Heart Palpitations: When to Seek Cardiologist Help

excuse me?

I often experience a sensation of my heart beating harder or skipping a beat, accompanied by a strong thump against my chest wall.
At the same time, I can feel my carotid artery pulsing strongly, followed by two weaker beats.
This occurs multiple times a day, lasting about 1-2 minutes, and sometimes even longer.
My heart rate is generally elevated, around 90-100 beats per minute.
Is this arrhythmia? I have previously had my T3, T4, and TSH levels checked, and they were normal.
Although I have experienced this before, I did not feel chest tightness or pain.
Recently, I have had a sharp pain near the xiphoid process on the left side, and my left shoulder feels particularly uncomfortable, close to the scapula.
Should I avoid stimulants like tea and coffee, maintain a regular routine, or should I see a cardiologist for further evaluation?

PINK, 20~29 year old female. Ask Date: 2006/02/19

Dr. Huang Guosheng reply Cardiology

Based on your symptoms, it appears you may have arrhythmia.
The causes of arrhythmia can include hyperthyroidism, medications, emotions, and certain foods (such as tea and coffee).
Correcting the underlying cause should improve the symptoms.
If discomfort persists, you may consider visiting a cardiology clinic for further evaluation.

Reply Date: 2006/02/19

More Info

Understanding heart palpitations can be quite concerning, especially when they are accompanied by other symptoms such as chest discomfort or pain. Based on your description, it seems that you are experiencing episodes of palpitations characterized by a sensation of your heart beating forcefully against your chest wall, along with noticeable pulsations in your carotid artery. These episodes last for about 1-2 minutes and occur multiple times a day, with your resting heart rate typically elevated at around 90-100 beats per minute.

Palpitations can arise from various causes, including anxiety, stress, caffeine intake, hormonal changes, or underlying heart conditions. Given that your thyroid function tests (T3, T4, TSH) are normal, it suggests that hyperthyroidism is not contributing to your symptoms. However, the presence of palpitations, especially when they are frequent and associated with discomfort in the chest and shoulder, warrants further evaluation.

The sensation of your heart "skipping" beats or pounding can be classified as arrhythmia, which is an irregular heartbeat. While many arrhythmias are benign, some can indicate more serious underlying conditions, particularly if they are accompanied by symptoms such as chest pain, shortness of breath, or fainting. The discomfort you describe near the sternum and left shoulder could be related to musculoskeletal issues, but it could also be a sign of cardiac ischemia, especially given your history of chest tightness.

In your case, it is advisable to consult a cardiologist for a comprehensive evaluation. The cardiologist may recommend several diagnostic tests, including:
1. Electrocardiogram (ECG): This test records the electrical activity of your heart and can help identify any arrhythmias or other abnormalities.

2. Holter Monitor: A portable device worn for 24-48 hours to continuously monitor your heart's rhythm. This can help capture any intermittent arrhythmias that may not be present during a standard ECG.

3. Echocardiogram: An ultrasound of the heart to assess its structure and function, which can help rule out any underlying heart conditions.

4. Stress Testing: This may be performed to evaluate how your heart responds to physical exertion and to check for any ischemic changes.

5. Blood Tests: To check for electrolyte imbalances, cardiac enzymes, and other markers that could indicate heart issues.

In the meantime, managing your lifestyle can also play a significant role in alleviating your symptoms. Reducing or eliminating caffeine and other stimulants, maintaining a regular sleep schedule, managing stress through relaxation techniques, and engaging in regular physical activity can all contribute to better heart health.

In summary, while lifestyle modifications are important, given the nature of your symptoms and their frequency, it is crucial to seek professional medical advice. A cardiologist will be able to provide a thorough assessment and determine if any further intervention is necessary. Your health and peace of mind are paramount, so do not hesitate to reach out for help.

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