Heart burn or angina and palpitations

Your Question: 37 y/o male with Sudden onset of palpitations w/SVT episode 6/mo ago.  Second SVT 1/week ago.  Normal echo, stress echo and EKG. PVCs and few cases of heart block. Chest pain with/without exercise, comes and goes in waves.  Sensation of heartburn not relieved by antacids.  Am I in danger/what next? 

You had just about all the cardiac tests I would have ordered at this point in someone with palpitations. They pretty much exclude the presence of coronary artery disease. However, your GI system has not yet been examined and I would focus on evaluating your heart burn at this point before examining your palpitations further:

  • Heartburn is caused by acid reflux.
    • About 50% of patients with a Hiatal hernia do not have acid rreflux and do not require treatment.
    • While patients with acid reflux may benefit initially from medical therapy, which includes life style changes and medications. However, if severe and/or chronic, it requires an operation.
  • Palpitations are the predominant symptom in Supra Ventricular Tachycardia (SVT) and PVCs. Occasionally, some patients have no awareness of a rapid heartbeat, but instead may have symptoms of fatigue and fainting. Other patients may have chest pain, shortness of breath or a sense of fullness in the neck. 

(Images from:  Supra Ventricular Tachycardia (SVT)

To diagnose SVT, the presence of an "extra nerve" in your heart needs to be confirmed. Individual cases of SVT can usually be distinguished by the electrical characteristics of your EKG or Holter monitor results. Occasionally, your cardiologist might recommend an EP study if concerned your SVT may be potentially dangerous to you.

An electrophysiology (EP) study is a test that records the electrical activity and the electrical pathways of the heart. This test is used to help determine the cause of heart rhythm disturbance and the best treatment. During the EP study, abnormal heart rhythm will be tested with different medications to see which one controls it best or to determine whether an ablation or cardioverter/defibrillator(ICD) is needed.

You may need an EP study:

* To determine the cause of an arrhythmia.
* To locate the site of origin of an arrhythmia.
* To decide the best treatment for an arrhythmia.

Hope this helps,

Dr T


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