Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your medical history and would like to explain that those pauses followed by strong heart beats may be caused by vegetative nervous system modulation (vagus nerve), which is a frequent finding in healthy young adults.

The normal result of your previous Holter monitoring supports this alternative.

Even if an extrasystolic cardiac arrhythmia is at some degree involved in your strange heartbeat feeling, it would have been an isolated rare phenomenon, with quite rare extrasystoles occurrence, difficult to be noted in a 24 hours Holter monitoring.

Consequently, it would be considered clinically quite irrelevant and without and prognostic significance.

As no medical evidence of any structural heart disease has been noted and also no any cardiac arrhythmia is concluded by the already performed underlying cardiac tests, I would like to assure you that nothing dangerous or life-threatening is likely to be related with your recent clinical symptomatology.

So relax and don't worry too much about it!

I would recommend performing some additional tests as follows:

- complete blood count (for excluding possible anemia),
- thyroid function tests (as thyroid dysfunction may be associated with palpitations),
- blood electrolytes level (for any potential electrolytes imbalances)

If all the above tests result normal, then anxiety may be responsible for amplifying your palpitations unpleasant feeling.

In such case, it is important to discuss with your attending doctor for the possibility of a temporarily anxiolytics therapy.

In this regard, following a physically active daily regimen with a lot of outdoor sports and recreational activities would be beneficial.

You need to discuss with your doctor on the above mentioned issues.

Hope you will find this answer helpful!

In case of any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri

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Brief Answer:
My answer as follows:

Detailed Answer:
Hello again!

Thank you for the addition information.

Your symptoms could be related to a dysfunction of the autonomic nervous system.

But it does not seem to be anything serious.

Anxity seems to play an important role in this clinical scenario. You should know that anxiety and physical stress, cause activation of the sympathetic nervous system, leading to a load of chatecolamines (adrenaline and noradrenaline) in your blood, causing skipped heart beats.

Anyway I would recommend performing another Holter monitoring and the above mentioned blood lab tests (complete blood count, thyroid hormone levels, blood electrolytes).

I would also recommend performing a brain EEG to exclude possible partial complex epileptic seizures, which could lead to this abnormal feeling in your chest.

Meanwhile, I would recommend performing a lot of physical activity (yoga, recreational sports, walking, jogging, etc.) which is really helpful in this clinical situation.

Hope you will find this answer helpful!

If you have any other uncertainties do not hesitate to ask me!

Best wishes,

Dr. Iliri

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