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Doctors Lounge - Cardiology Answers
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| SEARCHING
- Fri Dec 22, 2006 12:22 am |
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Hello, I am a thrity one year old female who has been having heart palpitations, or fluttering, flip flopping of the heart mostly while lying down. After the palpitations etc. sometimes I am short of breath and my fingers and feet tingle or feel cold, I feel dizzy and sometimes it seems as if the room starts to fade or become dark. I also experience mild chest pain, shoulder and neck pain with headache. On one occasion I was also very sick to my stomach. I have never had any serious sugeries. My doctor seems to think I am having panic attacks or anxiety attacks. He perscribed Lexapro for anxiety and Xanax for the flare ups. I also have Hypothyrodism which on my last test was fine and I take Synthroid. I also have Athsma, for which I use an inhaler as needed. Along with the other symptoms above, alot of the time I am very tired and weak and I have one to two migraines per month for which I was perscribed Relpax, I have only taken this medication once. My family has a history of heart disease. My Uncle had a tripple bypass at 39 and another bypass in his 50's. My grandmother died of congestive heart failure and her mother died of an heart attack. My aunt also has heart problems and I have a great aunt who had a brain tumor and died. My doctor doesn't seem to look into familhy history or ask about it. He just seems to be convinced that it's anxiety. I would really appriciate your opinion on this. Thank you so much for your time.
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| John Kenyon, CNA
- Fri Dec 22, 2006 3:04 am |
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 Dear Searching: While your symptoms are syfficiently vague to lead to a presumptive conclusion of anxiety as the root cause, there are two other factors that could be causing your symptoms. One is innocent and normal. The other warrants a closer look.
The "innocent" factor is bedtime palpitations, which are caused by the same mechanism as "after dinner" palpitations: a slowing of the heart due to natural fatigue and/or stimulation of the vagus nerve by digestion. This is quite normal.
The one that warrants a closer look is your positive family history for coronary artery disease. While premature beats, the usual cause of palpitations, are not diagnostic of heart disease at all, the fact that they brought you in to the doctor's office and caused you to disclose a positive family history, normally would be enough to warrant a cardiac consult to rule out any possible coronary artery disease. The simplest way to do this would be for your doctor to refer you for a nuclear scan stress test and echocardiogram. If these are all normal (as is likely) then you could feel safe in trying to ignore the palpitations or learn to live with them.
As your doctor has duly noted, there is a basis for suspecting many of your symptoms are caused by anxiety, and that has been treated. If your symptoms continue to make you uncomfortable then the real issue should be addressed by ruling out any possibility of coronary artery disease. My instincts suggest this to be a combination of normal ectopic heartbeats and some attendant anxiety, but I also feel it would be helpful to you to have active heart disease ruled out, something I would suggest to anyone with a strong postive family history. Good luck to you!
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