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High pulse, tremor, PREMATURE ATRIAL CONTRACTIONS on standing. ECG.

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Hi, I am 31 years old patientold and Male.

For the past 5 months I keep having the following symptoms on a daily basis:

- Resting pulse in the 90's when sitting and goes up to 120 when standing, walking or with minimal exertion.

- An intermittent vibration or tremor feeling in my chest, most noticeable when I am at rest or falling asleep.

- Premature atrial contractions, mainly happen when I am standing. Sometimes these make me feel very dizzy.

- Forceful throbbing pulse, I can feel my pulse everywhere. Can also see pulse in stomach when laying still.

- Sometimes my body feels like it shakes with every heartbeat.

- I often find myself feeling exhausted for no reason

The tachycardia is also triggered by minimal adrenaline, for example...when I am concentrating on something at work (office environment), I often find myself exhausted and I check my pulse and it's 100.

I have had the following tests

- 24 hour ECG: am in normal sinus rhythm.
- Blood tests to check Thyroid, Glucose, Kidney Electrolytes, all ok.
- Echocardiogram: normal
- 24 hour urine collection: normal

I am currently taking Perindopril 4mg for hypertension. My average Blood pressure with medication is 128/80.

I have also been prescribed Propranolol to be taken whenever i need it, and this does seems to help with the tachycardia.

I am not an anxious person and have minimal stress in my life. I do not drink alcahol or drink coffee.

I currently have a kidney stone but have been told by my doctor that this should not cause a fast pulse.

What are your thoughts on a possible diagnosis and what do you advise?

Category: Cardiologist

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Category: Cardiologist
 22 Doctors Online

Hello. Thank you for your query at DoctorSpring.com.

I understand your concern. Do you exercise regularly?
Lack of exercise may lead to increase in heart rate on low intensity exercise.
Those who are trained to exercise regularly do not have any major increase in heart rate on low intensity exercise. So if you are not trained to exercise regularly, then you may have this problem of increase in heart rate on minimal exertion.
Did you have your hemoglobin checked? Low haemoglobin may lead to increased heart rate on minimal exertion.
How did you come to know that you have Atrial Premature Complexes or PACs? Did you have a Holter examination done?
I would suggest you to undergo a treadmill test to look for the type of increase of heart rate. If it is the normal sinus rhythm, then Propanol or any other Beta Blocker like Metoprolol or Carvedilol are good for you and you may take them for long term benefit and symptom relief.
Alternatively, drugs like Ivabradine may be helpful for inappropriate increase of heart rate on minimal exercise.
Your blood pressure is well controlled.
Kidney stones wouldn't cause these symptoms.
Regards, Dr. Vivek Mahajan, DM Cardiology.


Patient replied :

Hi thank you for your reply and your recommendations.
Yes I have had a 24 hour holter monitor which picked up ectopic beats.
I can tell when I am having a PAC because I can feel the sensation in my throat and I have the urge to cough immediately after.
I have also had a 12 lead ecg which happened to pick up an Incomplete Right Bundle Branch Block. Do you think this has any significance to my symptoms?
Also could there be any reason for the vibration/tremor sensation I feel from my heart when I fall asleep?. It feels like a motor running sensation.
Thanks Again


Hello.
An incomplete rbbb doesn't have much of a clinical significance if present right from birth. In view of normal 2d echo findings it doesn't carry much of a significance.
The vibration like sensation in heart is unlikely to be pathologically significant in view of normal 2d echo.
I would still recommend a stress test in view of the increased heart rate in exercise. If it doesn't reflect any grave arrhythmia you can be relaxed and just continue propranolol or metoprolol.

Regards
Dr Vivek Mahajan


Patient replied :

Hi, thank you for your reply. I have one last question
i am wondering, for a condition such as Mitral Valve Prolapse, would it always be visible during an Echocardiogram?. Can the abnormality in the valve be proximal or can there be moments in the day where the valve functions well and then later starts to function abnormally again?
I am just wondering if it is worth me doing a repeat Echo, as alot of my symptoms seem to be similar of that of MVPS
thanks
I will leave a good rating after your reply


Hello,
Thanks for the follow-up.
MVP is usually not intermittent. Mitral regurgitation associated with MVP maybe intermittent. Subtle MVP maybe missed by the observer occasionally. If your previous echo in the recent times has been normal then there appears no need to do it again.

Regards
Dr Vivek Mahajan


Dr. Vivek Mahajan
Category: Cardiologist
Experience: 
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
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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