Heart Palpitations: Is It Arrhythmia?

Cardiac issues

Hello Doctor: I previously experienced chest tightness and palpitations, so I went to the hospital for a cardiac ultrasound and a 24-hour Holter monitor.
The doctor said the results were normal, but I still occasionally experience palpitations, and my heart rate has always been elevated, often exceeding 100 beats per minute and occasionally dropping below 100.
Could this be arrhythmia? Thank you, Doctor.

Niming, 20~29 year old female. Ask Date: 2021/10/24

Dr. He Dongjin reply Cardiology

Hello, a heart rate exceeding 100 beats per minute can easily lead to palpitations.
However, palpitations do not necessarily indicate an arrhythmia.
If the echocardiogram and 24-hour Holter monitor show no issues, there is no need to worry.
Changhua Hospital cares about you.

Reply Date: 2021/10/24

More Info

Heart palpitations can be a concerning symptom, especially when accompanied by feelings of chest tightness or anxiety. However, understanding the nature of these palpitations is crucial in determining whether they are indicative of a more serious condition, such as arrhythmia, or if they are benign.

Based on your previous evaluations, including echocardiograms and Holter monitoring, it appears that your heart function is generally normal. The echocardiogram results indicated normal left ventricular systolic function, normal wall motion, and no significant valvular disease. The Holter monitor results showed sinus rhythm with a maximum heart rate of 135 bpm and no significant arrhythmias such as premature ventricular contractions (PVCs) or supraventricular arrhythmias. This suggests that while your heart rate can be elevated, it does not necessarily indicate a pathological arrhythmia.

Palpitations can occur for a variety of reasons, and they are not always linked to arrhythmias. Common causes include:
1. Anxiety and Stress: Psychological factors can significantly influence heart rate and rhythm. Anxiety can lead to increased sympathetic nervous system activity, resulting in palpitations. This is particularly relevant if you have been experiencing stress related to exams or job searching.

2. Caffeine and Stimulants: Consumption of caffeine, nicotine, or other stimulants can lead to increased heart rate and palpitations. If you consume these substances, consider reducing your intake.

3. Dehydration and Electrolyte Imbalance: Insufficient hydration or imbalances in electrolytes (like potassium or magnesium) can affect heart rhythm. Ensure you are drinking enough fluids and maintaining a balanced diet.

4. Physical Activity: Engaging in vigorous exercise can temporarily elevate your heart rate. If you are not accustomed to intense physical activity, your heart may respond with palpitations.

5. Hormonal Changes: Fluctuations in hormones, such as during menstrual cycles or due to thyroid issues, can also lead to palpitations.

Given that your heart has been evaluated and found to be structurally normal, it is less likely that your palpitations are due to a serious arrhythmia. However, if you continue to experience these symptoms, it is essential to keep a record of when they occur, their duration, and any associated symptoms (like dizziness or chest pain). This information can be helpful for your healthcare provider in assessing your condition.

If your palpitations are frequent, bothersome, or associated with other concerning symptoms, it may be worthwhile to consult a cardiologist for further evaluation. They might recommend additional tests, such as an event monitor, which can provide more extended monitoring of your heart rhythm, especially during symptomatic episodes.

In summary, while your heart evaluations have shown no significant issues, the experience of palpitations can still be distressing. Focus on managing stress, maintaining a healthy lifestyle, and monitoring your symptoms. If you have ongoing concerns, do not hesitate to seek further medical advice. Your health and peace of mind are paramount.

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