Irregular Heartbeats: Causes, Symptoms, and Next Steps - Cardiology

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Irregular heartbeats, often referred to as palpitations, can be concerning and may arise from various causes. Your description of experiencing skipped beats in a pattern suggests that you might be experiencing premature contractions, which can be either atrial (PACs) or ventricular (PVCs). These contractions occur when the heart's electrical system misfires, leading to an early heartbeat followed by a compensatory pause, which can create the sensation of a skipped beat.


Causes of Irregular Heartbeats
1. Premature Contractions: As mentioned, PACs and PVCs are common causes of palpitations. They are usually benign, especially in the absence of underlying heart disease.


2. Anxiety and Stress: Emotional factors can significantly impact heart rhythm. Anxiety can lead to increased adrenaline levels, which may cause the heart to beat faster or irregularly.

3. Stimulants: Caffeine, nicotine, and certain medications can trigger palpitations. If you consume these substances, consider reducing your intake.

4. Electrolyte Imbalances: Low levels of potassium, magnesium, or calcium can affect heart rhythm. A blood test can help determine if this is a contributing factor.

5. Thyroid Issues: An overactive thyroid (hyperthyroidism) can lead to increased heart rate and palpitations. Thyroid function tests can assess this.

6. Structural Heart Issues: Although less common in younger individuals, structural problems such as valve disorders or cardiomyopathy can lead to irregular heartbeats.


Symptoms to Monitor
While you have experienced palpitations, it is essential to monitor for additional symptoms that may indicate a more serious condition, including:
- Dizziness or lightheadedness
- Chest pain or discomfort
- Shortness of breath
- Fainting or near-fainting episodes
If you experience any of these symptoms, it is crucial to seek immediate medical attention.


Next Steps
1. Holter Monitor: Since your symptoms occur intermittently, a 24-hour Holter monitor can provide a more comprehensive assessment of your heart rhythm over an extended period. This test records your heart's electrical activity continuously and can capture irregularities that a standard ECG might miss.

2. Echocardiogram: An echocardiogram can assess the structure and function of your heart. It can help identify any underlying issues such as valve problems or structural abnormalities.

3. Blood Tests: Checking your electrolyte levels and thyroid function can help rule out metabolic causes of your symptoms.

4. Lifestyle Modifications: Reducing caffeine and alcohol intake, managing stress through relaxation techniques, and ensuring adequate hydration can help alleviate symptoms.

5. Medication Review: Since you mentioned being prescribed Inderal (propranolol), it may be beneficial to discuss with your physician whether this medication is appropriate for your symptoms or if adjustments are needed.


Conclusion
While occasional palpitations are often benign, persistent or bothersome symptoms warrant further investigation. It is essential to maintain open communication with your healthcare provider, who can guide you through the necessary tests and help determine the best course of action. If your symptoms worsen or you develop new concerning symptoms, do not hesitate to seek immediate medical care.