What could cause irregular heart rhythms?

Question

Hi doctor,

I am a 54-year-old male. I do not smoke or drink, and I exercise regularly. For the last seven years, I have been experiencing sudden sleep disturbances accompanied by symptoms such as breathlessness, palpitations, and chest congestion. I underwent several tests, including an ECG, chest X-ray, echocardiography, exercise stress test, pulmonary function test, MRI scan of the brain, and a sleep apnea test. All of these tests were normal. Ultimately, I was diagnosed with acid reflux symptoms and, on my doctor's advice, took proton pump inhibitors for about four months (Pantoprazole 40 mg, Esomeprazole 40 mg, and Metoclopramide). I have discontinued the medication, and with lifestyle changes (such as having lighter dinners and doing breathing exercises), I have been able to control the symptoms effectively. However, I occasionally experience irregular heart rhythms, and on a medical specialist's advice, I took Propranolol 40 mg for two months. After seeing satisfactory results, the specialist advised me to discontinue the medication.

Now, the present episodes described below have compelled me to seek further opinion and advice. Occasionally, I feel dizziness, mild breathing difficulty, blurriness in my vision, and chest congestion. These symptoms are particularly evident when I bend my head while exercising, although this does not happen all the time. Last week, while doing a breathing exercise in a sitting position, I suddenly changed my posture to stand up and almost fainted, although I recovered immediately. Afterward, I felt weakness in my legs and arms, along with cold sensations and breathlessness. I play badminton for one to two hours daily without any problems. My vitamin B12 and hemoglobin levels are satisfactory, and my blood pressure has been normal, ranging from 85 to 130 mmHg, for the last five years without medication. There is no history of diabetes or high cholesterol.

Please advise.

Answer 1

Hi,

Welcome to icliniq.com.

I have reviewed your details, and I have the following insights: First of all, you have undergone many tests that may not have been necessary in your case; however since all the results are normal, that is reassuring. Your symptoms may be related to a few issues as I understand them. The first one is, of course, GERD (gastroesophageal reflux disease), for which you have received treatment.

However, there was a concern with your treatment: Metoclopramide is a medication that is not commonly used these days due to its side effects, known as extrapyramidal symptoms. This can cause dizziness and imbalance in some individuals, so your current symptoms might be an aftereffect of that medication. You should continue taking PPIs (proton pump inhibitors) because once you have GERD, it is unlikely to resolve completely, and the medication should be maintained for a long duration.

You mentioned experiencing irregular heartbeats, which is a serious and complex issue if this is indeed observed. While you may be "feeling" this, if it can be detected in our tests, it should be treated immediately.

To detect this, a standard ECG (electrocardiogram) may not reveal irregularities if they are subclinical or occasional, as in your case. We need to monitor the ECG patterns continuously over one full day to identify any issues. Therefore, I recommend a Holter study to check for any dysrhythmias, and once treated, your symptoms should resolve.

You also mentioned feeling dizzy and faint when you stand up, followed by recovery. This is a typical symptom of orthostatic hypotension, which means your blood pressure drops as soon as you stand, and your heart compensates for it within seconds. This is a common issue, and we need to identify the underlying cause. It could be age-related, organ-related, or possibly due to a blockage in the carotid arteries, among other factors.

It is difficult to pinpoint the exact cause until we conduct a thorough examination and perform tests based on our findings. I would suggest that you print out these points and consult a cardiologist in your area, asking them to consider all of these factors. This approach will likely lead you to a correct diagnosis and effective treatment. None of these problems are particularly difficult to treat.

I hope you find this information helpful.

Thank you.