Palpitations: When to Seek Medical Advice

Irregular heartbeat? Palpitations?

Hello, doctor.
Recently, I've been hesitant about whether I need to see a doctor again due to my palpitations.
Last year, I had an electrocardiogram and blood tests, and all the results were normal.
So, after reading some articles online, I started to wonder if palpitations are not actually a disease, which is why I'm hesitant.
Previously, they occurred every once in a while (about once every month or two), but recently, they have been happening almost daily for about three weeks, with varying durations, although they typically resolve within about 10 minutes.
They tend to occur when I wake up or before going to bed.
Interestingly, when the palpitations happen, I check my pulse, and sometimes it will stop for a beat while still maintaining a regular rhythm.

I've seen some articles online suggesting that I could wear a 24-hour or long-term monitor.
Are those covered by health insurance? My diet is quite normal; I only drink one cup of coffee a day and don't usually eat out.
Drinking coffee has been a long-standing habit, but recently, I stopped for a while, thinking it might be causing the palpitations, yet they still occur.
Before deciding to see a doctor, is there anything simple I can do to test myself to determine whether I should go to the hospital for an examination without wasting medical resources?

Nai, 30~39 year old female. Ask Date: 2011/02/11

Dr. He Dongjin reply Cardiology

Based on your description, it seems more like paroxysmal benign arrhythmia, such as premature ventricular contractions.
If this is causing you distress, you may consider visiting a cardiologist for a 24-hour Holter monitor evaluation.
Thank you, He Dongjin.

Reply Date: 2011/02/11

More Info

Palpitations, or the sensation of feeling your heart beating, can be a concerning symptom for many individuals. It is essential to understand when to seek medical advice regarding this issue, especially since you have experienced a notable change in the frequency and duration of your palpitations.

Firstly, it is important to recognize that palpitations can be caused by a variety of factors, including anxiety, caffeine consumption, hormonal changes, and underlying medical conditions such as arrhythmias or heart disease. Given that you have a history of palpitations and have previously undergone tests like an electrocardiogram (ECG) and blood tests with normal results, it is understandable that you might feel uncertain about the necessity of further medical evaluation.

However, the recent change in your symptoms—specifically, the increased frequency of palpitations occurring daily for the past three weeks, along with the sensation of your pulse stopping momentarily—warrants further investigation. While palpitations are not always indicative of a serious condition, persistent or worsening symptoms should not be ignored. Here are some guidelines to help you decide whether to seek medical attention:
1. Duration and Frequency: If your palpitations have become more frequent and last longer than before, this is a significant change. You mentioned that they now occur almost daily and can last up to 10 minutes. This change in pattern is worth discussing with a healthcare provider.

2. Associated Symptoms: Pay attention to any accompanying symptoms. If you experience dizziness, shortness of breath, chest pain, or fainting spells along with your palpitations, you should seek immediate medical attention. These symptoms could indicate a more serious underlying condition.

3. Self-Monitoring: While waiting to see a doctor, you can monitor your heart rate and rhythm. Keeping a diary of when the palpitations occur, their duration, and any associated activities (like caffeine intake or stress levels) can provide valuable information to your healthcare provider.
4. Caffeine and Lifestyle Factors: Since you mentioned that you consume coffee daily, it is wise to consider how caffeine might affect your heart. Although you have already tried reducing your caffeine intake without improvement, it may still be beneficial to eliminate it completely for a short period to see if your symptoms change.

5. Holter Monitor: You mentioned the possibility of wearing a 24-hour Holter monitor. This device records your heart's activity continuously for a day or more and can help identify any irregularities that may not be captured during a standard ECG. In many cases, insurance may cover this test if it is deemed medically necessary by your doctor.

6. When to Seek Help: If your palpitations persist, worsen, or if you develop new symptoms, it is advisable to consult with a healthcare provider. Even if previous tests were normal, changes in your symptoms can indicate the need for re-evaluation.

In conclusion, while palpitations can be benign, the recent changes in your symptoms suggest that it would be prudent to seek medical advice. A healthcare provider can perform a thorough evaluation, potentially including a Holter monitor, to ensure that there are no underlying issues that need to be addressed. Your health and peace of mind are paramount, and it is always better to err on the side of caution when it comes to heart-related symptoms.

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