HomeAnswersCardiologypresyncopeWhat causes heart palpitations and presyncope?

I have heart palpitations and presyncope events. Please help me with it.

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. K. Shobana

Published At March 10, 2021
Reviewed AtJuly 6, 2023

Patient's Query

Hi doctor,

I have heart palpitations and presyncope events. Please help me with it.

Hello,

Welcome to icliniq.com.

Your attached ECG (electrocardiogram) is fine. There are some motion artifacts and no significant abnormalities. So these ECG (electrocardiogram) do not help to explain the cause of syncope. Were these ECG (electrocardiogram) obtained during the events? Because cardiac abnormalities can be intermittent and may be normal when one is asymptomatic. However, if electrocardiogram is normal during the episodes, they are unlikely to be a primary cardiac cause. We have to search for other possible causes like anxiety or other psychological reasons, postural symptoms. Suppose it is impossible to obtain ECG (electrocardiogram) during episodes, then go for 24 hours of Holter monitoring. Your symptoms occur at rest or while getting up from sleep or sitting position? Your BMI (body mass index) is relatively high, so do you have any obstructive sleep apnea (OSA) symptoms like disturbed sleep with frequent awakenings, morning headache, day time sleepiness? As patients with OSA (obstructive sleep apnea) are prone to postural symptoms and arrhythmias like atrial fibrillation and ECG (electrocardiogram) during episodes, Holter monitoring will need help to conclude.

Patient's Query

Thank you doctor,

It was taken during the episode on an apple watch. They are frequently occurring during the day, on and off, lasting for less than a minute. My sleep is disturbed, and I am trying to lose weight and drastically cut down my calories. I do also suffer from headaches on waking. When they occur, I feel fuzzy or light-headed for a while, then they revert to normal. I do feel slightly more stressed.

Hi,

Welcome back to icliniq.com.

So there is a possibility of OSA (obstructive sleep apnea) in you, and obesity is the probable ultimate root cause for all these symptoms. The recently attached ECG (electrocardiogram) also could not capture anything, and there are just artifacts. With the symptoms, the probable cause appears to be ectopics (ventricular or ectopics). Since they are transient, they may not be picked by the time you go for an ECG (electrocardiogram). To circumvent this, either you should run your ECG (electrocardiogram) very frequently in the hope of capturing one or go a 24-hour Holter monitoring. It is better to get yourself evaluated and should undergo a thyroid test, sleep study, and echo (echocardiogram). Focus on weight loss, don't consume excessive coffee, avoid smoking, alcohol, etc. If applicable, these can worsen ectopics or palpitations.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sagar Ramesh Makode
Dr. Sagar Ramesh Makode

Cardiology

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