Heart Palpitations: Causes and Concerns Explained

Heart rate issues

Hello Dr.
Chen,
Since mid-December last year, I experienced a sudden and intense heart rate increase while sleeping at night, accompanied by shaking that lasted nearly five hours.
Shortly after waking up in the morning, I developed a mild fever (only fever, with no other symptoms, and it lasted for about 5-6 hours).
However, six days later, I had an acute allergic reaction and went to the emergency room.
It happened suddenly just 15 minutes after waking up, and within half an hour, it became severe.
The doctor suggested it might be a serious food allergy (even though I hadn’t eaten anything that day).
After being observed overnight, I improved, but soon after, I began experiencing rapid heartbeats for a week.
I went to a medical center for examination, and my thyroid function was normal.
An ultrasound showed only mitral valve prolapse.
I took Inderal for a week, which helped, but a month later, the heart rate issue gradually returned, often reaching the 130s.
This time, it was accompanied by pain in the upper left chest (only when the heart rate was fast), severe chest tightness, and occasional dizziness while sitting.
I visited a cardiologist again, who performed a 24-hour Holter monitor test, but I felt fine that day.
The results showed a slow heart rate of 54 bpm and a fast rate of up to 163 bpm.
The doctor said it looked fine, but I often feel short of breath after walking a short distance and frequently experience pain in the upper left chest.
I was prescribed SORBITRATE for a week, but I stopped taking it because it made me feel worse.
The doctor mentioned that at my age, there shouldn’t be any significant issues.
Two months ago, I noticed my hands and feet were showing signs of poor peripheral circulation, turning purple 3-6 times a day.
I took BOFTYL for three weeks, which improved the condition, but this week and last week, I suddenly felt very cold, my heart rate was slightly elevated, and my fingers turned purple.
This all started in December last year; I have never had issues with abnormal heart rates before.
I want to ask why this is happening.
A month ago, I had a mild cold, but my heart rate was very fast (around 160 bpm), and sometimes my pulse felt like it was beating twice in a row.
The internal medicine doctor suggested I might have "PSVT," but when I had the ECG, it was normal, so no cause could be identified.
Is this a possibility?
Every time I have a fever or gastrointestinal issues, I experience shaking and a rapid heart rate while sleeping at night (this happens about 1-2 times every six months, and the duration seems to be increasing; it has been happening for eight years).
Could this indicate a heart problem? The sudden increases in my heart rate are quite concerning.
Could you please take a look at this?
THANKS

EMMA, 10~19 year old female. Ask Date: 2005/05/01

Dr. Chen Guifeng reply Cardiology

The likelihood of autonomic nervous system dysregulation syndrome is quite high, and the phenomenon of cyanosis in the extremities may be indicative of Raynaud's phenomenon.
It is essential to self-regulate daily habits to improve these conditions.

Reply Date: 2005/05/01

More Info

Understanding heart palpitations can be complex, especially when they are accompanied by other symptoms such as chest pain, shortness of breath, and episodes of shaking or fever. Based on your description, it seems that you have been experiencing a range of concerning symptoms that warrant careful evaluation.

Causes of Heart Palpitations
Heart palpitations are often described as the sensation of a racing, fluttering, or pounding heart. They can be triggered by various factors, including:
1. Anxiety and Stress: Emotional stress or anxiety can lead to increased adrenaline levels, which may cause your heart to race. This seems to align with your experiences of shaking and rapid heartbeats during stressful situations.

2. Physical Activity: Exercise or even minor physical exertion can lead to palpitations, especially if you are not accustomed to it.

3. Stimulants: Caffeine, nicotine, and certain medications can stimulate the heart and lead to palpitations.

4. Hormonal Changes: Fluctuations in hormones, such as during menstruation or pregnancy, can also affect heart rhythm.

5. Medical Conditions: Conditions such as hyperthyroidism, anemia, or electrolyte imbalances can lead to palpitations. You mentioned that your thyroid levels were normal, which is a good sign.

6. Heart Conditions: Structural heart issues, such as mitral valve prolapse (which you have), can sometimes lead to palpitations. Additionally, arrhythmias like paroxysmal supraventricular tachycardia (PSVT) can cause episodes of rapid heart rate.

Your Symptoms and Concerns
You have described episodes of rapid heart rate (up to 163 beats per minute), chest pain, and feelings of dizziness, particularly when walking. These symptoms, especially when combined with your history of shaking and fever, could indicate several underlying issues:
- Mitral Valve Prolapse: This condition can lead to palpitations and sometimes chest pain. While it is often benign, it can occasionally be associated with more significant symptoms.

- PSVT: This is a type of arrhythmia that can cause sudden episodes of rapid heart rate. It is characterized by a heart rate that can exceed 150 beats per minute and is often triggered by stress or exertion. The fact that your heart rate normalizes during monitoring may suggest that you experience paroxysmal episodes, which can be challenging to capture on an ECG.

- Anxiety: Given your history of anxiety and the physical symptoms you experience during episodes, it is possible that anxiety plays a significant role in your palpitations.

Recommendations
1. Consult a Cardiologist: Given your symptoms and the complexity of your case, it is essential to have a thorough evaluation by a cardiologist. They may recommend further testing, such as an echocardiogram, stress testing, or even an electrophysiological study to assess your heart's electrical activity.

2. Monitor Symptoms: Keeping a diary of your symptoms, including when they occur, their duration, and any associated factors (like stress or caffeine intake), can help your doctor identify patterns and potential triggers.

3. Manage Anxiety: If anxiety is a contributing factor, consider discussing this with a mental health professional. Techniques such as cognitive-behavioral therapy (CBT), mindfulness, and relaxation exercises can be beneficial.

4. Lifestyle Modifications: Reducing caffeine and nicotine intake, staying hydrated, and ensuring adequate sleep can help manage palpitations.

5. Follow-Up on Peripheral Symptoms: The episodes of peripheral cyanosis (purple discoloration of fingers) you mentioned should also be evaluated, as they may indicate circulation issues that need to be addressed.

In conclusion, while your symptoms are concerning, they can often be managed effectively with the right approach. It is crucial to work closely with your healthcare providers to determine the underlying causes and appropriate treatment strategies.

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