Is it reasonable to have an echo done to evaluate my palpitations?

I am a healthy 27 year old female who, in the past 1-2 years, has been experiencing palpitations. What prompted me to see my PCP (Primary Care Physician) was an episode while shopping that left me dizzy, lightheaded and unsteady. He has checked a BMP (Basic Metabolic Panel), thyroid panel, an EKG and a Holter monitor, all of which has come back normal. I’ve had issues with anxiety in the past but it has been well managed after therapy and SSRI use for about a year. On the small chance that it was a contributing factor, I also stopped using an OTC antihistamine. The number of palpitations has greatly decreased but never gone away. Is it unreasonable to ask my PCP if an echo is appropriate? Also, would it show anything that the EKG/Holter wouldn’t?

Submitted by Katie J from Georgia on 12/07/2013

by Jose Diez, MD

The perception of palpitations, or extra cardiac beats are also described as “fluttering in the chest, butterflies in the chest, irregular pounding, etc…” Although they can be a symptom of cardiac disease, for the most part are benign and do not require any specific treatment unless they are associated with worrisome symptoms such as lightheadedness, fainting, shortness of breath, decline in functional class, or if they are too fast or too prolonged.

It is important to complete a cardiac evaluation in order to fully determine if the palpitations are generated from the upper or lower chambers of the heart, how frequent, how fast, their morphology, how do they start and terminate.

On clinical evaluation: what precipitates or alleviates the symptoms, associated medications/alcohol/caffeine/any other stimulants, on exam search for cardiac murmurs, gallops or extra cardiac sounds, search for manifestations of systemic diseases (anemia, thyroid disease).

Basic work up includes: ECG, CBC (complete blood count), BMP, TSH (thyroid stimulating hormone). In order to document the palpitations: Holter or more sensitive, an event monitor (to be used for at least 28 days). In order to evaluate for structural or valvular heart disease, a complete 2D echocardiogram.

Your cardiologist can help in guiding therapy or subsequent follow up after studies are completed.