Patient: I’m a 32 year old female. No significant health issues. I do have trace mitral valve regurgitation. I have a history of PAC’s and PVC’s that only occur randomly and never last long. I have suddenly began to experience an increase in PAC’s. I have went from 4 or so a day to nonstop attacks that last up to 14 hours then resolve. I went to my cardiologist and he said this was normal. He did not want to conduct another echo because I had a normal echo last year. He did have me wear a 24 monitor but has not given me the results yet. I am not sure what is causing these episodes of PAC’s but they are very hard to ignore. Sometimes my chest feels tight. I feel lightheaded. Or I get a squeezing sensation in my chest. Other times I feel fine while it’s happening but it’s hard to have a normal day when I can feel my heart fluttering. It’s a nonstop fluttering sensation. I have counted up to 20 PAC’s a minute. Is it normal to experience such an increase in these beats? My heart rate stays normal 58 while resting 70’s other times. I do not smoke, on no medications, and no caffeine.
Symptoms: Heart palpitations
Doctor: Welcome to Ask The Doctor online healthcare platform.We are committed here for the best answer possible based on the available details.In your case scenario, there are two different issues over here. First is that your PAC’s have been documented, but your doctor is not taking them seriously. Second is that you are experiencing them, but they are never documented in ECG or Holter.If it is the first case, your PAC needs further evaluation by Electrophysiological Studies (EPS). Medicines would be started according to the arrhythmia classified. Most helpful drug in such case is Propanolol.If it is the second case, then it seems to be due Anxiety and this feeling of heart racing is called as “Palpitations”. Your doctor is not taking them seriously considering anxiety is the cause.Palpitations can be because of Anxiety,Thyroid issues, medicines, alcohol and smoking,.I would advise you to get investigated for Thyroid issues and cardiac issues.You would require to get:1. Thyroid Profile2. ECGSince your ECG and Holter have been performed, you have not mentioned that they documented PAC’s or not. If yes, go for EPS. And if not, you just need to take care of your anxiety. You should start practicing yoga and meditation.Avoid excess of caffeine, caffeinated beverages.I would advise you strongly not to consume alcohol and do smoking in case you do.In severe cases, as discussed above ,we prescribe to our patients Propanolol (after being sure that these issues are not due to any cardiac or lungs problem) which helps in controlling anxiety symptoms as well as is a helpful drug for Arrhythmia’s .Share my opinion with your doctor.Get Well Soon.
Comments / Follow Ups
Patient: I had a 24 hr Monitor completed in 2010 that showed 4 PAC’s and 6 PVC’s. I do not have the results of my most recent Monitor but should have them soon. My doctor tested my thyroid and it was normal at 2.609. An EKG completed last week showed PAC’s. My concern is the sudden dramatic increase in the PAC’s. The episodes are lasting hours at a time and I am having 8-20 a minute. When I am sitting they are the worst. When I lay down they mostly go away. I can feel them while walking but not as bad as I can when sitting. Is it normal for someone to experience such a dramatic and sudden increase? Il
Doctor: In that case, you have PAC and PVC and it is not anxiety. Dramatic changes in arrhythmia’s are very common. You can take a second opinion if your doctor is not giving consideration to these symptoms. I suppose, you should be started on Propanolol.