Abnormal Heart Palpitations: Causes and When to Seek Help - Internal Medicine

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Abnormal pulsation in the epigastric region?


I noticed abnormal pulsations in my epigastric area upon waking up on June 30th.
There were strong pulsations for about 5 seconds followed by lighter pulsations for another 5 seconds.
After that, I frequently experienced brief mild pulsations lasting 3 to 10 seconds.
During these pulsations, I do not feel any discomfort, and my pulse is normal.
There is a noticeable wave-like motion on the left side of my epigastric area, and when touched, there is a distinct abnormal pulsation; however, I can measure a normal heartbeat when I press harder.

1.
What could this be a precursor to in terms of disease? Which specialty should I consult for diagnosis and treatment?
2.
I swim 1000 meters daily and currently feel no discomfort.
Should I stop or reduce my swimming activity?

Charlie, 40~49 year old female. Ask Date: 2001/07/02

Dr. Ke Zhengchang reply Internal Medicine


Reply to Mr.
Charlie: It is common for the general population to experience occasional arrhythmias, and there is no need to reduce regular physical activity.
It is recommended to visit a cardiology clinic for an electrocardiogram follow-up examination.

Reply Date: 2001/07/02

More Info


Abnormal heart palpitations can be concerning, especially when they manifest as unusual sensations in the chest. Based on your description, it seems you are experiencing episodes of strong and mild heartbeats, which can be classified as palpitations. These sensations can be caused by various factors, and understanding their potential causes is crucial for determining whether further medical evaluation is necessary.

1. Potential Causes of Palpitations:
- Physiological Factors: Palpitations can occur due to normal physiological responses, such as anxiety, stress, or vigorous physical activity. Caffeine, nicotine, and certain medications can also contribute to increased heart rate or palpitations.

- Cardiac Conditions: While many palpitations are benign, they can sometimes indicate underlying heart conditions, such as arrhythmias (irregular heartbeats), atrial fibrillation, or even structural heart issues. Given that you have noted a distinct wave-like motion in your chest, it may be worthwhile to consider whether this could be related to an arrhythmia.

- Electrolyte Imbalances: Low levels of potassium, magnesium, or calcium can lead to palpitations. Dehydration or excessive sweating, especially during swimming, can also affect electrolyte levels.

- Hyperthyroidism: An overactive thyroid can increase heart rate and lead to palpitations.

- Gastroesophageal Reflux Disease (GERD): Sometimes, gastrointestinal issues can mimic heart palpitations, as the esophagus is located near the heart.

2. When to Seek Help:
- If the palpitations are accompanied by symptoms such as chest pain, shortness of breath, dizziness, or fainting, it is essential to seek immediate medical attention.
- Given that you have experienced these sensations frequently since June 30, it would be prudent to consult a healthcare provider, preferably a cardiologist, to evaluate your symptoms further. They may recommend an electrocardiogram (ECG) or a Holter monitor to assess your heart's rhythm over a more extended period.

3. Exercise Considerations:
- Swimming is generally a low-impact exercise that is beneficial for cardiovascular health. If you are not experiencing any discomfort or significant symptoms during or after swimming, it may be safe to continue. However, if you notice that swimming exacerbates your palpitations or if you feel unwell, it would be wise to reduce the intensity or duration of your workouts and discuss this with your doctor.

- It is essential to listen to your body. If you feel any unusual symptoms during exercise, such as increased heart rate, dizziness, or chest discomfort, it is advisable to stop and seek medical advice.

In summary, while occasional palpitations can be benign, persistent or concerning symptoms warrant a thorough evaluation by a healthcare professional. A cardiologist can help determine the underlying cause of your palpitations and recommend appropriate management strategies. In the meantime, maintaining a healthy lifestyle, managing stress, and staying hydrated can be beneficial.

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