Persistent Heartbeat Sensations: Causes and Concerns

Persistent sensation of heartbeat?

Hello, Director.
I originally had no cardiovascular disease, but about 1.5 years ago, I experienced episodes of arrhythmia (atrial fibrillation) that were quite severe, occurring frequently and irregularly.
The rapid heartbeat was so intense that I couldn't sleep, and even when I finally fell asleep, I would wake up shortly after due to the pounding of my heart.
I visited the emergency room twice, and initially, medications like Propafenone and Dronedarone were ineffective in controlling my condition.
Following my doctor's advice, I consulted a psychiatrist and started taking Lurasidone and Risperidone, which stabilized my condition.
My electrocardiograms (including a 24-hour Holter monitor) have not detected any arrhythmias since then, but I now experience a persistent sensation of my heart beating regularly (24 hours), along with feelings of heart weakness and discomfort from the vibrations, which I can also feel in my carotid arteries.

I have undergone echocardiography, cardiac CT scans, and blood tests, all of which showed no abnormalities.
Although I have a thyroid nodule, my thyroid function tests are within normal limits.
I continue to take antiarrhythmic medications (Dronedarone + Sotalol) and psychiatric medications, but the persistent sensation of my heart beating remains.
After taking the medications for about six months, I underwent catheter ablation, but my symptoms did not improve post-surgery and remain the same as before.
Due to my illness and various stressors, I lost 10 kilograms over the past year, leaving me at 40 kilograms, and I have been unable to regain weight.
I am currently taking Nebivolol and psychiatric medications.
Doctor, what could be the cause of this persistent sensation of my heart beating? Is it serious? Could it lead to heart failure over time? What other medications or specialists should I consider seeking treatment from? Additionally, I am currently 54 years old; could this be related to menopause? Thank you.

michelle, 50~59 year old female. Ask Date: 2023/01/30

Dr. He Dongjin reply Cardiology

Hello, the reasons for continuously feeling the heartbeat can vary.
Is it serious? If it persists for a long time? If you have already undergone cryoablation and your heart rhythm has returned to normal, it is very likely related to menopause and autonomic nervous system dysregulation.
If that is the case, it is not serious and will not lead to heart failure.
Don't worry, continue to cooperate with your current physician for treatment.
Changhua Hospital cares about you.

Reply Date: 2023/01/30

More Info

Persistent sensations of heartbeat, often referred to as palpitations, can be distressing and may arise from various underlying causes. In your case, it appears that you have a history of atrial fibrillation (AF), which can lead to significant anxiety and physical symptoms, including the sensation of a racing or pounding heart. Your experience of feeling your heart beating continuously, along with the associated discomfort, can be attributed to several factors.

1. Post-Atrial Fibrillation Symptoms: After experiencing episodes of AF, it is not uncommon for individuals to have lingering sensations of heartbeats even after the arrhythmia has been controlled. This can be due to heightened awareness of heart activity, anxiety, or residual effects of the heart's electrical system adjusting after episodes of irregular rhythm.

2. Anxiety and Stress: Given your history of panic and anxiety, it is possible that psychological factors are contributing to your perception of heartbeats. Anxiety can heighten bodily sensations, making you more aware of your heart's activity. This is especially relevant if you have experienced significant stressors in your life, which can exacerbate both anxiety and physical symptoms.

3. Medication Side Effects: The medications you are taking, including antiarrhythmics and those for anxiety, can sometimes have side effects that include palpitations or a sensation of a racing heart. It is essential to discuss any new or worsening symptoms with your healthcare provider, as they may need to adjust your medication regimen.

4. Thyroid Function: Although your thyroid levels are reported to be normal, thyroid dysfunction can lead to palpitations. It may be worthwhile to monitor your thyroid function periodically, especially since you have a thyroid nodule.

5. Autonomic Nervous System: Dysregulation of the autonomic nervous system can lead to symptoms such as palpitations and a sensation of heart pounding. This can occur in the context of anxiety disorders, as well as in individuals with a history of heart rhythm disorders.

6. Physical Health: Weight loss and changes in physical health can also impact how you feel. A significant weight loss of 10 kg in a year, especially if unintentional, can lead to fatigue and a feeling of weakness, which may contribute to your perception of heart sensations.

Regarding your concerns about heart failure, persistent palpitations alone do not directly lead to heart failure. However, if there are underlying structural heart issues or if your heart is under stress from other conditions, it is essential to monitor your heart health closely. Regular follow-ups with a cardiologist are crucial to ensure that your heart remains healthy and to address any emerging concerns.

As for treatment options, it may be beneficial to explore the following:
- Cardiac Rehabilitation: Engaging in a structured program can help improve your cardiovascular health and may alleviate some symptoms.

- Psychotherapy: Cognitive-behavioral therapy (CBT) or other forms of therapy can help manage anxiety and stress, potentially reducing the perception of palpitations.

- Medication Review: Consult with your healthcare provider about your current medications. There may be alternatives that could help manage your symptoms better.

Lastly, regarding menopause, hormonal changes can indeed affect heart rhythm and overall cardiovascular health. If you suspect that hormonal changes may be contributing to your symptoms, discussing this with your healthcare provider may help in managing your symptoms effectively.

In summary, while your symptoms are concerning, they are not uncommon in individuals with a history of arrhythmias and anxiety. Continuous monitoring, a comprehensive approach to treatment, and addressing both physical and psychological aspects of your health are essential steps in managing your condition. Always consult with your healthcare provider before making any changes to your treatment plan.

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