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Forum Name: Arrhythmias

Question: Heart fluttering


 VickiL56 - Sun Sep 14, 2008 4:37 pm

I am a 52-year-old woman, perimenopausal, with heart flutterings that I've been experiencing since the birth of my youngest daughter 13 years ago. At the time, I thought it might be related to hormones, since I'd never experienced this until just after the delivery. However, my PCP didn't seem to take it too seriously, and told me flutterings or feeling as if my heart was "skipping a beat" was "common" and not to worry.

Well, this fluttering has never gone away, and I regularly experience it several times a day, almost everyday, even at rest. I am currently on estradiol and progesterone replacement therapy, so if this issue was related to estrogen drop, it doesn't seem to be alleviated by the estrogen I am taking. Although, I should note that my blood values on estrogen are still not in the optimal range that I'm seeking.

Please, can you tell me what might be some causes for sudden onset of fluttering heartbeat, and are there any tests I should be asking my current doctor for? Most have just shrugged it off over the years, and never really addressed it. I KNOW there must be some cause, and I'd like to know what it is and what I can do about it...or if I should be worried that this could develop into some sort of life-threatening arrhythemia.

Thank you.
 John Kenyon, CNA - Fri Oct 03, 2008 10:35 pm

User avatar Hello -

The good news is your doctor is correct, that these palpitations (usually premature ventricular contractions -- PVCs) are common. The bad news is that is so often the case, he didn't go into much detail about them, so you're left to wonder if something serious has been missed. So here's the deal with that: PVCs (and also premature atrial contractions or PACs, and a number of other less "popular" arrhythmias) are all not only common, but also harmless and of no particular diagnostic nor prognostic significance. They happen in almost everyone at some time or another. Some people develop them during some stressful event after never having had them before (or at least never having noticed them), and then they seem to be more frequent forever. Pregnancy is a very common reason for them to become noticeable and maybe more frequent as well, and once we start to notice these we rarely stop, but sometimes we do get used to them and they tend to become more like "background noise."

People who have mitral valve prolapse (MVP -- more common in women than in men and extremely common in the general population) usually have a greater frequency of these "fluttering" sensations, and again, usually some stressor or traumatic event (and pregnancy can be both) often start them up.

To put perhaps too fine a point on the prosaic nature of PVCs, some people have as their regular rhythm something called ventricular begeminy, in which every other beat is a PVC, and which, if it occurs in someone only occasionally, can be quite alarming, but usually in those who have it all the time they are totally unaware of it. Also, PVCs are more likely to occur when we are sitting quietly than when physically active (although in some people it is just the opposite), and also occur commonly after a meal (the same nerve which sets these off is also the one which controls digestive tract activity, so there's no getting away from it there), and are often felt when trying to fall asleep, especially when lying on one's left side. Caffeine and nicotine can send the heart fluttering, and hormonal changes (as with pregnancy, menopause and other such channges) can cause an increase in their frequency. In other words, just about any thing you can think of might cause them. Then again, very often there is no obvious cause. They are still benign. Twenty years or so ago they were considered to be a concern but during that time it's been realized they actually are quite normal, common and of no significance. People who aren't aware of them are very fortunate, but most of us feel them to some degree, and they are one of the most common causes of acute anxiety and visits to the emergency room. It is this very commonness and innocuousness that makes them such a problem because, as with your doctor, they are usually blown off without much of an explanation, leaving the patient feeling not heard. This is extremely unfortunate, because this is one of the most common questions raised here.

I hope this has served to ease your mind somewhat, and we really are here to answer questions and explain things, so if you have any further questions, please feel free to follow up here.

Best of luck to you. Stay in touch.
 VickiL56 - Sat Oct 04, 2008 12:34 am

John,

Wow! Thank you for the AWESOME reply to my concern about heart fluttering. I really appreciate all the information! If any doctor had ever given me even half that amount of information when I'd asked, my mind would've been put at ease years ago.

Likewise, I could really relate to a number of the factors you mentioned as being catalysts for an increase in this seemingly random fluttering. So, at least I know that I'm not imagining that there are certain times when it seems to get more frequent or noticeable.

By the way, now I'm wondering just what distinguishes PVCs, PACs, and MVP from true arrhythemias?

Thanks again for your time and all the great info!
 John Kenyon, CNA - Sat Oct 04, 2008 2:39 pm

User avatar You're very welcome. I'm happy that it made sense and helped clarify things some. I suspect that between the fact that most doctors now understand the irrelevance of the most common arrhythmias such as PVCs, and the relentless time factor involved in moving patients in and out of the office, this is just too time consuming for a lot of them. Still, it could save a lot of office visits and worry if they'd take the time to say it just once.

It's helpful, too, that you are able to recognize some of the aggravating factors and correlate them with increased awareness of these episodes.

A quick answer to your question about what differentiates premature beats of one sort from another and from "true" arrhythmias (something I basically feel the same way about, although these are all usually lumped together as arrhythmias) would be that the difference is in the locus, the origin of the errant impulse. PVCs arise in the ventricles, which are the lower, larger chambers of the heart, so they really seem to have a life of their own. Premature atrial contractions arise in the upper chambers (atria) so often feel less forceful but more "fluttery", and can sometimes (given the right conditions) trigger an episode of rapid heartbeat, but this is also usually easier to manage than a ventricular arrhythmia (often referred to as a tachyarrhythmia, meaning fast and irregular or, more precisely, wrong). Ventricular tacharrhythmias, almost always associated with some more serious underlying disease or disorder, are more problematic, but rarely occur in otherwise healthy hearts, so they are over in another class all by themselves.

MVP is not an arrhythmia because it isn't a rhythm but rather an often slight abnormality of the leaflets of the mitral valve, in which one or both leaflets are just a tad larger than nature intended, and so close, sometimes, a little bit sloppily ("floppy" is a word commonly used). This almost never has any practical, useful meaning, but it is a finding, and so it's recorded. It also just happens, for reasons yet to be understood, that people with this abnormality often also have more frequent premature beats of all sorts, as well as occasional atrial arrhythmias, usually only momentary, which can feel like a sudden flutter or rush. These same people are, for equally inexplicable reasons, also more prone to anxiety problems, panic disorder and migraines. It's an intriguing mystery, and not everyone who has MVP has this syndrome, or even any noticeable symptoms. Many do, though. They also usually have, at least part of the time, a distinctive murmur, called a "click" murmur, which also means nothing, but is usually considered a diagnostic sign for MVP, even though at the next exam it may not be heard. MVP is generally considered by most doctors, now, to be a "variation of normal", but people with MVP syndrome somtimes do require extra attention because of the weird, disturbing, and often seemingly unrelated symptoms they sometimes have (which is precisely what a "syndrome" is: a collection of symptoms that is recognizable).

The more you understand about these things the easier it is to react to them in a calm manner, which can only mean less disruption of one's enjoyment of life. That's why I tend to spend as much time as necessary explaining it. I know what a difference it can make.

There are other "true" arrhythmias that can arise, for other reasons, and they are generally manageable and most of them are more annoying than anything else, but we all get the "skips" once in a while.

Thanks for the followup and the kind words. It makes it all worthwhile. I'm glad I was able to help.
 Almost51 - Sun Nov 16, 2008 12:07 am

I, too, am greatly appreciative of your very detailed explanation of such an uncomfortable condition! When I read the post from VickiL56 it basically mirrored what I have been going through for the past 10 years. I originally went to the ER, wore a Holter monitor for 24 hours, was sent to a cardiologist for a stress test and not one of the doctors, either in the ER, my regular primary care physician, nor the cardiologist told me anything about what I was having. I was just told by the cardiologist that I had MVP and that was it! If I have caffeine or MSG the racing heart, heart palpitations and awful panicky feeling in the pit of my stomach start up. Over the years these have gotten worse if I especially accidentally eat food with MSG--it's much easier to stay away from foods with caffeine. I have a post in the Rheumatology section I would appreciate your consideration of an answer to my question. After the initial answer I got (which scared me at first) I added a reply, but did not get any other answer to my question. It is entitled "strange back cramp". Again, thank you so much for your wonderful descriptive answer to this puzzlement of many years for me (and I'm sure many others)!! Sincerely, Almost51
 John Kenyon, CNA - Mon Nov 17, 2008 12:20 pm

User avatar Hi there Almost51 -

I'm so happy my explanation of MVP (in a very short version) was helpful to you. I've also noted that many people with the associated syndrome are also very sensitive to MSG, something no one has been able to elucidate clearly as yet so far as I'm aware; it is, however, sufficiently well-documented and I'm glad you've mentioned it here, as it can often be a hidden trigger (especially since MSG itself is so often hidden in foods). A very useful and helpful addition to this thread.

I'll be checking on your other post regarding "strange back cramp" in a bit, and will follow up accordingly.

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