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"I experienced a pounding heartbeat and flip-flop sensation while swimming, what could this come from?"

ZocdocAnswersI experienced a pounding heartbeat and flip-flop sensation while swimming, what could this come from?


55 y/o m...This was the day after my doctor put me on Micardis and Tudorza (anti-cholinergic for asthma). I've taken Micardis before w/o incident. I discontinued the Tudorza. I'm a competitive masters swimmer (log ~7000 yards/wk). Although in good condition, I wasn't for many years...had mild hypertension, prediabetes, and high triglycerides. Through meds and exercise, I am controlling those things the last two years & dropped 20 pounds. Last check-up Aug 1, my BP was up a bit (135/73) and my doc put me back on Micardis. I've had two EKGs since the event...normal. Resting pulse the same. I'm slated to have an echocardiogram on Thursday. My cardiologists says a stress test isn't indicated, since I had one in 2010 that showed no evidence of cardiovascular disease. Meanwhile, swimming & lifting bring back the sensation. Any ideas what this could be coming from? I have stopped everything that I suspected of being the offending agent.


During exercise, your heart beats faster to keep up with the increased demands of your body. Specifically, it needs to beat faster in order to pump more oxygen-rich blood to your muscles, including the heart muscle itself. The fact that you sense a difference in your normal fast heart rate with exercise--a flip flop instead of regular but increased rate--suggests you may be suffering an arrhythmia. It is important to raise this concern with your physician in person. Several common arrhythmias include atrial fibrillation, atrial flutter, atrioventricular reciprocating tachycardia, AV nodal reentrant tachycardia, or atrial tachycardia. Of these, atrial fibrillation is by far the most common, and your history of hypertension, diabetes, and hyperlipidemia put you at higher risk for this. Atrial fibrillation increases one's risk of stroke, and it is therefore critical for you to ask your cardiologist about this. Rarely, arrhythmias can originate from the ventricles, or bottom chambers of the heart, as in ventricular tachycardia. Additionally, individuals commonly experience premature atrial or ventricular beats, which are essentially early heart beats that originate outside the heart's typical conduction system. These are typically benign but can be problematic if they occur frequently. Exercise, caffeine, stress, and alcohol can increase their occurrence. Given your new symptoms, it is important to undergo an EKG (which you report having done). An echocardiogram is also reasonable, as it can help identify any structural heart disease that may predispose you to an arrhythmia. Other potential tests include a 24-hour EKG monitor, an event monitor that you place on your chest to record the rhythm whenever you experience symptoms, or a treadmill test specifically to determine if exercise can induce an arrhythmia. Again, the decision as to whether these test are indicated and which ones are most appropriate will depend on the results of your history, physical exam, and EKG as interpreted by your cardiologist. I recommend you discuss these and other possibilities with your medical providers.

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