Heart Palpitations and Breathing Difficulties: A Comprehensive Guide

Arrhythmia, panic, shortness of breath?

Hello, I have been experiencing frequent shortness of breath, fatigue, and difficulty breathing, even while talking.
I underwent pulmonary function tests (Pre-bronchodilator) which showed: FVC: 2.71L, 97%; FEV1: 2.11L, 87%; FEV1/FVC: 77%; MMEF: 60%.
[Interpretation] 1.
Rule out small airway disease.
I also performed an exercise pulmonary function test, where I could only walk a little over 300 meters.
A low-dose chest CT scan without contrast enhancement showed: (No previous CT study for comparison) 1.
No evidence of interstitial lung disease (ILD).
No pleural effusion.
2.
Prominent lymph nodes in bilateral neck (se5im26-27).
3.
No bulky mass in the upper abdomen.
Gallbladder stone.
4.
No destructive bone lesion.
Remark: Vessels and solid organs are inadequately assessed based on this non-enhanced CT.
IMP: No evidence of ILD.
Prominent lymph nodes in bilateral neck (se5im26-27).
Echocardiogram Report:
[Atrium and Aortic Root] AO (mm) = 32, LA (mm) = 29
[Left Ventricle] IVS (mm) = 8, PW (mm) = 5, EDD (mm) = 40, ESD (mm) = 26, EDV (ml) = 71, ESV (ml) = 24, LV mass (g) = 76, LVEF: by M-mode measurement: 66%, LV Wall motion: Normal
[Right Ventricle] TAPSE = 18mm, Right ventricle wall motion: Normal
[Diastolic function] Mitral inflow E/A: 0.75/0.64 (E/A ratio = 1.17), Septal e: 8.21cm/s; Lateral e: 9.71cm/s; Septal E/e: 9.13; Lateral E/e: 7.72; Average E/e: 8.37;
[Valve lesion] MS: nil; MR: nil; AS: nil; AR: Trivial; TS: nil; TR: nil; PS: nil; PR: nil;
[Other findings] IVC diameter: 9mm with sniff collapse > 50%, Intracardiac vegetation: No; Pericardial effusion: None, Intracardiac thrombus: No, Congenital lesions: None
Conclusion: Normal LV systolic function with normal wall motion, Normal RV systolic function with normal wall motion, Normal diastolic function, Trivial AR.
Below are the tests conducted before the onset of the above symptoms, when I only felt occasional palpitations with a faster average heart rate, but not like the current symptoms.

1.
The baseline ECG showed sinus rhythm with a rate of 46-112/min.
The average HR was 71/min.

2.
There was sinus bradycardia without long pauses.

3.
No PSVT, PAF, VT, or VF.

4.
Few PVCs (total 42 beats), and PACs (total 8 beats) during the examination period.

5.
No marked events from the patient.
Holter Report: Code No.: LHA110-1124 Clinical diagnosis: Cardiac arrhythmia Test date: 2021/6/23 Analysis date: 2021/6/24 Hookup time: 11:41 Recording Time: 23 hr 57 min Analysis Time: 23 hr 57 min Analysis result: Technical quality of record: Good Dominant rhythm: Sinus Total Beats: 101016 Min HR: 49 BPM at 00:49:29 Avg HR: 72 BPM Max HR: 120 BPM at 08:17:05 Heart Rate Variability ASDNN 5: 67.1 msec SDANN 5: 95.3 msec SDNN: 117.7 msec AFib Beats: 0 (0.0%) AFib Duration: 0.0 min PVCs/couplets/Triplets/VT: 0/0/0 PACs/couplets/AT: 2/0/0 Fastest: 0 BPM Drop (delay > 2.0 sec)/Late: 0/3 Longest N-N: 1.3 sec at 05:24:06 Others: _Comments: *.
Sinus rhythm with a rate ranging from 49-120 bpm and a mean of 72 bpm.
*.
2 premature atrial beats.
*.
No AV block.
*.
No significant long pauses.
I would like to ask if my condition has worsened or if there are any cardiovascular diseases present, as I sometimes feel short of breath and easily fatigued, making me hesitant to exercise or engage in activities.
I am unclear if this is due to pulmonary or cardiac issues or psychological factors.
Sometimes, while sleeping or sitting without doing anything, my heart suddenly races or beats irregularly, which makes me fear sudden cardiac events or death.
After these symptoms began, I started experiencing full-body numbness, shaking, dry mouth, a feeling of not being able to breathe, and near-fainting episodes, leading to multiple emergency room visits.
I have since become reluctant to go out, fearing sudden episodes, and I easily tire, feeling less energetic than before.
In places like restrooms or basements, I often feel suffocated, as if there is no air, which triggers my symptoms again.
I consulted a psychiatrist and have been taking Clonazepam and Lorazepam, along with a prescription for anxiety medication, which has improved my symptoms somewhat, but I still occasionally experience sudden heart racing or irregular beats, and sometimes I feel a brief pain in my heart.
Additionally, two years ago, after receiving the COVID-19 vaccine, I frequently felt unwell, experiencing body aches, fatigue, and upon blood tests, I found elevated ANA (1:1280), SSA (387+), SSB (28-), C3 (89.8), IGE (944).
The doctor prescribed Plaquenil, which I have been taking for over a year, but my levels have remained fluctuating.
Recently, my Raynaud's phenomenon has worsened, and the doctor added another medication, Pletal.

Could you please advise if taking these medications long-term will affect my heart? Am I still suitable for receiving the flu or pneumococcal vaccines, as well as the new COVID-19 vaccine? Will my heart or immune issues worsen? Thank you for addressing my numerous questions.

Wu Zhi De Ren, 30~39 year old female. Ask Date: 2023/12/10

Dr. Wu Xueming reply Cardiology

The echocardiogram and 24-hour Holter monitor report did not indicate any significant structural or functional heart issues or arrhythmias, and vaccination did not have any impact.

Reply Date: 2023/12/10

More Info

Understanding heart palpitations and breathing difficulties can be quite complex, especially when multiple factors are involved. Based on the information provided, it seems that you have experienced a range of symptoms including shortness of breath, fatigue, and episodes of rapid heartbeats, which can understandably lead to anxiety and concern about your heart health.

Heart Palpitations and Breathing Difficulties
Heart palpitations are often described as feeling like your heart is racing, fluttering, or pounding. They can occur in the absence of any underlying heart disease, especially in response to stress, anxiety, caffeine, or other stimulants. In your case, the Holter monitor results indicate that while there were some premature atrial contractions (PACs) and a few premature ventricular contractions (PVCs), the overall heart rhythm was sinus, which is generally considered normal. The average heart rate was within a reasonable range, and there were no significant arrhythmias detected.

Breathing difficulties can stem from various causes, including respiratory conditions, anxiety, or even cardiac issues. Your lung function tests showed values that are largely within normal limits, which suggests that significant obstructive or restrictive lung disease is unlikely. However, the presence of prominent lymph nodes in the neck could warrant further investigation, as they may indicate an underlying condition that could contribute to your symptoms.

Psychological Factors
It’s also important to consider the psychological aspects of your symptoms. Anxiety can manifest physically, leading to sensations of breathlessness, palpitations, and even feelings of impending doom. The fact that you have experienced increased anxiety, especially after the COVID-19 vaccination and during stressful times, suggests that your symptoms may have a psychological component. The medications you are taking, such as Clonazepam (Klonopin) and Lorazepam (Ativan), are often prescribed to help manage anxiety and panic attacks, which can help alleviate some of the physical symptoms you are experiencing.

Medication Considerations
Regarding the long-term use of medications like Plaquenil (Hydroxychloroquine) and Prednisone, these can have side effects, but they are often necessary for managing autoimmune conditions. It is crucial to have regular follow-ups with your healthcare provider to monitor any potential side effects, especially concerning heart health. The medications you are on should not significantly impact your heart function if monitored properly.

Vaccination Concerns
As for vaccinations, it is generally recommended that individuals with autoimmune conditions receive vaccinations for influenza, pneumococcus, and COVID-19, as these can help prevent serious infections. However, it is essential to discuss your specific health situation with your healthcare provider, as they can provide personalized advice based on your medical history and current health status.

Recommendations
1. Follow-Up Care: Continue regular follow-ups with your cardiologist and primary care physician to monitor your heart health and any potential side effects from medications.

2. Mental Health Support: Consider speaking with a mental health professional if anxiety continues to be a significant issue. Cognitive-behavioral therapy (CBT) can be particularly effective for managing anxiety and panic symptoms.

3. Lifestyle Modifications: Incorporate stress-reducing activities such as yoga, meditation, or gentle exercise, which can help improve both your physical and mental well-being.

4. Emergency Plan: Given your history of severe symptoms, it may be beneficial to have an emergency plan in place. This could include knowing when to seek immediate medical attention and having a support system in place.

5. Monitoring Symptoms: Keep a diary of your symptoms, noting when they occur and any potential triggers. This can help you and your healthcare team identify patterns and adjust your treatment plan accordingly.

In conclusion, while your symptoms can be concerning, the tests you've undergone suggest that there may not be a significant underlying heart condition. However, the interplay between physical and psychological health is crucial, and addressing both aspects will be key to improving your overall well-being. Always consult with your healthcare provider before making any changes to your treatment or lifestyle.

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