If no abnormal arrhythmias are detected, there is no need for a pacemaker, and it will not lead to heart failure.

3.
It is recommended to return to the outpatient clinic to discuss medication dosages with your physician.

4.
If no abnormal arrhythmias are found, there is no risk to life.

5.
Mild mitral valve prolapse and mitral and tricuspid valve insufficiency will not significantly impact daily life.

Reply Date: 2021/06/22

More Info

Understanding arrhythmia and its associated symptoms can be quite complex, especially when combined with other heart conditions such as mitral valve prolapse (MVP) and mild regurgitation. Based on your description, it seems you are experiencing a range of symptoms that can be distressing and may require further evaluation and management.

1. Changes in Symptoms: The sudden increase in the frequency and intensity of your symptoms, such as the sensation of skipped beats, palpitations, and associated dizziness and chest discomfort, could indicate that your arrhythmia is becoming more pronounced. While it is not uncommon for arrhythmias to fluctuate in severity, the persistence of these symptoms warrants a re-evaluation. A 24-hour Holter monitor can provide valuable data on your heart's rhythm during symptomatic episodes. If your symptoms are not captured during a routine check, consider discussing with your healthcare provider the possibility of an event monitor, which can be worn for a longer duration to catch sporadic symptoms.

2. Heart Rate Variability: The heart rate fluctuations you describe, with rates ranging from 60-130 beats per minute, can be concerning. The fact that you have experienced episodes of tachycardia (heart rates above 100 bpm) and that previous tests did not show paroxysmal supraventricular tachycardia (PSVT) suggests that your episodes may be due to other forms of tachycardia or simply sinus tachycardia, which can occur due to anxiety, stress, or other factors. It is essential to differentiate between these types of tachycardia, as management strategies may differ.

3. Medication Management: You mentioned being prescribed Inderal (propranolol), which is a beta-blocker that can help manage heart rate and reduce symptoms of anxiety. If you are experiencing significant side effects, such as hypotension (low blood pressure) leading to dizziness, it is crucial to communicate this to your doctor. Adjusting the dosage or switching to a different medication may be necessary. It is not uncommon for patients to require titration of their medications to find the right balance between symptom control and side effects.

4. Risk of Life-Threatening Events: While arrhythmias can be alarming, the majority of cases, especially those that are classified as benign (like occasional PACs and PVCs), do not pose an immediate life threat. However, persistent symptoms that interfere with daily life and cause significant anxiety should be addressed. If you ever experience severe symptoms such as prolonged chest pain, shortness of breath, or fainting, seek emergency medical attention.

5. Impact of Structural Heart Conditions: Your existing conditions, including MVP and mild regurgitation, can contribute to your symptoms. While these conditions are often benign, they can sometimes exacerbate feelings of palpitations or discomfort, particularly in the context of anxiety or stress. It is essential to have regular follow-ups with your cardiologist to monitor these conditions and ensure they are not progressing.

In conclusion, it is vital to maintain open communication with your healthcare provider regarding your symptoms and any side effects from medications. If your symptoms persist or worsen, further investigations may be warranted, including potential imaging studies or adjustments in your treatment plan. Managing anxiety and stress through counseling or therapy can also be beneficial in conjunction with medical treatment. Your health and well-being are paramount, so do not hesitate to seek help when needed.

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