What could be the cause of infrequent heart flutters and skipped beats?

Hi doctor,

In the last two weeks, I have been to the ER and urgent care for this issue, and it does not seem to be resolving on its own. Earlier, I was on a long run (7 miles) when I had a series of consistent heart flutters that lasted about five to ten seconds. I stopped running and made an appointment with a cardiologist. It is important to note that I have experienced infrequent heart flutters and skipped beats, but I have never experienced palpitations like this previously. About two weeks ago, I started a new low-stress job that I was very excited about. During the shadowing process, I ended up having (what was diagnosed as) a severe panic attack with heart fluttering, shaking, chest tightness, and occasional (mild) chest pains. I ended up in an ambulance and at the ER. Here is a list of tests that they ran: complete blood count with automated differential, comprehensive metabolic panel, magnesium, potassium, TSH, troponin, high sensitivity. Here is what the doctor’s report said: “You came to the ER with fluttering in your chest and chest tightness. We performed a comprehensive workup today, which revealed no findings to explain your symptoms. As discussed, it is important that you call the office or the listed provider as soon as possible regarding your visit to ensure that you receive prompt outpatient evaluation and treatment of your complaint. Follow up with your cardiologist as planned. Also, as discussed, return to the ER immediately if you develop any new concerning or worsening signs or symptoms. Specifically, chest pain, difficulty breathing, vomiting, loss of consciousness, persistent lightheartedness, or other concerning symptoms.” Upon returning home, I had several more panic episodes. I ended up seeing a GP. Here is a list of tests they performed: EKG, CBC, basic metabolic panel, hepatic function panel, troponin, covid, and a flu test. The doctor said all my tests came back normal. My diagnosis was episodic paroxysmal anxiety. It is important to note that this doctor told me I could continue exercising without worry. It is also worth mentioning that I did not feel I was having an episode at the time of the visit. After this, I continued to have episodes, including one on a train that was incredibly severe. Sweating through my shirt, heart fluttering or beat skipping, and weakness in my limbs and neck. After this episode, things seemed to get better the next day. I went back to my job and made it through the day (I had several attacks throughout the day, but I just dealt with them) without issue. The next day (yesterday) started well, as I went on a long walk and had no serious heart or panic events of any kind. Then about 1 pm, I had the sensation that, despite breathing properly, I could not get enough oxygen. I stayed calm through this, but I did feel my breathing patterns change once I became aware of it. I also felt weakness in my limbs. I checked my oxygen saturation, and it read 98 to 99%, and my pulse was slightly elevated, about 60 bpm. Blood pressure was normal, too, maybe slightly elevated (I think 128/74). This continued into the evening, but I eventually ended up falling asleep (and feeling like I slept well that evening). This morning I decided to take the doctor’s advice and resume my normal exercise. I started running from my house at a slow pace and got maybe a quarter of a mile before my heart started palpitating again- fluttering and skipping beats. When I stopped, it worsened. It seemed like every other beat was a flutter or a skipped beat for about 30 seconds. When I tried to sit on the curb, it worsened again, so I just stood there and tried to catch my breath. It is worth mentioning that my heart did not feel normal. It was pounding, and it felt like the beating between the two chambers was more separate than normal. I did not experience the pain of any kind or lightheadedness. I stood there for a bit until it stopped, then I walked home. That brings us to right now. I am worried, and my parents want to take me to the ER again. I am hoping you have some sound advice for me.

Hi doctor,

Thank you for your reply. I should have mentioned previously that I do not drink, smoke, or do any drugs. I have done in the past, but I gave up drinking or smoking over four months ago before all of these problems started, and I was not an addict by any means. I gave up smoking marijuana 13 days ago after many years of chronic weed smoking. My mom seems to think that this is causing extreme anxiety, but I am inclined to disagree with her. These episodes are coming out of nowhere and do not appear to be brought on by anything emotional to me. While I do not have a history of early family heart disease, my grandfather on my dad’s side had a heart attack at 55, but doctors believed it was brought on by his severe alcoholism. He also had high blood pressure later in his life, and I am not sure when that started for him. After he quit drinking, he no longer had heart attacks. He died of a stroke over 30 years later. My grandfather on my mother’s side (87 years old) had a heart attack at 84 but refused medical care. When my parents finally brought him in, he was diagnosed with A-fib. He takes Eliquis daily. Currently, he has late-stage vascular dementia. Both doctors told me that my EKG did not indicate an A-fib rhythm, but I was not having an episode when I went to visit either doctor. My quality of life has been severely affected by this. I lost the new job that I started when all of this happened. I am having a hard time leaving my house in fear of an impending attack. I feel depressed on account of not being able to do the things I love. It has been like this for two weeks.