Heart & Cardiology/Palpitations



I am a 20 year relatively fit guy.

I have been experiencing heart palpitations on and off now for the last few months. The feeling is 2 quick beats followed by a pause then a thump and then back to normal. Some times I will have one and sometimes I will have three in a row.

About 4 months ago I was in hospital with Atrial Fibrillation where I spent a night in high care. They did blood tests the evening and the following day I saw a cardiologist. They did an Echo and a stress test on the treadmill. All tests came back normal and there was no real explanation for why it happened other than a few factors like stress and caffeine.

Since then I have stopped caffeine all together and I feel I manage my stress a lot better. However its made me very anxious when it comes to my heart because I do not want to go through that again. For the last couple months I have been having palpitations which are causing anxiety and I struggle to shake them. The Dr said everything seems fine and I should just monitor it to see if they get worse. I don't get any shortness of breathe or dizziness.

My question is, if all of the tests at the hospital came back normal is it safe to say these palpitations are completely fine and its just something I need to learn to deal with and they will go away? If this is the case is there anything else I can do to reduce them and take my mind off them all together?

Thank you and I look forward to your response!

Hi, some related reading, http://blog.myheart.net/2014/06/29/afib-with-rvr-when-the-heart-races-out-of-con

Lets go in to a little detail here regarding your question. There are 4 veins that drain in to the left side of the heart known as pulmonary veins. They essentially empty the lungs full of oxygen rich blood and deliver it to the left heart for it to be pumped around to the body. The area where these veins drain in can contain tissue which is a little irritable and fires of extra beats. These extra beats are known as atrial ectopic beats and these are the sensations you feel. in fact most atrial fibrillation generates from very excitable tissue in these regions. In fact, in atrial fibrillation ablation, a procedure sometimes used to cure atrial fibrillation involves delivering small burn lines around these veins to prevent the beats escaping and starting atrial fibrillation. Given that you have had atrial fibrillation and now you are having these frequent sensation, we can be almost certain that the extra beats you are feeling are atrial ectopic beats.

Atrial fibrillation is more common than you would think, its is common in elderly, however there are many fit young people like yourself that have it, with a higher predominance in athletes. You removed triggers such as alcohol and caffeine, this may be effective in some cases but not in others. As to whether these are dangerous, the short answer is no. The presence of them does suggest you have irritable focus of tissue however and of course would be at risk of atrial fibrillation again. Its reasonable to have some form of monitoring for say 24 hours whereby you would find out the frequency of these, and also to see if you are still having runs of atrial fibrillation.

These atrial ectopics are more annoying than dangerous. Knowing that many people would opt for observation alone and no specific treatment. If symptomatic it is reasonable to try a medication such as a beta blocker. If this doesn't work and the symptoms are annoying you to the extent you need rid of them then other medications known as rhythm control medications can be tried. In some cases for example failure of medication, or particularly high frequency (i.e literally all day) then a catheter ablation procedure can be tried. At that point an electrophysiologist should be managing the case.

So basically you likely have atrial ectopic beats, if so they aren't dangerous, if the symptoms affect you despite them being relatively benign then its reasonable to trial some medication, your testing was reassuring and ruled out underlying structural heart disease,
Hope that was helpful,  

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Mustafa Ahmed MD


Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease


Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology


Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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