Q. I felt a fluttering in my chest and was short of breath. What can be the cause?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by iCliniq medical review team.
Published on Mar 17, 2017

Hi doctor,

I am a 24 year old male weighing 221 lbs. I felt a fluttering in my chest yesterday for the first time, which only lasted for five seconds and I felt short of breath. I got an ECG, x-ray, CBC and HbA1c done today. I am worried about my ECG being abnormal. I am scared that there could be something wrong and I have no other symptoms besides shortness of breath.

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hello,

Welcome to icliniq.com.

Do not worry because the probability of any serious illness at this age is low.

However, these are probably an arrhythmia like atrial fibrillation or PVC (premature ventricular contraction), which are not a serious condition. These can cause all your symptoms and can be managed with medicine.

  • Do you smoke or drink? If yes, then you need to stop.
  • Please upload your ECG so that we can analyze it better and get a better opinion.

Revert with the reports to a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

Hi doctor,

Thank you for replying. I gave up drinking two months back, but even before I only used to drink occasionally. And, I do not smoke at all. I am also attaching my ECG reports.

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hi,

Welcome back to icliniq.com.

There is nothing serious in your ECG report (attachment removed to protect patient identity). Machine generated ECG reports are not correct all the times, so grossly reports are normal. Are you an athlete or a weight lifter?

The first possibility is cardiac arrhythmias, where the heart rate suddenly rises and then decreases, which leads to flutter, shortness of breath, etc.

In arrhythmias, the possibility is of atrial fibrillation or PSVT (paroxysmal supraventricular tachycardia). Both are a benign condition and respond well to drugs and are permanently cured with radiofrequency ablation.

The reason I am suspecting for your symptoms and short PR interval on ECG is conduction of impulses is fast through your heart, which can sometimes lead to arrhythmias and rapid heart rate. If you did not have any symptoms, it would have been a normal finding.

So the next step will be, we need to rule out this possibility. I would suggest you get the following tests done.

  1. 24 hour Holter monitoring, so that we can record these episodes of flutters on ECG and confirm our findings.
  2. Echocardiogram, to look for overall heart function.

Visit a nearby cardiologist for these investigations, and after his or her consent start taking tablet Ciplar LA (Propranolol) 20 mg once a day, which will control your flutter.

If the above investigation is not successful in picking up anything, then we might need electrophysiological studies which can diagnose and treat the arrhythmia permanently in most of the cases.

So, no need to worry, as these are not life threatening and usually only cause symptoms.

Revert with more information to a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

Hello doctor,

I do not do any heavy lifting, and I am not an athlete. I have recently changed my lifestyle, and that is when I started noticing these symptoms. I have an appointment to see a cardiologist, and I am very scared at the moment. I have only had the fluttering happen to me once or twice. It is weird because I do not have these episodes while I am working out. But, it happens when I am standing or just not doing something. I was also prescribed anxiety medication, which helps a little bit with the shortness of breath. I am going to attach my result that I had about a month ago. Could you tell me if any of these cause something to go wrong with my heart? I was exposed to hepatitis A, which is the reason for high levels in my liver in the results, and my glucose was high because I ate that morning. I also did a HbA1c today, but have not gotten the results yet.

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hi,

Welcome back to icliniq.com.

Your reports (attachment removed to protect patient identity) are fine. Mild elevation in sugar and liver enzymes are acceptable, so nothing to worry much.

  • If you are having underlying anxiety, then it can certainly cause fluttering in your heart. I am not suspecting any serious illness in you and also the possibility of arrhythmias is there, but considering you also have anxiety the possibility goes down.
  • Your age is also not compatible with serious cardiac illness. Still, I would advise you to get the above mention tests done, just to be sure.
  • You continue your anti-anxiety medicine and Ciplar (Propranolol) LA, which is also an anti-anxiety medication. It will control anxiety, palpitations, and flutter.

For further queries consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

Hi doctor,

Thank you for replying. I wanted to know if it could be a coronary artery disease or any kind of heart disease? I do not know if it is related. I am having shortness of breath and my blood pressure is 123/87 mmHg. I lost about 8 to 9 lbs in the last month. I get scared because after I changed my lifestyle all these things keep popping up. I am doing all the right things to get healthy again. It just frustrates me and makes my anxiety worse.

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hi,

Welcome back to icliniq.com.

It is highly unlikely to be a coronary artery disease. Neither your symptoms nor your age is compatible with this.

Blood pressure is fine, as any anxiety or stress can elevate it slightly.

  • You mentioned about hepatitis A, so weight loss, weakness, fatigue, etc., are common during and after viral phase. It is a vicious cycle.
  • Shortness of breath associated with tingling is very much suggestive of anxiety. It occurs due to hyperventilation leading to decreased ionized calcium levels causing tingling.
  • So, just try to ignore your symptoms and engage yourself in some other activities like yoga, meditation, and deep breathing exercises.
  • Also, for anxiety, I would suggest you a combination of Nexito (Escitalopram) and Ciplar, for a few days then we can gradually taper them. Consult your doctor, discuss with him or her and take medicine with consent.

For more information consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

Hi doctor,

Thank you for the reply. I have lost the 8 to 9 lbs by working out daily and eating healthier. The hepatitis A, according to my doctor, no information regarding the exposure. And, I do not have it anymore. Hepatitis A was the reason for the high levels in my liver, and it would just pass on its own. It was years ago. I was not diagnosed with anxiety, but giving all the symptoms, it could, in fact, be it. I was given a low dose of Lorazepam, which helps with the shortness of breath and it calms me down. Do you think that if it were not anxiety, then Lorazepam would not have worked at all?

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hello,

Welcome back to icliniq.com.

First, regarding your liver enzymes, I feel it is because of fatty liver. As you tend to accumulate fat in the body, similarly it accumulates in the liver and tends to raise enzymes a bit. Weight loss is a treatment of choice, and a liver ultrasound can be done to confirm it.

  • So, losing weight is a good sign and should be continued. You can test your enzymes again, and you will mostly find them elevated as that of previous. Hepatitis A is less likely as you mentioned, so I thought you must have been tested for hepatitis A.
  • Anxiety is diagnosed by symptoms only and no tests available. Your symptoms are compatible. Also, you responded to Lorazepam, which is again a supportive evidence. Otherwise, Lorazepam will not cure your heart problem and shortness of breath.
  • Lorazepam is also a good drug for anxiety you can continue it if you are responding. If you feel it is giving an inadequate response, then you can just add Propranolol to it after consulting your doctor.

For further information consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

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