Help! My Doctor Says My EKG Is Normal, but My Heart Is Still Pounding!

Please note that if you are experiencing any out of the ordinary cardiovascular issues, dial 911 or go to your nearest emergency room immediately.

It happens more often than you may think. Patients feel their heart beating out of their chest or their heart skipping a beat and immediately call their doctor or head to the ER thinking that they may be having a heart attack. Once they’ve been cleared, they may be told that everything is fine, or they may have had a panic attack. However, this fast heartbeat irregular heartbeat continues, and the patient does not get the satisfaction of an appropriate diagnosis.

No, your medical team is not to blame. Rather, diagnosing an arrhythmia in an unspecialized medical setting is challenging. But why is that?

The answer sometimes revolves around the electrocardiogram or EKG. When EKG was invented, it was revolutionary in that it could detect a host of irregular heartbeats including Atrial Fibrillation or Afib. A quick, noninvasive test could now give us an incredible amount of information about the heart. Today, technology has advanced so far, that you can even purchase a wearable EKG (pros and cons of this in a different article). While not a medical device, it can offer some helpful information for your cardiologist.

However, as we learn more about the heart, and in particular about arrhythmias of the heart, we know that the heart does not always malfunction in a linear way. In other words, the arrhythmia may be paroxysmal or occasional. Paroxysmal arrhythmias are often undetected by EKG’s because the diagnostic only offers a single snapshot in time. If the arrhythmia isn’t occurring at that time, it will remain undiagnosed.

Why you need to see an electrophysiologist

An electrophysiologist is a specialist in the rhythm of the heart. EPs like Dr. Tordini have a number of diagnostic tools at their disposal that a family doctor, and even most general cardiologists, do not have. For example, we have long-term monitoring systems like Holter monitors, event monitors, and loop recorders which can either be carried or implanted for anywhere from a few days to a few years. These devices monitor the heart continuously and are very good at telling us if there is an arrhythmia. If these devices fail to detect an arrhythmia and the patient is convinced of a problem, we can opt for what is known as an EP study, where a catheter is threaded up to the heart and the electrical system of the heart is mapped by advanced imaging software. If we do opt for an EP study, a cardiac catheter ablation or cardiac cryoablation can be performed immediately afterwards, sparing our patients the need to come back for a second procedure.

The Bottom Line

Ultimately, you know your body best. In many cases a racing heart or your heart skipping a beat may be related to stress, anxiety or even a normal variance. However, this can also be an arrythmia. While most arrhythmias are not immediately dangerous, they do increase the risk of potential problems. For example, Afib, the most common arrhythmia, increases the risk of stroke by up to five times. Heart attack risk is also higher. Therefore, patients should visit not only their cardiologist but an electrophysiologist to understand how their heart is performing and to rule out any serious issues involving their heart rhythm.

Dr. Tordini takes a conservative, stepwise approach to treating any arrhythmias that she finds. We start with lifestyle and dietary changes that can help normalize the heartbeat and rhythm. We can then move onto antiarrhythmic and anticoagulant medication. If these do not work, we can employ several curative procedural solutions that are safe and effective for a wide cross section of patients. To learn more, please schedule a consultation with Dr. Tordini at one of her three locations in the Tampa area.

Dr. Tordini is a part of Florida Medical Clinic Orlando Health