Early Beats and Palpitations: Causes and Concerns

Premature beats and palpitations?

Hello, doctor.
I previously suffered from panic disorder and took medication, but after stopping the medication, I did not experience a relapse.
However, later on, I visited a traditional Chinese medicine practitioner for body adjustment.
During acupuncture (with about 6-10 needles inserted throughout my body), I suddenly experienced a rapid heartbeat and felt like I was going to die within a minute.
After the needles were removed, the practitioner helped me with acupressure, which alleviated the symptoms.
That night, I inexplicably experienced another episode of rapid heartbeat and had to go to the emergency room, where I was given sedatives and antiarrhythmic medication to stabilize my condition.
Since that incident, I have been feeling tense and anxious, and although taking Chinese herbal medicine has helped somewhat, I have started to experience sudden episodes of rapid heartbeat or strong heartbeats without warning.

Could you please tell me if this is premature ventricular contractions (PVCs), arrhythmia, or simply palpitations? I have undergone a 24-hour Holter monitor and an echocardiogram, which indicated mild mitral valve regurgitation but not severe enough to require medication.
During the Holter monitoring, I did not have any episodes of rapid heartbeat, but the doctor mentioned some palpitations (or arrhythmia; I didn't hear clearly).
They said it was not serious and did not prescribe any medication, yet I continue to experience these intermittent episodes, especially when pressure is applied to my chest (for example, when lying on my stomach), which leads to sudden strong heartbeats.
What could be the underlying issue? Is it possible that there is an electrical conduction problem in my heart, like an extra pathway? (My father has had a similar issue and underwent catheter ablation.) Additionally, I would like to understand why acupuncture might have triggered these subsequent discomforts.

VV, 30~39 year old female. Ask Date: 2023/03/12

Dr. Wu Xueming reply Cardiology

Many factors in daily life can contribute to this condition, such as emotions, stress, irregular sleep patterns, or excessive intake of caffeinated beverages.
It is advisable to adjust your lifestyle and engage in regular exercise.
However, if symptoms persist, it is recommended to seek further examination at a hospital.
For questions regarding acupuncture, please consult a traditional Chinese medicine practitioner.

Reply Date: 2023/03/12

More Info

Understanding early beats and palpitations can be quite complex, especially when there is a history of panic disorder and other medical interventions like acupuncture. Based on your description, it seems you are experiencing episodes of increased heart rate, which can be categorized into several potential causes, including premature beats (early beats), palpitations, or even anxiety-related symptoms.

Premature beats, also known as premature atrial contractions (PACs) or premature ventricular contractions (PVCs), are common and often benign. They occur when the heart's electrical system misfires, causing an early heartbeat. These can be triggered by various factors, including stress, caffeine, alcohol, or even certain medications. Given your history of panic disorder, it's possible that anxiety could also be a contributing factor to these sensations.

Your experience during acupuncture, where you felt a sudden increase in heart rate, could be attributed to several factors. Acupuncture can stimulate the autonomic nervous system, which controls involuntary bodily functions, including heart rate. In some individuals, this stimulation can lead to heightened awareness of heartbeats or even provoke anxiety, resulting in a rapid heartbeat. The sudden increase in heart rate you experienced during the session may have been a response to the stress of the procedure or an anxiety reaction, especially if you have a history of panic attacks.

The fact that you have undergone a 24-hour Holter monitor and echocardiogram, which showed mild mitral valve regurgitation but no significant issues requiring medication, is reassuring. Mitral valve regurgitation can be common and often does not lead to serious complications, especially if it is mild. However, it is essential to continue monitoring your symptoms and communicate any changes to your healthcare provider.

The episodes of feeling your heart "jump" or beat harder, especially when lying in certain positions, could be related to positional changes affecting your heart's filling and output. When you lie on your stomach or in a position that compresses your chest, it can alter the dynamics of blood flow and heart function, potentially leading to the sensations you describe.

Regarding your concern about a possible electrical short circuit in your heart, this is less likely without specific evidence from your tests. However, if your father has a history of similar symptoms and underwent ablation for arrhythmias, it might be worth discussing this family history with your cardiologist. Genetic predispositions can play a role in certain heart conditions, and understanding your family's medical history can help guide your evaluation and management.

In summary, your symptoms may be a combination of anxiety, benign premature beats, and possibly positional effects on your heart. It is crucial to maintain open communication with your healthcare providers, including both your cardiologist and any mental health professionals, to address both the physical and psychological aspects of your condition. If your symptoms persist or worsen, further evaluation, including possibly a referral to a cardiologist specializing in arrhythmias, may be warranted. Additionally, consider discussing with your healthcare provider the potential impact of acupuncture on your symptoms and whether it may be beneficial to explore other forms of stress management or relaxation techniques that do not provoke anxiety.

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