Palpitations, Coughing, and Vomiting: A Chest Medicine Perspective

Q: Palpitations, Coughing, and Vomiting: A Chest Medicine Perspective

Hello： The chest X-ray shows no abnormalities in the lungs, and the cough is not persistent. <br>It is suspected that the main issue lies in the arrhythmia and temporary cardiac backflow obstruction, leading to chest tightness and cough. <br>During the ECG, it happened to capture

Wheezing, coughing, vomiting, and incontinence?

Hello, Director Yang.
I had a stent placed in October 2013.
About five months later, I began experiencing occasional missed beats, accompanied by vomiting (usually without anything in my stomach, but in rare cases, severe vomiting can lead to expelling water).
A myocardial perfusion scan and echocardiogram showed no issues, but a 24-hour Holter monitor detected several instances of missed beats.
My doctor said these were premature contractions and deemed them harmless, suggesting continued observation.
During this time, I consulted a pulmonologist who found nothing wrong, and a gastroenterologist performed an endoscopy, which only indicated mild inflammation, likely related to aspirin, without prescribing any medication.

To avoid confusion, I will directly describe the occurrences of missed beats, coughing, vomiting, and wheezing:
1.
Over the years, these symptoms typically occur when I walk a certain distance or climb stairs (if I take a moment to regulate my breathing before climbing, I may not experience missed beats, coughing, or wheezing).
2.
They also occur when I am anxious or lifting heavy objects.
3.
The missed beats are characterized as 1-2, 1-2, (1 disappears) followed by a sudden thump of 2.
4.
Sometimes, the missed beats can occur with intervals of one to two months (when they do occur, they can last intermittently from one day to half a month).
5.
Additionally, there are less frequent instances where I feel a contraction in the center of my chest (about two inches above the xiphoid process) or slightly to the left.
The symptoms sometimes disappear quickly, while at other times, I experience continuous missed beats, coughing, wheezing, and vomiting (the order of occurrence varies).
Occasionally, the symptoms may suddenly resolve after severe vomiting, leaving only chest pain caused by persistent coughing.
Therefore, I even hope that when symptoms occur, they lead to severe vomiting quickly!
Since March 2014, I have consulted both a pulmonologist and a gastroenterologist, both of whom found no issues.
The cardiology department has performed three myocardial perfusion scans, annual echocardiograms, and electrocardiograms.
X-rays only indicated the presence of premature contractions, with no other issues detected, and no signs of tuberculosis or similar conditions.
I usually do not worry much when I am well, but I occasionally fear that if the contractions become too severe, it could lead to serious consequences! Each time I am examined, the most I experience is mild missed beats, and I do not typically have coughing, vomiting, or wheezing at that moment.

The following are the results from my chest X-ray last month (which also appeared normal): cardiomegaly, prominent lung markings, and clear bilateral costophrenic angles.

I would like to ask Director Yang, given my situation, what other possibilities might there be? Or which specialty should I seek further consultation from? Thank you for your assistance.

Mr. Zhang, 60~69 year old female. Ask Date: 2023/10/21

Dr. Yang Wenda reply Pulmonology

Hello: The chest X-ray shows no abnormalities in the lungs, and the cough is not persistent.
It is suspected that the main issue lies in the arrhythmia and temporary cardiac backflow obstruction, leading to chest tightness and cough.
During the ECG, it happened to capture a moment when the missed beats were not severe.
It is recommended to consult a cardiologist for a 24-hour Holter monitor.

Reply Date: 2023/10/21

More Info

Understanding the symptoms of palpitations, coughing, and vomiting from a chest medicine perspective involves a comprehensive approach to diagnosing and managing these interconnected issues. Based on your detailed description, it appears that you have been experiencing a complex interplay of symptoms following the placement of a stent, including palpitations (premature contractions), coughing, and episodes of vomiting, particularly during physical exertion or stress.

Palpitations
Palpitations, especially those characterized as premature ventricular contractions (PVCs), can be benign in many cases, particularly if they are infrequent and not associated with significant symptoms like dizziness or syncope. The fact that your heart has been evaluated with echocardiograms, myocardial perfusion scans, and 24-hour Holter monitoring without significant findings is reassuring. However, it is essential to continue monitoring these symptoms, especially if they become more frequent or severe.

Coughing and Vomiting
The coughing and vomiting you describe, particularly when they occur alongside palpitations, could be related to several factors:
1. Gastroesophageal Reflux Disease (GERD): Given that you have undergone an endoscopy that showed mild inflammation, GERD could be a contributing factor. The reflux of stomach contents can irritate the esophagus and trigger cough reflexes, which may also lead to vomiting, especially if the reflux is severe.

2. Anxiety and Stress: Your symptoms appear to be exacerbated by physical exertion and stress. Anxiety can lead to hyperventilation, which may cause palpitations and a sensation of breathlessness, potentially leading to coughing and even nausea or vomiting.

3. Cardiac-Related Symptoms: Although your cardiac evaluations have been largely normal, the combination of palpitations and respiratory symptoms could suggest a need for further investigation into your heart function during exertion. Sometimes, exercise-induced arrhythmias can occur, which may not be captured during routine monitoring.

Recommendations
1. Follow-Up with a Cardiologist: Given your history of stenting and ongoing symptoms, it would be prudent to have a follow-up appointment with a cardiologist. They may consider performing an exercise stress test to evaluate your heart's response during physical activity.

2. Gastroenterology Consultation: Since you have experienced gastrointestinal symptoms, a follow-up with a gastroenterologist may be beneficial. They can assess for GERD or other gastrointestinal issues that may be contributing to your symptoms.

3. Pulmonary Evaluation: If your cough persists or worsens, a pulmonary function test may be warranted to rule out any underlying respiratory conditions, especially if you have a history of smoking or exposure to irritants.

4. Lifestyle Modifications: Managing stress through relaxation techniques, regular exercise (as tolerated), and dietary modifications to reduce reflux can be beneficial. Avoiding heavy meals, caffeine, and alcohol, especially before physical activity, may help mitigate symptoms.

5. Monitoring Symptoms: Keep a detailed log of your symptoms, including their frequency, duration, and any associated activities or triggers. This information can be invaluable for your healthcare providers in determining the underlying causes and appropriate management strategies.

Conclusion
Your symptoms of palpitations, coughing, and vomiting are multifaceted and may stem from a combination of cardiac, gastrointestinal, and psychosomatic factors. Continued collaboration with your healthcare team, including cardiologists, gastroenterologists, and possibly pulmonologists, will be essential in managing your condition effectively. Regular follow-ups and open communication about your symptoms will help ensure that any changes in your health status are promptly addressed.

Similar Q&A

Understanding Symptoms: Nasal Congestion, Chest Pain, Vomiting, and Palpitations

Hello, I have been experiencing severe nasal congestion since December, which often prevents me from sleeping at night. (When my nose is clear, I have thick white phlegm.) After two to three weeks of significant sleep deprivation (<5 hours), I began to experience chest pain an...

Dr. Lin Zhebin reply Family Medicine
Hello: Based on the symptoms you described, we should consider the possibility of a respiratory or gastrointestinal infection. Additionally, the symptoms of chest pain and palpitations may indicate a cardiac issue, as potential causes can involve multiple organs. It is recommende...

Managing Long-Term Heart, Cough, and Headache Issues: A Patient's Journey

Dear Dr. Chen, I have been suffering from persistent cough and headaches for over twenty years, and I have been on antihypertensive medication for the past ten years. For the last two months, I have frequently felt tightness in my chest. One day, I felt extremely unwell, experie...

Dr. Chen Guifeng reply Cardiology
The only medication that must be taken daily in the long term is for hypertension; most other medications are for short-term use and are not of major concern. The adjustment of mindset is the most important factor!

Managing Heart Palpitations and Coughing: A Patient's Guide

Recently, my mother has been experiencing coughing when she speaks, but it does not occur when she is silent. Occasionally, she also feels chest tightness and palpitations. We previously took her to see a pulmonologist, who indicated that both the electrocardiogram and chest X-ra...

Dr. Wu Xueming reply Cardiology
If the heart rate is below 50 beats per minute, it is recommended to reduce the dosage or discontinue the medication.

Understanding Coughing and Heart Palpitations When Lying Down

Hello Dr. Yang! I am a 25-year-old male. This year, I have frequently been drinking tea, which has caused me to experience palpitations at night. After I stopped drinking tea, the palpitations significantly improved. Occasionally, when I consume tea-based beverages, I notice that...

Dr. Yang Wenda reply Pulmonology
Hello: It is recommended to see a pulmonologist and to avoid cold foods! Best wishes!