DEAR DR. GOTT:
I am a 32-year-old female, 5’ 8” tall and weigh 125 pounds. I have no health problem but do smoke.

Since I was about 12 years old, I have had occasional heart palpitations. They usually occurred if I ate too much sugar or was under a lot of stress. There is no family history of heart disease other than my grandfather who died of a heart attack in his late 50s.

When I was pregnant with my second child, I was anemic and had frequent palpitations but was told it was normal. I had no problem during the birth. I continued to have these even after my hemoglobin was back to normal. I then started having an occasional dull achy feeling in my left upper chest that sometimes went down my left arm or up my neck. It’s been 18 months since I gave birth and they palpitations continue on an almost daily basis. Some days I will have five or more episodes, other days none. I have noticed that I am more likely to have them if I am in a certain position, such as bending over or lying on my left side. If I lie on my right side, I rarely have any.

I have had a normal EKG. My cholesterol, blood pressure and thyroid are all normal. I have never had shortness of breath, lightheadedness or fainting. My only medication is alprazolam (as needed) for anxiety which comes out of the blue.

I have mentioned these episodes to my doctor several times but he does not seem concerned.

Should I request to have my heart checked or and if so, what tests should be done?

DEAR READER:
Palpitations usually are felt when the atria (low pressure chambers) or the ventricles (high pressure chambers) contract between heart beats.

Atrial beats are harmless and can be ignored. Extra ventricular contractions, on the other hand, can reflect a cardiac disorder.

I recommend that you seek a consultation with a cardiologist who will probably ask you to wear a cardiac monitor for 24 hours or an event monitor for up to a month. He also may suggest a stress test and a cardiac ultrasound exam.

Based on the details in your letter, I doubt that your palpitations are serious but knowing that with certainty will help reduce your anxiety level. Perhaps your palpitations are a manifestation of your anxiety or a mild panic attack. If this is the case, maybe a switch in medication is in order.

Start with the cardiologist. He or she is best qualified to diagnose and treat cardiac abnormalities.