Managing Occasional Heart Palpitations: Expert Advice for Relief - Cardiology

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Sometimes I feel my heart racing or skipping beats at rest?


Hello, Doctor He.
I learned online that you are a compassionate and patient physician, and I would like to ask you some questions.
I sometimes experience skipped heartbeats that can last for about 3 to 4 hours when severe.
This is not a daily occurrence and is paroxysmal in nature.
I take Xanax 0.25 mg to manage the anxiety caused by the skipped beats, but it does not alleviate the discomfort during the episodes.
I also have mild asthma, and my doctor prescribed a calcium channel blocker (Herbesser 30 mg) to take during these uncomfortable moments, but it does not resolve the skipped beats and may even make them feel worse.

I would like to ask you, during these paroxysmal skipped beats, I experience shortness of breath and chest tightness.
Aside from Xanax, since I have mild asthma, am I unable to use selective beta-blockers to relieve the shortness of breath and chest tightness at that moment? In your professional opinion, are there any other medications that could help alleviate my paroxysmal skipped beats during an episode? This issue has been troubling me for a long time, and I look forward to your expert advice.
Thank you.
P.S.
1.
The skipped beats mostly occur when my heart rhythm is normal, and I do not have issues with tachycardia.
2.
I have undergone various examinations at the hospital, including a CT scan, and there are no organic heart problems.

Mr. Huang, 40~49 year old female. Ask Date: 2022/03/17

Dr. He Dongjin reply Cardiology


Hello, if you have mild asthma, can you use selective beta-blocker medications? It's hard to say, but you can give it a try.
If you do not experience an asthma attack, you may use beta-blocker medications, which are theoretically more effective than calcium channel blockers for treating paroxysmal atrial fibrillation.
However, individual responses may vary due to different body constitutions.
Changhua Hospital cares about your well-being.

Reply Date: 2022/03/17

More Info


Managing occasional heart palpitations can be a challenging experience, especially when accompanied by symptoms such as shortness of breath and chest discomfort. It’s important to understand that while palpitations can be benign, they can also be indicative of underlying conditions that may require further evaluation and management.


Understanding Heart Palpitations
Heart palpitations are sensations that feel like your heart is pounding, fluttering, or beating irregularly. They can occur in isolation or be associated with other symptoms such as dizziness, chest pain, or shortness of breath. In your case, the palpitations are described as paroxysmal, lasting for several hours, which can be distressing.


Potential Causes
Palpitations can be triggered by various factors, including:
1. Anxiety and Stress: Emotional stress or anxiety can lead to increased adrenaline levels, which may cause palpitations.

2. Stimulants: Caffeine, nicotine, and certain medications can provoke palpitations.

3. Hormonal Changes: Fluctuations in hormones, such as during menstruation or menopause, can also contribute.

4. Underlying Heart Conditions: Although you mentioned that tests have ruled out structural heart issues, conditions like atrial fibrillation or other arrhythmias can still be a consideration.


Current Management Strategies
You are currently using Xanax (alprazolam) to manage anxiety related to your palpitations, which can be effective for anxiety but may not directly address the palpitations themselves. The calcium channel blocker (Herbesser) prescribed for your asthma symptoms may not be the best choice for managing palpitations, as they can sometimes exacerbate the sensation of palpitations in certain individuals.


Recommendations for Relief
1. Beta-Blockers: While you mentioned concerns about using selective beta-blockers due to your asthma, it’s worth discussing with your healthcare provider. Some beta-blockers are cardioselective and may be safer for asthmatic patients. They can help reduce the frequency and intensity of palpitations by slowing the heart rate and reducing anxiety.

2. Lifestyle Modifications:
- Avoid Stimulants: Reduce or eliminate caffeine and nicotine intake.

- Stress Management: Techniques such as deep breathing exercises, yoga, or mindfulness can help manage anxiety and reduce the frequency of palpitations.

- Regular Exercise: Engaging in regular physical activity can improve overall cardiovascular health and reduce stress.

3. Medication Review: Since you are experiencing discomfort during palpitations, it may be beneficial to revisit your medication regimen with your healthcare provider. They might consider alternatives that can provide relief without exacerbating your asthma.

4. Monitoring and Follow-Up: Keep a diary of your palpitations, noting the frequency, duration, and any associated symptoms. This information can be valuable for your healthcare provider in determining the best management strategy.

5. Further Evaluation: If your symptoms persist or worsen, further evaluation may be warranted. This could include a Holter monitor to capture your heart rhythm over an extended period or an electrophysiological study to assess for any underlying arrhythmias.


Conclusion
While occasional heart palpitations can be benign, it’s essential to manage them effectively, especially when they cause significant discomfort. Collaborate closely with your healthcare provider to explore the best options tailored to your specific situation. With the right approach, you can find relief from your symptoms and improve your quality of life. Remember, it’s crucial to communicate openly with your doctor about your experiences and any concerns you may have regarding your treatment plan.

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