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Q. I have twitching in the upper left chest. Is it a matter of concern?
Patient's Query
Hi doctor,
I have an unusual strange feeling system. There is a twitch or spasm in the upper left chest where the heart is. It has been twitching constantly on and off all day. I have not been sleeping well for the last 3 to 4 days and I am on Adderall 20 mg XR and 2 x 30 mg IR daily. I am sure the lack of sleep and the Aderall are the cause. Is there any reason for concern? It is annoying but there is no chest pain or angina. As of my last heart checkup about six months ago, I have a healthy heart. 34 years old and active but this fluttering or spasm thing is annoying and just want to make sure it is not the coronary artery or something like that.
Answered by Dr. Ilir Sharka
#
Hello,
Welcome to icliniq.com.
I passed carefully through your concern and would explain that your symptoms do not seem to be related to cardiac ischemia. These muscle twitching may be caused by possibile water and electrolytes imbalances. This, in turn, is favored also by Adderall (Amphetamine) intake. I recommend checking your blood electrolytes level together with acid-base disorders. Trying some physical procedures, like warm massage over the affected area, in addition to any anti-inflammatory drug could be of value like Naproxen.
Also, checking your ECG would be necessary for excluding any arrhythmic events or any feature that would indicate any hydro-electrolytic imbalances that may trigger the above symptoms. Sleeping not-well is an important contributor for generating muscle twitching and other issues. You should be careful with the drug intake and periodically check ECG and blood parameters to timely prevent further homeostatic abnormalities. You should discuss with your attending doctor on the above-mentioned issues.
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Dear Dr. Roach: I am a 70-year-old woman in reasonably good health. For the past 18 months or so, I have had a vibration or fluttering in my chest. It happens only upon awakening — in the morning, middle of the night or after a nap.
Dear Dr. Roach: I am a 70-year-old woman in reasonably good health. For the past 18 months or so, I have had a vibration or fluttering in my chest.
It happens only upon awakening — in the morning, middle of the night or after a nap. I’ve had an EKG and worn a Holter monitor for 24 hours. My doctor seemed to think the results were normal, except for one short episode of a heart rate of 120. I don’t want to sound like a hypochondriac, but it’s somewhat disconcerting, since it keeps happening.
Should I be concerned or pursue it further?
A.E.H.
Fluttering sensations in the chest are very common at all ages. Your doctor quite reasonably worried about an abnormal heart rhythm (arrhythmia), and a Holter monitor measures every heartbeat for 24 hours.
If you had the sensation while wearing the Holter monitor, and at the time of the symptoms you had a normal heart rhythm, that’s very good evidence that the sensation is not being caused by your heart rhythm.
Sometimes, if a person has no symptoms during the 24 hours, the doctor might order an event monitor, which is like a Holter that you wear for a month, and records only if you tell it to or if it recognizes an abnormality.
So, if you had symptoms during your Holter, I would be reassured that it’s not a heart-rhythm problem. If not, you should speak with your doctor about an event monitor.
Not all fluttering is caused by heart-rhythm issues. Muscle twitching (called fasciculations) in the chest muscles causes similar symptoms.
Dear Dr. Roach: When I sit and take a meal or drink coffee, my eyes slowly close. But I’m not asleep. My daughter or son-in-law will speak my name or bump my foot to get me to open my eyes.
I was having coffee the other day and actually dropped my cup. I am getting worried.
I’m 80 years old and in good health.
Anon.
The most concerning condition that comes to mind would be myasthenia gravis. It’s caused by antibodies at the site where the nerve tells the muscle what to do (called the neuromuscular junction).
The eyelids are the classic involved body site, with more than 50 per cent of people affected predominantly in the eyelids. Double vision also is common in this condition.
Early on, myasthenia gravis has intermittent symptoms, but over time they become more persistent. I would recommend that you visit a neurologist. Physical exam, blood tests and sometimes an EMG (a test of nerve and muscle activity) and a trial of medication in the office make the diagnosis.
Early symptoms of myasthenia gravis can be subtle, and it’s entirely possible that what you have is something much simpler.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to