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Heart palpitations with ectopics on Holter monitoring and normal ECG

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Hi im a 26 year old male and for the past near 2 years ive been suffering from heart palpitations. It started as one skip beat or flutter, i went to the doctor and he told me it wasnt serious, prob ecotopic so i thought nothing of it. I went on about for about a year and it was just getting worse, so i went back to the doc and had an ecg which was fine. She recommended a holter monitor which showed 3 extra beats which she said everyone can have but for some reason im noticing them so she sent me for an echocardiogram. They have the results but havnt asked me to come in so i made an appointment for friday. I guess they think its fine, but i know something is very wrong. My symptoms have goten so bad, I cant sleep at night, i am litterly up all night till the sun comes up. I am tired but when i ly down just before i am about to fall to sleep i get a feel of lightheadness or dizzieness, and a feeling like when your just about to fall to sleep and you wake up suddenly like your falling off a cliff. I get this every five minutes. I started to sleep sitting in a chair and then luy down which worked for a while, but now i get this sitting up aswell. my pulse feels very weak its irreguler 4 fast beats then 5 real slow and so fourth. at night when i get a pound in the chest i fell lightheaded for just a second when sitting up or lying down. Latley ive been getting shortness of breath also which comes and goes, but never feel fatigue. Things are just getting worse by the week and i just cant deal with it anymore. I aslso suffer axiety and am so stressed about it. Do you think its bad? should i go to the hospital tonight if things get worse as i cant see a doctor untill friday?

Category: Cardiologist

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Category: Cardiologist
 25 Doctors Online


Thank you for your query at

Your symptoms and your investigation reports do not correlate. One question I would like to ask you is whether during the 24 hr Holter examination you had, did you have this sensation of palpitations and falling while being asleep? If you had these symptoms at that time and still you had the Holter showing only 3 VPCs then there is a very strong possibility that whatever you are suffering is not related to heart. It could be anxiety. Also you could take a neurologist's opinion to rule out some condition like narcolepsy (you get similar hallucinations while falling asleep in this condition), although I am no expert in neurology.. its just a suggestion.

Since you are suffering from this for last 1 year, I dont think it is any emergency sort of thing. If there is a ECG lab nearby when you are having such a symptom get an ECG done. That would help. IF you didnt have any symptoms during the time the previous Holter was applied, get it repeated again. Your ECHO report and Repeat Holter (with symptoms occuring in the duration that it was applied) if normal you should seeks help from neurologist or a psychiatarist (for anxiety).

Please let me know the reports and the answer to the question whether during the 24 hr Holter examination you had, did you have this sensation of palpitations and falling while being asleep?

Dr Vivek Mahajan

Patient replied :

hi there, my heart was pounding and palpitating while I had the holter monitor and it said 3 extra beets often and sinus ecotopic and probable enlarged left something sorry I cant remember. I believe, my sleep problems were present then but had just started and was no where near as bad as now. My sleeping problem started only over a month ago. I have time off work because of this and am afraid of loosing my job. Ive had palpitations for a longer than a year, started out as 1 skip or flutter every say hour, now I feel it every 20 seconds all day everyday and can go fast then slow. Can anxiety cause it that often? is it bad? Before I had the echocardiogram my doc said to make an app for a cardiologist afterwards if nothing was wrong, is it worth seeing one?


Thanks for the follow-up.

3 extra beats often and frequent APCs. This is different from having just 3 extra beats as you earlier mentioned. If you have frequent extra beats then you could have these palpiations. Frequent extra beats will lead to a weak heart occasionally and lead to shortness of breath. So if indeed you have frequent extra beats then all your symptoms can be explained. Then I recommend you to show it to a cardiologist in person. Get ECHO too.

On the other hand if the holter just says 3 extra beats in entire 24 hrs then you may chose to ignore it provided the report does not mention NSVT or non sustained VT.

Dr Vivek Mahajan

Patient replied :

yes 3 extra beats often. I am worried, ive already had an echo and am seeing the doc on Friday to discuss results. If anything is bad or wrong would it have shown on the echocardiogram/ ultrasound? If I am getting frequent extra beats, does this explain the symptoms im having eg sleeping?


This does not explain most of the sleep related symptoms. Those symptoms definitely root from anxiety and stress. Try to stay relaxed and avoid stress. Yoga, meditation and even medications can help in this regard. On other hand if the extra beats are frequent that itself can result in some anxiety and accentuate the symptoms.

I am very sure about the 3 extra beats. Since I don't have access the complete reports please discuss it with your Doctor. I feel that everything will be alright. If that is the case you may want to get some professional help in managing your stress. A Thyroid function test (TSH) needs to be done to rule out any thyroid related illness. (which can cause similar symptoms )

Hope this helps.
Thank you

Patient replied :

Hi thanks for the reply, I forgot to mention I had a thyroid test done a while back that come back fine. With my sleeping problem its weird, its not that im not tired, when I lay down to go to sleep every few minutes I get a dizzy sensation, or some funny feeling in my head. Sort of lightheadness but weird only for a second. I can lay there and watch a movie and I don't have this, it only when I try to sleep and it happens all night until the morning but for some reason around 6am or 7am I fall to sleep. Can this still be anxiety? I will definitely let the doctor Know of extra beats. I ask again if there was something serious wrong with my heart would a echocardiogram confirm it?

It could be anxiety related or a sleep disorder. But very less likely to be related to your heart. So get a cardiac evaluation first. If things are ok (most likely scenario) you should take measures to address the stress and sleep disorder. (including professional help)

Echocardiogram looks for the structure and blood pumping function of the heart. So if there is something wrong in this regard ECHO will confirm it. However Palpitations and Arrhythmias are better evaluated by different types of ECG studies (not ECHO). The diagnosis is a not difficult for a qualified Cardiologist and I am sure that your Doctor will choose the appropriate investigation.

Hope this helps
Thank you

Dr. Vivek Mahajan
Category: Cardiologist
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
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