Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I carefully passed through your medical history and facing the results of your two previous Holter tests, cardiac ultrasound and your clinical conditions during the last two years, I would conclude that:

1. regarding your ectopic heart beats, as your doctors have concluded, they have no clinical significance. They are too scarse to be considered, do not imply any cardiac disorders and do not need special treatment.

2. regarding mitral valve prolapse, it is not very rare echo graphic finding, mainly found in females, but also in males in a lower degree. Individuals with MVP are generally more prone to subjective unpleasant feelings such as palpitations, anxiety, atypical chest pain, etc.. They frequently experience several kinds of cardiac arrhythmia such as ectopic beats, supraventricular tachycardia, etc. When coupled with mitral regurgitation, it is necessary to follow endocarditis prophylaxis whenever an invasive procedure is programmed (tooth extraction, endoscopic procedures, surgery, etc.).
Nevertheless, besides those unpleasant feelings I described and some special considerations I described above, MVP when not associate with important mitral valve regurgitation, it is a benign condition.

MVP can disappear when present, but may be modulated by loading conditions (resting, physical exertion, lying position, etc.).

Regarding your fluttering heart feeling probably it may be a short run of a supraventricular arrhythmia, but it may also be only an exaggeration of some isolated ectopic beats. If this feeling becomes repeats again and becomes frequent it is necessary to perform a new Holter monitoring.

Though you may have been quiet without any bouts of anxiety during that flutter feeling, anxiety disorders by itself may increase the day-night levels of adrenaline (catecholamines), leading to extrasystoles.

Anxiety may disrupt the circadian cycle of adrenaline production and break down, leading to persistently high levels of adrenaline during the night, with consequent sleep disorders and possible arrhythmic events.

So a better longstanding control of anxiety would minimize the predisposition for even some scarse ectopic beats occurrence.

All your symptoms (extreme tiredness, sleepiness, feeling down, etc.) seem to be part of a chronic anxiety disorder.

I recommend you to discuss with your attending physician (psychiatrist, therapist), to find a better strategy for overcoming this problem.

Besides, I would advise checking also your thyroid function tests, just to be sure for excluding any possible underlying adverse effects.

Hope you will find this answer helpful!

Feel free to ask any other questions whenever you need!

Greetings!

Dr. Iliri

---

Brief Answer:
My opinion as follows:

Detailed Answer:
Hi again,

I would say that as a general rule ectopic beats may be spread almost equally through the day-night interval.

But during the first part of the day (as you declare) the level of catecholamines shows an important peak level, which may be responsible for some more isolated extrasystoles (though not clinically significant).

From the other part, what is more important in triggering bouts of ectopic beats seems to be anxiety.

As anxiety may disrupt the usual profile of the day-night adrenaline level changes, several patterns of extrasystolic arrhythmia may happen (quite different among several individuals).

You need to consider modulating your life-style, with more recreational activities, outdoor physical training or just walking, as this would help in breaking down excessive adrenaline, improving your humor and decreasing the chances for generating unpleasant ectopic beats.

To conclude, I would like to remind you that those scarce ectopic beats are so irrelevant, without any clinical significance.

So, relax and don’t worry!

Kind regards,

Dr. Iliri

---