What Causes Irregular Heart Beats?

Posted on Thu, 20 Mar 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 20 Mar 2014 Answered on

Wed, 9 Apr 2014 Last reviewed on

Question : Hello. I have experienced on and off heart flutters for the past year. They will come for a day or two or even a week or two and then disappear, sometimes for months at a time. Lately they have come on more often and stayed away less time. (they'll disappear for a day or two and then reappear for a week or so). In the past year I've had 4 EKG's and they all came back normal (one said possible Left Atrial Enlargment but the doctor thought it was inaccurate and a result of me having the ekg in the middle of a panic attack as my heart was racing.) But two EKG's since did not suggest that. Two weeks ago I went for a check up and once again had a normal EKG and my bloodwork was fine. Cholestoral was minimally high but not at an alarming level. I requested a referral to see a cardiologist so they can look further into my heart flutters. (my father was hypotrphic cardiomapathy and we want to rule that out). Anyway, this HMO is a disaster and it's taken two weeks and I still don't have the referral. The heart flutters are still here. I have no other symptoms. No chest pain, no light headedness, no sweating, no passing out etc. Should I just relax and be patient and wait for my cardiologist referral? Or should I go to the ER? I'm worried if I go to the ER they'll just do another EKG, see its fine and tell me to follow up with a cardiologist (I just had a normal EKG two weeks ago!) I suffer from Generalized Anxiety Disorder so I know that could be an issue as these flutters tend to come at very stressful times for me. So I'm just looking for some advice about whether to hit the ER or to just calm myself and wait to see the cardilogist.

Answered by Dr. Anantharamakrishnan (16 minutes later)

Brief Answer: Relax / You may wait Detailed Answer: Dear friend, Welcome to Health Care Magic You are right… In ER, they will only do an ECG / and some basic lab tests of emergency nature Unless you are having the episode at that particular time, it may not help – either the doctor or the patient! The next step is to see a Cardiologist…Irregular heartbeats need to be DOCUMENTED by ElectroCardioGram (EKG). Standard ECG records the electrical activity of the heart, for a few seconds. It can detect the arrhythmia occurring during that time only. If the episode occurs randomly or precipitated by a specific activity like exercise or anxiety - one needs Holter or event monitor. Holter records for days; Event monitor for weeks / Holter records continuously / Event monitor only at certain times . ECHOcardiogram is necessary to see the heart valves (Mitral Valve Prolapse) / heart muscle (Cardiomyopathy) and heart function (Ejection fraction, wall motion abnormality) / clots / and so on... TMT – Treadmill exercise ECG; may be with thallium isotope – is necessary to evaluate ischemia (reduced blood flow / Coronary Artery Disease) Many cases of palpitation are benign, especially when associated with normal ECHO and may not require treatment. If you also have SYMPTOMS LIKE BLURRED VISION, DIZZINESS, LOSS OF CONSCIOUSNESS, SHORTNESS OF BREATH, CHEST PAIN along with this, you need urgent work up... Relax. You are young; you sound intelligent – you stand an excellent chance of returning to normalcy. Be positive – why fear the heart beats faster, forcible or more? The problem is only if it could not beat! You are tolerating the rate well - means that you may not have any basic disease of the valve, muscle and so on. Be in touch with your doctor - it is a question of time and you will be well. Medicine is well advanced nowadays – management is possible for almost all situations... Take care Wishing all well God bless

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (17 hours later)

Thanks, doctor. That's reassuring. Any idea what can be causing this? Why do my EKG's keep coming up normal? Wouldn't the EKG pick up an enlarged heart or something like it? Or would an EKG only pick up a bad heart enlargement? Is it possible I do have an arrhythmia and my anxiety makes it worse? I can't seem to get any answers! Thanks for the information.

Answered by Dr. Anantharamakrishnan (32 minutes later)

Brief Answer: Routine EKG has limitations Detailed Answer: Hi An EKG is just a record of electrical activity / it has a lot of limitations... / The recording takes a few seconds and will miss the missed beats, unless they happen to occur then by chance… / hence the need for continuous monitoring… / Permanent changes like chamber enlargement, heart attack and so on – lead to and leave permanent changes… Anaemia / Anxiety / Alcohol / Tobacco (smoking) / Caffeine (too much tea, coffee, cola) / Fever / Infection / Pain / Stress / Thyroid / calcium, magnesium / Medicines like Phenylephrine used for ‘cold’; Salbutamol used for asthma and so on - may be responsible.... / At times, abnormal nerve paths in the heart (bypass tracts) or disease of the conduction system may be responsible! Yes, anxiety can cause arrhythmia / arrhythmia can cause anxiety – a vicious cycle indeed. It is generally mediated by the Sympathetic nervous system (…adrenaline). The first line medicine here is generally beta blockers, like Metoprolol – slow release and small dose. It will benefit both anxiety and missed beats. Your doctor will give proper prescription and follow up Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar