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"I have heart palpitations sometimes after vigorous exercise. Is this serious?"
I am 5'8" Caucasian, 25 years old, my blood pressure is usually 110/65, with a RHR of 55bpm or so. I weigh 158Lbs and am around 7% body fat. During swim team practice I was feeling normal. Towards the end, directly after sprinting 25 yards, my chest had slight intermittent tightness. I then placed two fingers on my left carotid artery to take an approximation of my pulse, and to see if I could feel any irregularities in my heart rhythm. I felt my heart rate to be between 160-170Bpm. Although this could be considered high, I am an experienced athlete, and I am used to it. What troubled me was my heart ryhythm was sporadic. I seemed as though after every 5-10 beats my heart would skip a beat, and cause me to feel a slight tightness. After my heart rate had recovered to around <140bpm, I could no longer detect this abnormality. Needless to say, I was alarmed and called it quits for that day.
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. Chest pain during exercise can be a normal occurrence due to manipulation of the cartilaginous joints of your rib cage. However, it can also be from more serious condition such as arrhythmia, hypertrophic obstructive cardiomyopathy, valvular disease, or coronary artery disease, and it is important for you to be evaluated in person by your physician. A rapid heart rate during exercise may be normal, but it could also be due to an arrhythmia such as atrial fibrillation, atrial flutter, atrioventricular reciprocating tachycardia, AV nodal reentrant tachycardia, or atrial tachycardia. More uncommonly, it could be due to a ventricular arrhythmia, such as ventricular tachycardia, which originates in the ventricles, or bottom chambers of your heart. The sensation of skipped beats could also be true to premature, isolated beats that originate in your heart but outside the typical electrical conduction system. These are common and can be completely benign. However, in some instances, they can occur so frequently that they pose a problem for your heart. Given your symptoms, it is important for you to be evaluated by your physician. A typical evaluation consists of a thorough history and physical exam and EKG. Depending on these findings, it is possible you would need to undergo a transthoracic echocardiogram (ultrasound of your heart), treadmill exercise test, or 24-hour EKG monitor. Again, I urge you to seek consultation with your physician to help determine the next steps in your evaluation.
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