A different kind of palpitation (stuttering/twitching followed by very fast heartbeat). Is it common?

[MTRJ75]

Some long time members know I've had a few threads about PVCs or skipped heartbeats. What I've experienced now a few times over the last week or so is a bit different. It's like a short 3-5 second stutter in the chest (maybe a PVC due to trapped gas?), but then a REALLY fast heartbeat for about 10-20 seconds. It's not usually long enough that I can catch it on a monitor before it goes back to normal, but it feels incredibly fast, like at least twice the normal rate and it's definitely a sensation I can physically feel. 

I often get the skipped beats, but the stutters (or maybe it's even a twitching) and especially the following super rapid following heartbeat is something new. Is this something I need to worry about or a common issue here? 

[Pistol]

1 hour ago, MTRJ75 said:

I often get the skipped beats, but the stutters (or maybe it's even a twitching) and especially the following super rapid following heartbeat is something new. Is this something I need to worry about or a common issue here? 

@MTRJ75 - anytime you feel new fast or irregular heart beats it is best to see a cardiologist. Especially if you have symptoms like dizziness, lightheadedness or chest pain with the palpitations/irregular beats. At the minimum your doc might want to do an EKG but often they will order a holter monitor in the hopes of catching those irregularities. I - for example - get episodes when my heart beats vey strong and oddly regular, like a robot. Turns out I have atrial flutter when that happens. But you won't know if it is something harmless or serious unless you get it checked. So - I would see the doc on this one. 

[MTRJ75]

Luckily, I have a tele-med appointment with cardiologist tomorrow, but this is such an odd pattern. I have twitches all over the place all the time, so I wonder if this is a muscle or nerve twitch that's setting off the cardiac system. I wouldn't expect them to catch it on monitor. It hasn't happened every day and even when it has, it's gone before I can set up Kardia or a heartrate monitor to record it. The shortness in length is good news I guess, but you only have to lose once. 

[MTRJ75]

So while I've been waiting for the cardiologist to call later, I've been consulting Dr Google and reading some wonderful things about how autonomic dysfunction is correlated to cardiac sudden death by causing these arrhythmias, especially autonomic neuropathy which I've been diagnosed with.

I've also read that the problem may be fixable by ablation, but those have a low success rate in people with dysautonomia and can even worsen POTs. 

On the other side, I've also read that SVT may not be dangerous or even need treatment, if that's what it is, but that's often when it happens in much younger people. 

My body doesn't seem to be satisfied unless I'm living my life in fear. Hopefully, I can avoid sudden death until my cardiologist appointment later. 

Edit: I did have a cardiac MRI just over a year ago (Dec 2019) that showed a structurally normal heart, but I don't know if that matters in these instances when the electrical system is all mixed up. 

[Pistol]

Hi @MTRJ75 - no worries. CAN ( or cardiac autonomic neuropathy ) is not the same as neuropathic POTS. It is mostly in patients with diabetic neuropathy or due to old age. And the tachycardia that usually occurs with dysautonomia is not life threatening. SVT is altogether another can of worms - it is a tachycardia but a different type of tachycardia. It CAN be dangerous and usually - if severe - they consider an ablation. 

In POTS we mostly experience, sinus tachycardia and PVC's and PAC's - all harmless. They feel terrible but do not cause sudden death or heart attacks. I am sure your cardiologist told you the same. If none of your monitors ever showed anything other than the above you have nothing to worry about. If you have other arrhythmias ( not related to dysautonomia ) needs to be evaluated by the cardiologist, most likely with another holter monitor. 

[MTRJ75]

Not neuropathic POTs, my neurologist diagnosed autonomic neuropathy in addition to POTs (and CFS/ME). It's written that way in the disability paperwork or I wouldn't have even seen it and asked. I thought auto neuropathy was just another way of saying autonomic dysfunction, but it's apparently it's own thing. 

Cardio said that if SVT and only for a short while, it's not dangerous. If it goes on longer than 10 minutes or goes out of rhythm get to the ER. If it happens again, try to catch a recording. If not, we'll try to do a monitor, but will be tough to catch. May have to do a loop recorder. 

The thing she would worry about is ventricular tachycardia and without catching it on record, she can't tell. 

She did say, as I wrote above, that having a normally structured heart on MRI is good, but that tells us nothing about the electrical or nerves. She's hopeful that the new meds to stabilize mast cells might help with cardiac issues as well. She's also going to get me some samples of Ivabradine. It might help to get it insurance approved if I can show them I've already benefited from it. 

But right now, it's really just something else to worry about on top of everything else. 

[Pistol]

@MTRJ75 - sounds like you are in good hands! I think you can stop worrying for a bit, she's on top of it and would have told you if you were in immediate danger of sudden cardiac death. 

[MTRJ75]

I guess...I hope @Pistol

I'll report back in if I don't make it. 

She kept mentioning an EP too yesterday and it didn't hit me until I was lying in bed last night that she was talking about an electrophysiologist. 

[peachychou123]

I’ve actually experienced a very similar symptom, just the other day it happened again. 

 

Like you I am used to the usual PVCs and PACs but very occasionally (like once a month or less) I will get a scary episode with a couple skips and then suddenly my heart will go BOOM BOOM BOOM BOOM very fast for about 10 seconds. It usually happens when I am laying in bed or my stomach is irritated because I ate something spicy or forgot to take my reflux meds. I have had multiple EKGs and they said everything looked good. It’s possible you had a short run of SVT but SVT is usually harmless and can usually easily be fixed if it recurs. If your heart goes back to normal rhythm right after that’s a great sign! You’ve got through it and its likely just a harmless vagus nerve thing.

[MTRJ75]

Thanks @peachychou123I believe it's a combination of digestive system (not necessarily immediately after eating/drinking, but not very long after each time) and thickened mucus (sjogren's) causing it. Thankfully I've gone a week without another episode. Now I just have to stop the anticipation. 

[peachychou123]

37 minutes ago, MTRJ75 said:

Thanks @peachychou123I believe it's a combination of digestive system (not necessarily immediately after eating/drinking, but not very long after each time) and thickened mucus (sjogren's) causing it. Thankfully I've gone a week without another episode. Now I just have to stop the anticipation. 

I totally get your fear, I was terrified when it happened too but if you’ve had your heart checked and it’s structurally healthy it’s unlikely a little blip would cause any danger to you. Your heart corrected itself and seems to have done so repeatedly which is good, if these episodes last longer than a couple minutes or so you should go to the ER though. I really do believe the vagus nerve is responsible for so many of these strange little skips. I had gastritis lately and my PVCs and ectopics were way more frequent. I’ve had short runs of these very hard fast beats infrequently for the past 3 years or so. I struggle with anxiety with new symptoms too really wouldn’t spend any more mental energy on it. In fact the ER dr I mentioned it to the other day said these type of short, hard fast palpitations are very common and nothing to worry about in a structurally normal heart  

[MTRJ75]

Ha, I'm shocked the ER doc didn't ascribe it all to anxiety and send you home with some xanax. 

I've always had chronic gastritis, dating back to well before my dysautonomia issues. More than 15 years. Just recently I've heard that this can have a mast cell cause as well. 

I should add that I believe whatever muscular instability I have in my throat/chest also feels like a factor. Very trembly, like an old car in the cold. Like things need to be tightened up. This feels like where the twitchiness or stuttering comes in and is the part that's responsible for most of my concern in coordination with cardiac nerves. 

[MeganMN]

I just had this same thing start about a month ago, wore a monitor for 7 days and ended up having 260 separate episodes of SVT for 5-20 beats.  Cardiologist said that it is not dangerous, but may be contributing to my symptoms of dizziness, chest pressure, etc.  He recommended an ablation.  Why are ablations risky for people with POTS?  I have non-tilt table diagnosed POTS, but the Cardiologist is wondering if it is all related to the SVT and ablation might resolve things.  Curious.  Interesting to hear other people with similar stuff.

[MTRJ75]

1 hour ago, MeganMN said:

I just had this same thing start about a month ago, wore a monitor for 7 days and ended up having 260 separate episodes of SVT for 5-20 beats.  Cardiologist said that it is not dangerous, but may be contributing to my symptoms of dizziness, chest pressure, etc.  He recommended an ablation.  Why are ablations risky for people with POTS?  I have non-tilt table diagnosed POTS, but the Cardiologist is wondering if it is all related to the SVT and ablation might resolve things.  Curious.  Interesting to hear other people with similar stuff.

https://www.dysautonomiainternational.org/page.php?ID=228

Quote

* Sinus node ablation/modification. The role of sinus node ablation and modification in patients with IST has not been well defined and it should only be seen as a last resort treatment. Although short-term success rates were favorable (76%-100%), long-term outcomes were disappointing, and the need for permanent pacing and other procedural-related complications has been reported.(1,2,3,9,10,14) Sinus node ablations are not recommended in patients with POTS, as this often worsens the condition.(1,15)

 

[MeganMN]

@MTRJ75 Thank you- I will have to do some more research- I did not have Sinus Tach, it is some other misfiring node in the Atria- not sinus.  They would not be doing ablation on the Sinus Node, but on the irritable focus elsewhere.  Thank you so much for the info! I will grill the Cardiologist a little bit more. I had many, many episodes of Atrial Tachycardia.