How to identify the reason for palpitations?

Question

Hi doctor,

I am suffering from heart palpitations. Also, I have occasional breathlessness. For a while, I used Propranolol. But, it did not work. So, the doctor asked me to do a thyroid test, and the result was normal. I do not know what to do. Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Palpitations can be of two types. Sinus arrhythmia (only fast heart rate, but rhythm is normal), and this is not to be worried. Arrhythmias - There are many types of arrhythmias; some are atrial in origin, and some are ventricular in origin. If your thyroid profile is normal and you are not relieved by Propranolol, then it can be abnormal rhythms. I would suggest you go for a test called Holter. It will keep a record of your heartbeat for 24 hours. We can easily see the nature of defective beats and their origin, either atrial or ventricular. I would like to see your ECG (electrocardiogram) before suggesting any medication.

I hope this helps.

Please revert so I can assist you further.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

All three ECG or electrocardiogram photos you sent to me are perfectly normal (attachment removed to protect patient identity). Sinus arrhythmia, which is very common in young males, is also not present, and your ECG or electrocardiogram is in perfect sinus rhythm, which is absolutely normal. Throughout your history, most likely, it can be episodes of sinus tachycardia where the heart rate increases for a few seconds or minutes and again settles down to normal.

I do not know about your smoking habits. It contains nicotine, which increases heart rate. So, if you are a smoker, please stop smoking. Also, do not take alcohol. I will suggest the following medicines for 21 days. Consult your specialist doctor, discuss with him or her, and take the medicine with consent. Take the tablet Propranolol 10 mg twice daily at 9 a.m. and 9 p.m., and take the tablet Clonazepam 0.5 mg once daily at 9 p.m. Be on the safe side.

I would suggest you go for a complete blood profile, as less hemoglobin (anemia) is the most common and the most overlooked cause of palpitation in youngsters. Holter test will be done using a small machine, which is going to keep a record of your heartbeat for 24 hours. If an episode of palpitation repeats itself in 24 hours, it is going to record the nature of the beats at the time of palpitation. You should have also attached your thyroid tests with the ECG, as we have to consider everything when dealing with palpitations. A thing that might appear normal to a physician may appear slightly abnormal to a cardiologist. As of now, there is nothing to worry about. Also, take a proper sleep.

I hope this helps.

Please revert so I can assist you further.

Thank you.

Answer 3

Hi,

Welcome back to icliniq.com.

Your ECG or electrocardiogram is normal. The ECG records the heartbeat of your heart for 30 seconds. Your main complaint is palpitations. If palpitations are not present during those 30 seconds, an ECG will record nothing and will be normal. Your thyroid profile is normal, and you are a non-smoker and non-alcoholic.

I have to take a detailed history of yours before putting you on any medicines, as in your case, all common causes of palpitations have been ruled out. Brittle hairs can indicate anemia, but we can undergo a very easy test to complete a blood profile, which will tell the percentage of hemoglobin in your blood. As Propranolol and Clonazepam make you dizzy, I would lower the dose.

Please answer the following.

Do you feel lassitude, lethargy, and lack of energy level in your body?
Do you ever feel a hissing or roaring sound in your ear?
How long does dizziness last?
Does palpitation occur at night or in the day?
How long does every episode of palpitation last?
What are the relieving factors of palpitation?
How much time does it take to settle down?
How frequently does palpitation occur, daily or weekly?
What work do you do?
Do you sleep properly?
Do you have anyone in the family with the same problem?
Do you have social anxiety? Tell me your anxiety levels.

As your thyroid profile and ECG are normal, a detailed answer to all these questions is very important before I can prescribe your tests and start with medicines. Do not panic. Write the answers pointwise. Till that time, stop all medicines.

I hope this helps.

Please revert so I can assist you further.

Thank you.