Unexplained Palpitations: Causes and Solutions

Palpitations of unknown origin?

Hello doctor, about a month ago, one night I suddenly felt my heart racing and couldn't sleep (I had been smoking and it was almost 4 AM).
I went to the emergency room where the doctor gave me a sedative so I could go home and sleep.
The next day I felt fine and went about my usual routine—eating, smoking, showering, and taking a bath.
However, after my bath, I suddenly experienced palpitations for the first time, feeling like my heart went from normal to racing very quickly.
I rushed to the emergency room again, experiencing shortness of breath but no chest pain.
When I arrived, my heart was still racing.
The doctor checked my ECG, which was normal but showed a fast heart rate.
Blood tests were normal, with no signs of hyperthyroidism or myocardial injury.
A chest CT scan with contrast was also normal.
After returning home, I was too scared to smoke again and even lost the craving for it.
I started experiencing many symptoms: dizziness, strange visual disturbances, and constant anxiety.
The palpitations occurred mainly after meals, and my left hand would often feel numb.
I had an echocardiogram done by a cardiologist, which was normal, and a stress test also showed no signs of myocardial ischemia.
A pulmonologist reviewed my previous CT scan and said my lungs looked clear, with normal lung capacity and no chronic obstructive pulmonary disease.
A neurologist performed a neck ultrasound, which was normal with no plaques or stenosis.
I had blood tests done at a clinic, which showed no signs of metabolic syndrome, and my fasting blood sugar was normal, though my glomerular filtration rate was 82.
Despite all these tests coming back normal, I still feel something is off.
I have trouble sleeping, dream frequently, and my weight has been steadily decreasing, which is really affecting my life.
Before this incident, I used to stay up late, sleep until noon, eat, smoke, and spend the day on the computer, consuming about a pack of cigarettes daily for the past seven years.
Since the incident, my lifestyle has changed.
Now, I can feel my heartbeat every time I go to sleep; it speeds up when I turn over.
I know it's normal, but being aware of it is quite bothersome.
I feel tired and unfocused every day, and my left chest feels strange.
Sometimes, if I eat too much, taking a deep breath can make my heart feel pressured and skip a beat.
I have a hunchback and always thought it was due to my ribs or sternum pressing inward, but the pulmonologist said that wouldn't cause it.
My blood pressure before getting up and before sleeping is always within 120/80.
Doctor, what do you think is wrong with me? If this continues, I really fear I might become depressed, as sometimes just eating makes my left hand numb, and occasionally I even feel pain in my chest.
My daily life is filled with the fear of a heart attack and a stroke.

Xiao Bin, 20~29 year old female. Ask Date: 2015/01/25

Dr. He Dongjin reply Cardiology

Hello, please stop scaring yourself.
You are experiencing anxiety, not a heart disease.
You have undergone all necessary heart examinations, and everything is fine.
The symptoms you are experiencing are due to panic attacks.
You should visit a mental health specialist and consider medication to help manage your anxiety.
Don't be nervous; Changhua Hospital cares about you.

Reply Date: 2015/01/25

More Info

Understanding unexplained palpitations can be a complex issue, especially when accompanied by anxiety and other physical symptoms. Based on your description, it seems that you have undergone a thorough medical evaluation, including tests such as ECG, echocardiograms, and blood tests, all of which have returned normal results. This is a positive sign, but it does not alleviate your distress or the symptoms you are experiencing.

Palpitations, or the sensation of feeling your heart beating rapidly or irregularly, can be triggered by various factors. In your case, the onset of palpitations coincided with smoking and late-night activities, which can contribute to increased heart rate and anxiety. Caffeine, nicotine, stress, and lack of sleep are common culprits that can exacerbate palpitations. Additionally, the body's response to stress can lead to heightened awareness of bodily sensations, making you more sensitive to your heart rate.

The symptoms you describe—dizziness, visual disturbances, and feelings of pressure in the chest—can be associated with anxiety and panic attacks. It is not uncommon for individuals experiencing anxiety to have physical symptoms that mimic cardiac issues. The fear of having a heart attack or other serious conditions can create a cycle of anxiety that perpetuates the feeling of palpitations. This is often referred to as "health anxiety" or "hypochondria," where the individual becomes overly concerned about their health despite medical reassurance.

Given that your medical evaluations have ruled out significant cardiac or pulmonary issues, it may be beneficial to explore the psychological aspects of your symptoms. Cognitive-behavioral therapy (CBT) is a well-established treatment for anxiety and panic disorders. It can help you identify and challenge negative thought patterns that contribute to your anxiety and teach you coping strategies to manage your symptoms. Mindfulness and relaxation techniques, such as deep breathing exercises, can also be effective in reducing anxiety and the perception of palpitations.

Additionally, lifestyle modifications can play a crucial role in managing your symptoms. Since you mentioned that smoking has been a part of your routine, quitting smoking can significantly improve your overall health and reduce anxiety levels. Regular physical activity, a balanced diet, and adequate sleep are essential for maintaining both physical and mental well-being. Engaging in activities that you enjoy and that promote relaxation can also help alleviate stress.

It's important to communicate openly with your healthcare providers about your ongoing symptoms and concerns. If you feel that your current treatment plan is not addressing your needs, consider seeking a second opinion or consulting with a mental health professional who specializes in anxiety disorders. They can provide you with tailored support and strategies to help you cope with your symptoms.

In summary, while your medical evaluations have not indicated any serious underlying conditions, the psychological impact of your symptoms should not be overlooked. Addressing both the physical and emotional aspects of your experience is crucial for achieving relief and improving your quality of life. Remember, you are not alone in this journey, and seeking help is a positive step toward recovery.

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