Persistent heart palpitations
February 11, 2010 | 15,00 EUR | answered by Dr. med. Olaf Stephan
Hello,
I (22, male, student) am urgently seeking advice on a problem that has been bothering me for the past 6 months. I have been suffering from chronic heart palpitations during this time. Constantly, especially at night, I feel my heartbeat throughout my whole body. My pulse is normal, but every systole makes my whole body vibrate. Even when I am calm. That's why I have already been to the hospital and seen many other doctors, but no pathological changes could be found (thyroid, blood tests (CRP, ESR, EBV, Lyme disease...), ECG, stress test, chest x-ray, Holter monitor, echocardiogram... all normal).
The diagnosis in the hospital was: Somatoform cardiac symptoms with anxiety disorder (hypochondria).
Additionally, I have completely lost my appetite. I constantly think that I am suffering from a serious illness.
I was prescribed Opipramol by my former neurologist, but they make me very tired and sluggish.
I am a competitive athlete and fully capable, as long as I can sleep at night.
I am afraid that this palpitations will never go away and my whole daily life will suffer as a result...
What do you think about the diagnosis from the hospital and what can I do to feel better again?
Thank you, Manuel
Dear Inquirer,
Based on the medical history you provided, I can understand the diagnosis given by the hospital and largely agree with it. Normally, the heart beats discreetly and unnoticed by us. Palpitations refer to any form of heart pounding that is perceived as disturbing. Palpitations are a very common symptom in general practice and cardiology, often causing anxiety for patients. However, the term palpitations does not necessarily indicate the presence of an abnormal heart rhythm or disease. Only a detailed medical history allows for initial differentiation and correct indication for further investigations using technical methods. The purpose of these investigations is to distinguish between an organically caused disorder and a so-called functional disorder.
All possible non-invasive diagnostic procedures have been carried out on you with the result of a normal finding, which almost certainly excludes an organic disease as the cause of your described palpitations. At present, there is no indication for further investigations, especially involving invasive techniques, as these carry a certain risk. The fact that you are considered organically healthy does not change the existence of the symptoms you are experiencing. It is now necessary to consider a functional cause and proceed with relevant diagnostics. For example, an anxiety disorder (such as cardiophobia) based on negative experiences, a possible depressive disorder related to lack of appetite, or a state of inadequate conflict resolution may be present in you. It is strongly advised that you consult a psychologist or specialist in this field to identify the source of any fears or conflicts with their help. Our subconscious and soul play a crucial role in this, making it difficult to explain things logically or rationally, which is why attempts at self-healing often fail. If necessary, any potential medication should be prescribed and monitored by a specialist, as many substances used have high potential for dependency and side effects.
To be clear, I do not consider you "crazy," but I believe that a "psychological" issue may be triggering the somatic sensations you are experiencing. Through appropriate psychological treatment, there is a high likelihood that you will soon be permanently relieved of your symptoms.
Best regards, O. Stephan.
