Example

Question

"I have suffered from heart palpitations and an irregular heart beat since I was 20 years old. This phenomenon usually occurs during periods of rest and is extremely noticeable when I want to sleep on my right side, lie on my back with my upper body elevated and when I bend over quickly. My heart beats normally again as soon as I change positions.

I underwent testing 15 years ago (resting and Holter ECG, x-ray, ultrasound), but the heart specialists did not find any pathological cause for my symptoms. Although a "discrete prolapse" of the mitral valve was found, it was not thought to be associated with the symptoms.

I learned to live with it, but the arrhythmias have become much stronger in the past six months, and now even occur when I'm at work (I'm a teacher). I also have trouble falling asleep because I can only lie on my left side. As soon as I'm on my right side, the heart palpitations and irregular heart beat start. I also experience a feeling of pressure behind my breastbone, but only when resting.

I do strength and endurance exercises twice a week. I feel fit and have these complaints only very rarely when working out (only when I lift something very heavy).

A blood test conducted two months ago by my family doctor (including thyroid levels) showed normal values. I try to ignore the arrhythmia, but still have feelings of panic. Should I have the situation examined again? Is it dangerous? Can I do something about it?"

  • female
  • 36 years old
  • 62 kg / 172 cm / BMI 20.96
  • non-smoker
Reply

You have written to us concerning the unpleasant sensations of your irregular heart beat. Being able to feel your heart beat is referred to in medical terminology as palpitations. Palpitations are relatively common and very often a harmless phenomenon experienced by particularly sensitive or attentive individuals. Some people are aware of their heart beat, particularly if stressed or feeling strong emotions (often in moments of excitement or anxiety), or as a reaction to certain stimulants such as coffee. If you can feel your heart beat, it may be perceived as irregular (arrhythmia, palpitations) or as a more rapid than normal (tachycardia). Everyone experiences irregular heartbeats to some extent, but they are only dangerous in certain situations, for example if they occur frequently or in rapid succession. Only rarely are palpitations caused by a structural disease of the cardiovascular system, especially at your age and when the heart is performing effectively. Furthermore, extra heart beats (arrhythmias) and episodes of rapid heart beat are rarely dangerous and do not usually require treatment.

The examination conducted 15 years ago (which yielded generally normal results) combined with the fact that the symptoms almost never occur during exercise are reassuring and suggest that there may be no dangerous arrhythmia or heart-related disease.

However, as you presently have additional symptoms (feelings of pressure) and the palpitations are occurring in new situations, we advise you to undergo another cardiological examination by a heart specialist. Due to the mitral valve prolapse observed in the initial tests, it would be advisable to examine if and how the prolapse has changed, and whether there is a simultaneous mitral regurgitation (leakage of the valve with backflow of blood from the ventricle into the atrium). The latter can occasionally occur in case of prolapse and may lead to palpitations. The prolapse itself is also thought to be associated with a slightly increased rate of heart rhythm disorder. In addition to a renewed echocardiography (heart ultrasound), an ECG over a longer duration (Holter ECG) is advisable: 24 hours usually suffices for daily symptoms; otherwise, 48 hours are recommended. A stress test ECG can identify arrhythmias during exercise and, as with a resting ECG, is part of a standard cardiac examination.

In summary, based on the absence of complications during exercise and the long-term experience of living with the condition, the probability of a dangerous rhythm disorder is low. However, occasional testing is recommended because of the known mitral valve prolapse and the altered symptoms. After testing, your heart specialist can also provide you with specific information on possible therapeutic measures (based on the findings).