Heart Palpitations: When to Seek Further Evaluation

My heart feels strange?

Hello doctor, I have recently been experiencing a sensation in my heart that feels like it is twisting or writhing.
It's a bit like a twitching sensation, but it doesn't hurt.
Last month, due to frequent palpitations and chest tightness, I consulted a doctor and underwent an electrocardiogram (ECG) and a 24-hour Holter monitor, which showed mild arrhythmia.
The doctor said there was no need for a follow-up appointment.
Should I consider getting an echocardiogram? Or could this sensation of heart twitching be related to increased stress, as I have been under more pressure lately?

Xiao Bu, 20~29 year old female. Ask Date: 2014/01/20

Dr. He Dongjin reply Cardiology

Hello, you are correct.
Recently, due to increased stress, I have experienced autonomic nervous system dysfunction, leading to palpitations and chest tightness.
Basically, there is no major issue, and the doctor said there is no need for a follow-up visit.
A cardiac ultrasound may not be necessary.
Finding an emotional outlet and relaxing oneself is the key to resolving this.
Changhua Hospital cares about you.

Reply Date: 2014/01/20

More Info

Heart palpitations can be a concerning symptom, and understanding when to seek further evaluation is crucial for your health. Based on your description, it sounds like you are experiencing sensations in your heart that feel like twitching or movement, which can be unsettling. You mentioned that you have a history of palpitations and chest tightness, and that you have already undergone an electrocardiogram (ECG) and blood tests, which indicated mild arrhythmia. Your doctor advised against a follow-up appointment, which may suggest that they did not find any immediate cause for concern.

However, it's important to consider several factors when evaluating your symptoms further. First, the nature of your palpitations is significant. If they are infrequent, short-lived, and not associated with other symptoms such as dizziness, fainting, or chest pain, they may be benign. Stress and anxiety can indeed contribute to palpitations, as they can lead to increased adrenaline levels, which may cause your heart to beat faster or feel irregular.

On the other hand, if your palpitations are persistent, worsening, or accompanied by other symptoms, it would be prudent to seek further evaluation. An echocardiogram (heart ultrasound) can provide valuable information about the structure and function of your heart, helping to rule out any underlying conditions such as valvular heart disease or cardiomyopathy. Given that you mentioned increased stress levels, it is also worth considering whether your symptoms could be related to anxiety or panic attacks, which can manifest as palpitations and a sensation of heart fluttering.

In general, here are some guidelines on when to seek further evaluation for heart palpitations:
1. Frequency and Duration: If your palpitations occur frequently or last for an extended period, it is advisable to consult a healthcare provider.

2. Associated Symptoms: If you experience dizziness, fainting, chest pain, or shortness of breath along with palpitations, you should seek immediate medical attention.

3. Change in Pattern: If there is a noticeable change in the pattern of your palpitations, such as becoming more frequent or more intense, it is worth discussing with your doctor.

4. Family History: If you have a family history of heart disease or sudden cardiac events, it may warrant further investigation.

5. Response to Stress: If you believe that your symptoms are related to stress, it may still be beneficial to discuss this with a healthcare professional, as they can provide strategies for managing stress and anxiety, which may alleviate your symptoms.

In conclusion, while your previous tests may not have indicated a serious issue, your ongoing symptoms and the context of increased stress suggest that further evaluation could be beneficial. An echocardiogram could provide reassurance or identify any underlying issues that may need to be addressed. It is always better to err on the side of caution when it comes to heart health, so if you feel uncertain, don't hesitate to reach out to your healthcare provider for further guidance.

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