What causes severe heart palpitations?

Question

Hello doctor,

The symptoms I experience include heart palpitations and continuous, nonstop neck cracking, which also causes pain in my cervical spine. I randomly have episodes of heart palpitations. One time, I suddenly jumped three feet out of bed, shocked by a rapid, hard heartbeat that lasted for seven seconds. That was scary. It felt as if my heart was going to burst out of my chest, and the beat extended up to my upper chest, throat, and neck. It was not the typical heartbeat we get from exercising; it was a strange episode of palpitations.

After that incident, I did not experience anything similar for months, maybe even a year. Then, I had another episode with the same intensity, but this time it lasted for 15 minutes, coming and going, accompanied only by sweating. Since then, I occasionally experience palpitations for one to two seconds while I am either sleeping or awake. They now mostly occur when I stand up to pee, lasting only a quick second before going away.

I hae done a CT scan and ultrasound heart tests, and all doctors have told me my heart is fine. I also wore a 24-hour Holter monitor, but during the test, I surprisingly did not experience any palpitations. This is making me really worried. Can you help me understand what other tests I should consider?

When I shower, I get tired and my heart starts beating, but these beats are not palpitations. It feels like my heart is beating as if I were exercising, like playing soccer. I get this quick heartbeat when I pee, when I pray on the floor, when I walk up a simple set of stairs, and right before falling asleep. It is as if my brain prevents me from sleeping—right as I close my eyes and begin to fall asleep, my heart starts racing again. When I laugh hard, my heart beats like I have been running or playing sports. Every small activity causes my heart to beat normally, but the rate is similar to what you would expect during physical exertion.

As I mentioned, sometimes I experience quick palpitations, which feel different from fast heartbeats. It is as if my heart is racing for a brief second, trying to escape through my throat.

One of my biggest concerns is a sensation in my chest and lungs, where I feel a tingling or bubbly feeling for one to three seconds, which travels up to my throat. There is no pain, and it is not heartburn. This sensation happens often, sometimes every minute, or at other times every five to 10 minutes, lasting for just a few seconds. It feels like a small lightning bolt or a line moving slowly from my chest up to my throat and back down again. This sometimes causes a tight or scratchy feeling in my throat for a split second, then it returns to my chest.

What should I do? I am dealing with a lot of stress and anxiety. I sleep at 10 or 11 AM, waking up at 6 PM, and the cycle repeats. I think a lot and am very afraid of what will happen.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

Based on your symptoms, the possibility we need to rule out is cardiac arrhythmia, such as atrial fibrillation or paroxysmal supraventricular tachycardia (PSVT). These conditions occur intermittently, so they may not be picked up on Holter monitoring, especially since you did not experience those symptoms during the Holter test. It would be helpful if you could provide your ECG and other reports if available.

In most cases, these arrhythmias are not life-threatening, although they can cause uncomfortable sensations. First and foremost, try to calm yourself and avoid thinking negatively. If you are experiencing these symptoms daily now, I would recommend repeating the Holter test, or even opting for a 48-hour Holter monitor. In some cases, long-term monitoring such as an implantable loop recorder may be necessary if the Holter test does not capture the symptoms.

If these tests identify the issue, that is great. If not, further tests such as electrophysiological studies (which are invasive) may be considered, but they should be a last resort. For now, please attach your reports and proceed with the repeat Holter test, preferably for 48 hours. If this is unsuccessful again, we can explore other options.

Regards.

Answer 2

Hello,

Welcome back to icliniq.com.

I have reviewed the information, and it does not appear to be serious. There is certainly a possibility of cardiac arrhythmia, such as ventricular ectopics, or less likely atrial fibrillation or PSVT (paroxysmal supraventricular tachycardia), which are usually not life-threatening. Ventricular ectopics can cause similar symptoms and are commonly seen in young individuals like you. Additionally, anxiety may be contributing to your symptoms. You should try to calm yourself.

At this point, you do not need any major tests other than a repeat Holter monitor, as we cannot proceed until the diagnosis is confirmed. In my opinion, it is better to go ahead with the repeat Holter, since you did not experience symptoms during the previous monitoring. If the repeat test is unsuccessful, we can consider using extended monitoring.

Thanks and regards.