Coronary artery disease and heart rhythm abnormalities

Dear Ask The Doctor: Sometimes when I strain myself either physically or mentally I get irregular  painful heartbeats lasting up to an hour. What could that be?

Dear Heinz: In someone of your age, with a history of heart arrthymias, on dofetilide (Tikosyn), this warrants further investigation. Your symptoms could be related to occasional heart rhythm abnormalities, for example, paroxysmal atrial fibrillation. In addition to this, chest pain on exertion or chest pain associated with an irregular heart beat, may indicate underlying coronary artery disease. I would advise attending your family doctor or cardiologist urgently for an ECG and 24 hour Holter monitor, exercise stress test or coronary angiography as appropriate to elicit the underlying diagnosis.