Heart Palpitations and Shortness of Breath: Causes and Concerns

excuse me?

Why do I sometimes feel a heaviness in my chest and occasionally experience palpitations? I previously had an electrocardiogram that came back normal, but for the past 5 to 6 years, I have felt short of breath even with minimal exercise (at that time, my weight was normal), and I still experience shortness of breath now.
Could you please advise on the possible reasons?

Jane, 10~19 year old female. Ask Date: 2007/01/25

Dr. He Dongjin reply Cardiology

Dear Jane, based on your description, you likely have mitral valve prolapse.
An electrocardiogram cannot diagnose this condition, but some simple medications may help control your symptoms.
It is advisable for you to undergo further examination at Changhua Hospital.

Your tall and slender physique is often considered the ideal model figure that many girls aspire to.
However, in the eyes of a physician, this elongated body type and sensitive personality are typical characteristics of patients with mitral valve prolapse, also known as MVP.
Approximately 5% of the population is affected by this condition, which is notably more prevalent in females, who are twice as likely to be affected as males.
The primary features of these patients are being thin and tall.

If there are mucinous changes in the connective tissue of the valve during embryonic development, leading to elongated and lax valves, prolapse may occur later in life.
When the heart contracts, the elongated valve may not close properly, resulting in the backflow of blood from the left ventricle into the left atrium.
In addition to the characteristic "click" of the prolapsing valve, a heart murmur may also be heard.

Patients with this abnormal constitution often report a variety of symptoms throughout their body, including dizziness, insomnia, palpitations, chest pain, panic, fatigue, chest tightness, generalized numbness, shortness of breath, and gastrointestinal discomfort.
These symptoms may be related to autonomic nervous system dysregulation, which involves either excessive or insufficient responses from the sympathetic or parasympathetic nervous systems.
Clinically, patients may present with various arrhythmias, including sinus tachycardia (the most common), bradycardia, ventricular tachycardia, atrial flutter, atrial fibrillation, or even cardiac arrest.

The chest pain associated with mitral valve prolapse can sometimes be difficult to distinguish from angina or myocardial infarction.
The underlying cause may be the excessive movement of the elongated valve, which can overstretch the heart muscle, leading to localized hypoxia, arrhythmias, and autonomic nervous system dysregulation.
Mitral valve prolapse is also commonly found in patients with congenital heart defects (such as atrial septal defect), hypertrophic cardiomyopathy, and certain congenital connective tissue disorders (such as Marfan syndrome).

Patients with prolapse symptoms may seem to have issues throughout their bodies, but over 90% of cases are benign.
Aside from being somewhat anxious, they do not pose significant health risks.
Regular exercise, adequate rest, and occasional use of low doses of beta-blockers or sedatives may suffice.
Only a small percentage of patients (about 1%) may experience complications such as heart failure, endocarditis, arrhythmias, stroke, or sudden death.
Therefore, patients with mitral valve prolapse, especially those with significant heart murmurs, should have follow-up examinations at least once a year.

Reply Date: 2007/01/25

More Info

Heart palpitations and shortness of breath can be concerning symptoms that often lead individuals to seek medical advice. Understanding the underlying causes of these symptoms is crucial for proper management and reassurance.

Causes of Heart Palpitations
Heart palpitations are sensations that your heart is pounding, fluttering, or beating irregularly. They can occur due to various reasons, including:
1. Anxiety and Stress: Emotional factors such as anxiety, panic attacks, or stress can trigger palpitations. The body's fight-or-flight response releases adrenaline, which can increase heart rate and cause palpitations.

2. Physical Activity: Exercise increases heart rate, and for some individuals, this can lead to palpitations, especially if they are not accustomed to physical exertion.

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 affect heart rhythm.

5. Medical Conditions: Conditions such as hyperthyroidism, anemia, or electrolyte imbalances can lead to palpitations. Structural heart issues, although less common, can also be a cause.

Causes of Shortness of Breath
Shortness of breath (dyspnea) can be caused by a variety of factors, including:
1. Respiratory Issues: Conditions such as asthma, chronic obstructive pulmonary disease (COPD), or pneumonia can lead to difficulty breathing.

2. Cardiac Conditions: Heart-related issues, such as heart failure or arrhythmias, can cause inadequate blood flow and result in shortness of breath.

3. Anxiety: Anxiety and panic attacks can also manifest as shortness of breath, often accompanied by a feeling of tightness in the chest.

4. Deconditioning: If you have been less active, your body may not be as efficient at handling physical exertion, leading to feelings of breathlessness during activities that previously did not cause issues.

Your Specific Concerns
In your case, you mentioned experiencing a sensation of heaviness in your chest and palpitations, along with shortness of breath during physical activity. Given that your previous electrocardiogram (ECG) results were normal, it is reassuring that there are no immediate signs of serious cardiac issues. However, the persistence of these symptoms warrants further investigation.

1. Anxiety and Stress: If you have a history of anxiety, it could be contributing to both your palpitations and shortness of breath. Anxiety can cause hyperventilation, which may lead to feelings of breathlessness.

2. Physical Fitness: If you have not been regularly active, your cardiovascular fitness may have declined, making you more susceptible to feeling short of breath during exertion.

3. Respiratory Function: Given your history of feeling breathless with minimal exertion, it may be beneficial to evaluate your lung function further, especially if you have a history of respiratory issues.

Recommendations
1. Consult a Healthcare Provider: It is essential to discuss your symptoms with a healthcare provider who can perform a thorough evaluation, including a physical examination and possibly additional tests such as a stress test or echocardiogram.

2. Lifestyle Modifications: Engaging in regular physical activity, managing stress through relaxation techniques, and avoiding stimulants may help alleviate your symptoms.

3. Monitor Symptoms: Keep a diary of your symptoms, noting when they occur, their duration, and any associated activities or stressors. This information can be valuable for your healthcare provider.

4. Consider Psychological Factors: If anxiety is a significant factor, consider speaking with a mental health professional who can provide strategies for managing anxiety and its physical manifestations.

In summary, while your heart palpitations and shortness of breath can be distressing, they may be related to anxiety, physical deconditioning, or other benign factors. A comprehensive evaluation by a healthcare professional will help determine the best course of action for your specific situation.

Similar Q&A

Understanding Palpitations: Symptoms and Cardiovascular Concerns

Hello Doctor: I have recently been experiencing dizziness, palpitations, and shortness of breath. These symptoms usually occur when I suddenly change positions, causing my heart rate to increase by 20-30 beats per minute. I also experience dizziness, and sometimes I feel that I h...

Dr. He Dongjin reply Cardiology
Hello, Xiaoxian: I apologize for the late response due to the National Day holiday. Based on your description, if you typically have low blood pressure along with chest tightness, palpitations, or shortness of breath, it would be advisable to consider the possibility of mitral va...

Understanding Shortness of Breath and Heart Palpitations: Causes and Concerns

I have been feeling short of breath this week, experiencing a sensation of not being able to take a full breath, which leads me to frequently take deep breaths. Sometimes, this is accompanied by mild palpitations. Is this a symptom of a medical condition? Additionally, I sometime...

Dr. Huang Guosheng reply Cardiology
Hello Ms. Wang: If your breathing difficulties are not constant, they may be caused by anxiety or stress. Additionally, anxiety and stress can also lead to an increased heart rate; managing stress appropriately should help. For some individuals, coffee can cause an increased hear...

Understanding Heart Palpitations and Breathing Issues in Seniors

Hello Doctor: I would like to ask about my grandfather's heart issues. He often experiences palpitations and shortness of breath when breathing. What could this possibly indicate?

Dr. Huang Guosheng reply Cardiology
There are many causes of shortness of breath, such as heart failure, chronic obstructive pulmonary disease (COPD), pleural effusion, pericardial effusion, and anemia. It is recommended to visit an outpatient clinic for further evaluation.

Understanding Unusual Heart Symptoms: Dizziness, Palpitations, and Weakness

Dizziness, palpitations, continuous shortness of breath, generalized weakness and numbness, and occasional chest pain.

Dr. Ke Zhengchang reply Internal Medicine
Hello, Mini: It is common for young women to experience symptoms such as palpitations and shortness of breath. Common causes include anxiety, arrhythmias, and asthma. It is advisable to follow up with a cardiology clinic for further evaluation.