I have leakage in my heart and thickening of the heart wall. Lately I will awaken three or more times at night and feel like the inside of my body is shaking, although it is not visible. The shaking lasts for 10 to 30 seconds. My pulse is normal, and I had a stress test. Now I am wearing a 21-day heart monitor. Doctors are puzzled and so am I. What do you think?

Post cardiology consultant Dr. Douglas Zipes responds:

“You don’t say how much valve leakage you have or how thick your heart wall is; both factors are important for me to determine what is going on. I would guess these changes are not too serious because you would probably have more symptoms like shortness of breath, fatigue, and so on. How did you do on the stress test? Lack of visible shaking when you were symptomatic would exclude chills, seizures, cramps, and so on. The next thing I think about is a heartbeat disorder, a so-called arrhythmia.

“Arrhythmias commonly cause palpitations that, to some, are a feeling of shaking inside the body, with nothing visible on the outside. But you say your pulse is normal. I assume that you mean it has been checked while you had those feelings. If not, then it could be perfectly normal in between episodes and still be responsible for your symptoms. The results from the heart monitor should show whether you have an arrhythmia. But remember, the monitoring must be done while you are symptomatic to be valid. Let me know what the test shows, and we can go on from there.”

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