[41F] Experiencing palpitations and occasional dizziness

Patient Description

A 41-year-old female reports experiencing heart palpitations described as skipped beats, a pounding heart, and a sensation of the heart pulsing into the throat for the past two years. The palpitations are not related to stress and seem to worsen at specific points in her menstrual cycle. She is unable to exercise at a high level due to tachycardia and sometimes feels dizzy when exercising, although she does not experience palpitations during exercise. The patient also experiences lightheadedness, which has improved over time and now occurs rarely, sometimes triggered by walking or turning her head to the left when lying down. She rates her dizziness as a 3 out of 10 in severity and finds that rest alleviates it. She has not experienced syncope or near-syncope. She reports mild, dull, pressure-like chest discomfort. Her medical history includes obesity since 1998 and migraines since 2009. She is currently taking Metoprolol and vitamin D3 daily, and uses Ibuprofen as needed for migraines. The patient has a family history of atrial fibrillation (afib) in her father and has used tobacco, alcohol, and cannabis in the past. No new medications or supplements have been started recently, and she has no known drug allergies.

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Arora's Assessment

What might be happening

Based on the information provided, the following conditions might be considered:

  • Non-Sustained Ventricular Tachycardia (NSVT): This is a heart rhythm disorder where the heart beats faster than normal. It's characterized by three or more consecutive heartbeats originating from the ventricles at a rate of more than 100 beats per minute, but lasting less than 30 seconds. NSVT can occur in individuals with or without heart disease. In your case, the palpitations and dizziness you've been experiencing could be related to NSVT. However, it's important to note that NSVT can have various causes and can sometimes be a sign of underlying heart disease.

  • Premenstrual syndrome (PMS): Hormonal changes during your menstrual cycle can cause a variety of physical and emotional symptoms, including palpitations. If you notice that your symptoms worsen at specific points in your menstrual cycle, this could be a possible explanation.

  • Anxiety or Panic Disorder: Anxiety or panic disorder can cause physical symptoms such as palpitations, dizziness, and chest discomfort. Although you mentioned that your symptoms occur at rest and are not related to stress, it's still possible that anxiety could be contributing to your symptoms.

  • Migraines: Migraines can sometimes cause dizziness and palpitations, especially if they're severe or frequent.

What you can do

  1. Follow up with your healthcare provider: Given your symptoms and the potential for underlying heart disease, it's important to follow up with your healthcare provider. They may want to perform additional tests, such as an EKG or echocardiogram, to further evaluate your heart.

  2. Monitor your symptoms: Keep track of when your symptoms occur, their severity, and any potential triggers. This information can be helpful for your healthcare provider in determining the cause of your symptoms.

  3. Maintain a healthy lifestyle: Regular exercise, a balanced diet, and maintaining a healthy weight can all contribute to heart health. However, given your symptoms, it's important to discuss with your healthcare provider what type and amount of exercise is safe for you.

  4. Manage stress: Although you mentioned that your symptoms are not related to stress, managing stress can still be beneficial for overall health. Techniques such as deep breathing, meditation, and yoga may be helpful.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe chest pain or discomfort
  • Trouble breathing or shortness of breath
  • Fainting or near-fainting
  • Rapid or irregular heartbeat that doesn't resolve on its own within a few minutes

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with your healthcare provider for accurate information.

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10 mo ago

People Also Ask


What are heart palpitations and what causes them?

Heart palpitations are sensations of a fast-beating, fluttering, or pounding heart. They can be caused by stress, exercise, medication, or, in some cases, an underlying medical condition such as arrhythmia or heart disease.


How can hormonal changes during the menstrual cycle affect heart palpitations?

Hormonal changes during the menstrual cycle, particularly fluctuations in estrogen and progesterone, can affect the cardiovascular system and lead to symptoms like heart palpitations. Some women may notice these symptoms are more pronounced at certain times in their cycle.


What is Non-Sustained Ventricular Tachycardia (NSVT) and how is it diagnosed?

Non-Sustained Ventricular Tachycardia (NSVT) is a condition where the heart experiences episodes of rapid beats originating from the ventricles, lasting less than 30 seconds. It is diagnosed through tests like an EKG, Holter monitor, or an echocardiogram, which help assess heart rhythm and function.


Can migraines cause symptoms like dizziness and palpitations?

Yes, migraines can sometimes cause symptoms like dizziness and palpitations, especially if they are severe or frequent. These symptoms may be related to changes in blood flow or the nervous system during a migraine attack.


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