Arrhythmias: Symptoms, Causes, and Treatment Options

Arrhythmia

Hello, doctor.
Thank you for providing online consultation services.
It has been almost seven years since I first noticed my arrhythmia, and it seems to be getting worse.
In recent years, it appears to occur daily, with variations in duration and severity.
The arrhythmia symptoms I can feel include at least the following types, which sometimes occur in quick succession: 1.
Irregular heartbeats that fluctuate between fast and slow, strong and weak, or a sudden absence of a heartbeat in one area, only to feel it in a nearby area (often accompanied by shortness of breath).
2.
A pause followed by a strong heartbeat (premature ventricular contractions).
3.
A sensation of the heart trembling.
Two days ago, I sought medical attention after feeling unwell for several consecutive days.
The doctor diagnosed me with more severe premature ventricular contractions (five instances of PVCs in a 10-second ECG, but not occurring consecutively) and prescribed meletin, with a follow-up appointment in a week.
Additionally, last March, I experienced significant discomfort and, upon examination at the hospital, an echocardiogram revealed mild mitral valve prolapse, but a 24-hour Holter monitor showed 1/5 of arrhythmia.
At that time, I was prescribed propranolol for a month.
I apologize for the lengthy description, but I wanted to provide a complete account of my symptoms for your reference.
Thank you for your patience in reading this.
I would like to ask: 1.
Since the uncomfortable symptoms are not always persistent, how should I be treated if various arrhythmia symptoms do not manifest during a doctor's visit or examination? I am very concerned about the possibility of suddenly experiencing dangerous symptoms.
2.
Are the arrhythmia symptoms I mentioned related to mitral valve prolapse? If they are not closely related, what could be causing these symptoms? What should I do next? After taking meletin for two or three days, I cannot be sure if my condition has improved, which is quite frustrating...

Chen, 20~29 year old female. Ask Date: 2015/06/20

Dr. He Dongjin reply Cardiology

Hello, actually everyone experiences arrhythmias, such as premature contractions; it just varies in severity.
What should be considered is whether it is life-threatening.
If there is no risk to life, then it is just about symptom management, and if it becomes uncomfortable, medication can be taken as needed.
However, if the symptoms have been occurring more frequently lately, it is advisable to take medication regularly for a period of time.
This condition, like mitral valve prolapse, is related to the stability of the autonomic nervous system.
Factors such as anxiety, poor sleep, high stress, anger, and changes in climate can exacerbate symptoms.
It won't disappear; even with medication, it only reduces the frequency of occurrences.
So, try to relax and coexist peacefully.
Changhua Hospital cares about you.

Reply Date: 2015/06/20

More Info

Understanding arrhythmias can be quite complex, especially when symptoms vary in intensity and frequency over time. Based on the information you've provided, it appears that you have been experiencing a range of symptoms associated with arrhythmias, including palpitations, irregular heartbeats, and sensations of your heart "skipping" beats. These symptoms can be distressing and may lead to anxiety about your heart health.

1. Symptoms and Diagnosis
Arrhythmias can manifest in various ways, and the symptoms you describe—such as your heart racing or feeling like it is "skipping" beats—are common. The fact that you have experienced these symptoms for several years, with a perceived increase in severity, is important to note. Your description of feeling your heart "not beating" in certain areas and then resuming can be indicative of premature ventricular contractions (PVCs), which you mentioned were diagnosed during your recent evaluation.

The diagnosis of arrhythmias often relies on the use of Holter monitors, echocardiograms, and electrocardiograms (ECGs). These tests help capture the heart's electrical activity over time and can identify irregularities that may not be present during a standard office visit. If your symptoms are intermittent and do not occur during testing, it can be challenging for healthcare providers to pinpoint the exact nature of your arrhythmia.

2. Treatment Options
In terms of treatment, the approach can vary based on the type and severity of the arrhythmia. Since you have been prescribed Meletin (a brand name for a medication that may help manage arrhythmias), it suggests that your healthcare provider is taking your symptoms seriously. However, if you do not notice improvement after a few days, it is essential to communicate this with your doctor. They may consider adjusting your medication or exploring other treatment options.

For many patients, lifestyle modifications can also play a significant role in managing arrhythmias. Regular exercise, a balanced diet, and stress management techniques can help reduce the frequency and severity of symptoms. Additionally, avoiding stimulants such as caffeine and nicotine may also be beneficial.

3. Connection to Mitral Valve Prolapse
Regarding your question about the relationship between your symptoms and mitral valve prolapse (MVP), there is indeed a connection. MVP can sometimes lead to palpitations and arrhythmias, particularly in younger individuals. The structural changes in the heart associated with MVP can affect the heart's electrical conduction system, potentially leading to the symptoms you are experiencing. However, not all individuals with MVP will experience arrhythmias, and many lead normal, healthy lives without significant issues.

4. Next Steps
Given your ongoing concerns, it may be beneficial to seek a second opinion from a cardiologist who specializes in arrhythmias. They may recommend further testing, such as an electrophysiology study, which can provide more detailed information about the electrical pathways in your heart and help determine the best course of action.

In summary, while your symptoms are understandably concerning, many arrhythmias are benign and manageable. It is crucial to maintain open communication with your healthcare provider, adhere to prescribed treatments, and consider lifestyle changes that may alleviate your symptoms. If you ever feel that your symptoms are worsening or if you experience new symptoms, such as chest pain or shortness of breath, seek medical attention promptly. Your health and peace of mind are paramount, and addressing these concerns with a specialist can help you find the reassurance and treatment you need.

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