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Forum Name: Cardiology Symptoms

Question: Started with chest pain


 hopeydib - Fri Feb 09, 2007 11:43 am

I am a 29 yo female. about 9 months ago I went to the ER with chest pain. I was given an ekg & chest xray. DIagnosis was chest wall pain. I was given an antiinflamitory to take for 10 days. The pains did go away, for about 3 months. There I was again in the ER, same tests same diagnosis, same meds. I got the same results pain went away for a while but came back. This time my doctors office had an opening & I saw my regular doctor, he agreed with the previos diagnosis and gave me arthrotec. Same thing happened pain came back. To the ER I went again this was about 3 weeks ago. This doctor did a chest xray, ekg and blood work to rule out a geart attack. No heart attack same diagnosis diffrent name. This time they called it costochondritis. he gave me hydrocodone for pain and tolmetin. 1 Week to the day later I passed out and was brought back to the ER. This time I told them I had been dizzy for a few days as well and felt like my heart was skipping a beat. Well they looked in my ears and took blood. I was told that I had a retracted eardrum in one ear and an ear infection in the other. I was given a script for meclizine & clarithromycin & sent home. They said if I didnt feel better in 3 days follow up with my regular doctor. Well 3 days later i still felt very weak, dizzy, & heart felt like it was skipping a beat so I saw my regular doctor. He checked my ears said they looked pretty good but I had a little fluid behind my left ear drum. He perscribed guaifenex and told me to make another appointment if I ddnt feel better soon. Well I went back at the begining of this week cuz I still feel weak, and like my heart is skipping a beat. This time he did an ekg, and blood work. He now says I have an irregular heart beat, and sent me to get a holten monitor for 24 hours. Well about 4 hours into that I had to remove the monitor cuz I was allergic to the adhesive. My blood work showed an elevated wbc count so on an antibiotic I went. he had also put me on xanax cuz he felt i was under alot of stress. (my father is in the hospital, & i cried when he said I had an irregular heart beat) I am now gripped with fear that i will die or something bad will happen if I take the pills. I feel the skipped beat and are afraid the meds will make the problem worse. My fathe was given 6 - 12 months to live 13 months ago. he has had multiple heart attacks, strokes, & chf. I fear i will be in his shoes if i don't find out whats wrong with me. I now get tired doing anything. I was in bed most of the day yesterday, got up when the kids were due home & sat on the couch. At dinner time I put bacon in the oven and was totally drained. I had to go lay down, I got up to eat dinner and was wiped out again. I am scared out of my mind and cant even think about taking the meds with out having a panic attack. I know I should take them but I'm afraid of having a heart attack or passing out again and having no one home to call for help. Should I be seing a cardiologist or another specialist? I feel like something is wrong with me but no one has found it. I went from being very active, everyday to not even being able to make my bed every day. please give me an idea of wher to turn.
 John Kenyon, CNA - Fri Feb 09, 2007 10:31 pm

User avatar Dear hopeydib - I believe you are suffering from a thing I have named "Horrible Coincidence Syndrome." It's not a joke and I do not in the least mean to make light of your suffering. What happens is something turns up that draws the subject's attention
toward a certain area of concern, then other things happen, coincidentally, which seem to confirm the person's worst fears.

You have had a classic presentation of chronic costochondritis. It has been treated appropriately, but has been peristent, and there is probably a reason for this, something physical you are doing or have done which has aggravated one or more of the costochondral joints in your chest - or you may have a connective tissue disease which shows as flareups of painful cartilginous areas, as well as other, rather random-seeming symptoms.

While all of us on occasion have "skipped" (actually usually premature) heartbeats, they often go unnoticed unless they become frequent or we are under some unusual stress. You have had a double dose of stress in that you've had this peristent costochondritis, which caused you to consider that your heart might be involved, plus you are dealing with the seriuos illness of your father,who happens to be suffering from a serious form of heart disease. This certainly qualifies as a "horrible coincidence." The anxiety and stress you've been feeling would provoke more premature heartbeats than usual, but I assure you that unless you suffer from serious heart disease (in which case you'd have had a lot of far more serious symptoms before now), premature heartbeats are virtually never of clinical significance. In fact, they are almost only of concern in people with advanced CHF - such as is your father's case.

Alll that being said, you did have an increased white count. While the most likely reason is some sort of infection (thus the antibiotics), it also could be caused by a flareup of connective tissue disease. This is something that is often difficult to diagnose in short order, and the antibiotics should be harmless to your heart. The Guafeinex is probably the most innocuous medication one can take and has virtually no side effects (and definitely no cardiac ones), and the Xanax will definitely give you at least some short term relief from the mounting anxiety you are experiencing. None of the drugs has even potential cardiac side effects, and no doubt will make you feel somewhat better.

This appears to be a truly awful coincidence complicated by your rightful and natural concern and anxiety over your father's illness. Xanax is probably the thing that would afford you the greatest possible short-term relief. Also some rest and relaxation. If you have either a low-grade infection or a collagen disease, you would feel run down and low on energy. The anxiety you are feeling would likely take away whatever "juice"" you might have left.

Nothing to fear from the meds, and I'm convinced of the relative innocence of the chest pain. I' also want to be very reassuring about the "skipped" beats. In a normal, healthy heart they are of no significance at all, but they not only can cause one to feel additional anxiety, but anxiety also causes more of them. It is a vicious cycle. The Xanax often can serve to break this cycle and actually make them go away or be reduced in frequency.

I hope I have helped ease your concerns some. I will hold good thoughts for both you and especially your father.

Please do keep in touch.
 hopeydib - Sat Feb 10, 2007 10:00 am

Thank you for your time and concern. I will take the meds as reccomened. You have cleared alot up for me and made me feel my worries and concerns were not unfounded or only in my head. We have recived word yesterday that my dad will have to attempt a quadruple bypass, but they feel he may not survive due to other health issues (polio, diabetes, athritis, etc.). You have helped to make me realize his symptoms are not mine they are his & my symptoms are mine. I was researching all my syptoms and only seeing all the bad things it could be not the simple multiple problems it could be. There is 1 reason the internet can be a very bad thing. I honestly thought I would die suddenly of a heart attack. I do have another question regaurding your answer, well 2 questions. The costochronditis seems to flare when I am not doing much at all sometimes it wakes me up, sometimes its doing dishes is this normal & is there a way to heal it and not have it come back (as it scares the crap out of me each time due to dads history)? Also if it is a connective tissue disease should I be asking for a specific test or doing anything on my own to help this problem? Thanks again for your help and concern.
 John Kenyon, CNA - Sat Feb 10, 2007 11:48 am

User avatar Hello again - You are very welcome, and I'm glad you're going to take the meds. I think you'll notice a big difference, at least in terms of the anxiety level. Just remember that Xanax has a short half-like (it's supposed to work for six hours but usually goes away sooner than that) and it's best for temporary situations - if you find it becoming ineffective don't just take more; let your doctor know, as there are other drugs in the same family that are better for long-term management of anxiety if that becomes a problem. But it is a great short-term help. It may make some people slightly drowsy, also, although that usually wears off with continued use.

It's a great insight you've gained, that your father's symptoms and illness are not yours. It's very easy to do that reverse projection (there is a correct psychological term for that but it won't come to me now) and take on the symptoms, problems, etc., of another. Another great insight you've shared is the discovery of the two-edged nature of the internet: information without context. It is very easy to learn things about symptoms which, taken out of context can sometimes be terrifying. You are obviously very intelligent, so I'm glad you shared that here where others will read it also.

Costochondritis can be caused by a lot of things, including unwitting postural errors, repetitive upper body tasks (liike lifting a small child with one arm), and also by recurrent viral inflammation (with or without other symptoms), coughing, and, of course, connective tissue disease. I wouldn't want to send you off looking for trouble, as it usually has some very prosaic, boring cause. But if you were to develop other, related symptoms, over time, such as joint pains or other really random, annoying aches, pains, etc., then yes, there are blood tests to determine if there is an autoimmune (connective tissue) disease present, to what extent, and sometimes to narrow it down to a specific one. This isn't something most doctors would do on the basis of a single, localized problem, though, so best to give it a chance to resolve before going on a hunt.

Again good luck to you, and keep us updated.
 hopeydib - Tue Feb 20, 2007 1:14 pm

Hi again!
I have been back to my regular doctor to review the results of a 24 hour holter monitor. He has set me up with a cardiologist late this week because of one finding.

Here is what the hand written part of the test says....
"24 hour holter reviels NSR, th average heart rate was 78 bpm, the range was 47 bpm - 114 bpm, there was a 2 second pause on ftB7, 534 AM need to consult about 2nd degree type II heart block"

My doctor says it is probably nothing and there is no need to worry but he would feel better if a cardiologist agrees that is nothing. He did say if I had this conditon treatment would depend on the excat diagnosis of cardiologist, but could range from drugs to a pace maker. He told me not to worry, but Hello, he just said I may need a pacemaker. Ok this is where I start to freak out.

My main question is can you tell me in english what this heart block is & if I have it will I be able to lead a normal life with a pacemaker?

Thanks for the time put into giving any insight an this new finding.
 John Kenyon, CNA - Tue Feb 20, 2007 1:55 pm

User avatar Hi Hopeydib - One of the most disturbing things a doctor can mention is the possible need for a pacemaker. I think they often forget (or maybe never have realized) what an emotional impact this can have on people. The reason they'd lose track of that fact is that for them, as well as for most modern pacemaker users, it really becomes very nearly a non-issue. Still, it's somethng extra, and it frightens people, usually unnecessarily.

What was seen was a single incidence of 2nd degree heart block. Now he didn't happen to mention whether that was Type One or Type Two, did he? There's a significant difference, and one is far less serious, as a rule, than the other. In either case, however, a single episode of 2nd degree heart block would seem to be a freakish anomaly and probably really does mean nothing. Usually second degree heart block is an established pattern. When it occurs singularly as in your holter monitor test it is most likely either just that (an aberration that means nothing) or a faulty reading on the part of the doctor or the tech who saw it first (sometimes the doctor simply reads the reported findings).

Heart block means that all the regular sinus (normal) hearbeats do not get through the atrio-ventricular node (AV node) that resides between the upper and lower chambers of your heart and helps to keep things orderly. Its purpose, in effect, is to block certain undesireable rhythms or rates from reaching the ventricles and to generally function as a "hall monitor." It can develop some sort of occult disease at times, or be damaged due to surgery or infection, and then it can malfunction and block normal heartbeats. Second degree block, type one, usually isn't very serious, although it can, in some people, cause transient light-headedness. It rarely progresses to a more complicated block. It also is not considered a "condition" unless it is constant. Many people can experience a transient block like this without even realizing it, for a number of reasons including the effects of medication, metabolic disturbances, stress, sleep disturbance, etc. This usually passes without notice. It is probably unfortunate that one such occasion of a block showed up on the the Holter tracing, because now it does have to be followed up, and I'm willing to bet it will be found meaningless.

In very rare cases this could be an early sign of disease of the AV node, in which case eventually a person might require a pacemaker. Given the way yours turned up, I find that hightly unlikely, but of course it will require the analysis of a specialist to be absolutely certain that's not the case, and will probably mean a later follow up Holter monitor to see if there is any evidence of such an odd occurrence in a different 24-hour period. If it were me I'd want to be certain, but I also wouldn't be overly concerned, as it really does seem like an aberration, and because pacemakers have become so inoccuous.

A 2-second pause could have been a simple sinus pause, blocked premature atrial contraction (PAC) which occurs more often in normal persons, or even a random, inexplicable, one-time appearance of what most likely would have been second-degree type one block.

By all means go ahead with the follow up, as it will in any case help to reassure you, but go in knowing that a single pause in 24 hours is usually nothing. If the cardiologist decides it is still up in the air after looking at the tracing and doing a 12-lead EKG, then probably a second Holter device would be ordered. If, on the other hand, for some bizarre and unlikely reason you by then are showing a regular pattern of 2nd degree block but are without symptoms, then the cardiologist will hopefully explain the various possibilities and make some suggestions.

This is, I feel certain, a non-issue, but everyone concerned is under a certain obligation to be sure that's the case. The chances of this being anything that would eventually require a pacemaker are very slim, but still worth knowing about. The only thing worse than finding that you might need a pacemaker some day would be to not know. Best case will be a pat on the back and assurance that this is just one of those wierd little things that usually pass unnoticed.

Good luck to you, I hope you find this reassuring, and please do let us know what you find out.
 John Kenyon, CNA - Tue Feb 20, 2007 2:01 pm

User avatar Post script to Hopeydib - I just now realized your doctor did note that it was possbily Second Degree Type Two, if it was a block at all. This is even less likely than the more worrisome Type One, but if that's what it was, it is a far less serious issue anway, and still remains a likely freak incident, especially because of the time when it was noted; many transient and innocent one-time blocks are noted during sleep and I'm guessing that at that hour you were either asleep or just recently or partially awake. All the more reason to not be overly concerned.

Again, please do keep us updated.
 hopeydib - Tue Feb 20, 2007 2:58 pm

Yes I was asleep at that time. I will post back friday with what the cardiologist says. Thank you for all your help & concern, you deserve a gold medal and a million dollars for helping me through all this.
 hopeydib - Fri Feb 23, 2007 3:04 pm

I Saw the cardiologist today, he feels the holten monitor was fairly normal. He said the pause should not be of to much concern, & that in some people it is normal but it will be something to monitor as I get older. He did have one concern though.

He has set me up for an echo and a treadmill test. He feels the costoondritis should have at least cleared up some by now, and because the sypmtom of that is chest pain he wants to make sure that that is an accurate diagnosis (especially due to family history). He said due to the symptoms I have had (weakness, chest pain, head aches, etc) we should at least look into making sure my heart is ok.

He says the echo is a simple test that will show alot (shape & size of heart), & the treadmill will show alot (activity)as well. Hopefully this can be resolved easily, with minimal findings (I would be happy with no findings).

Thanks again for all your time, thoughts, answers, & concerns.
 John Kenyon, CNA - Tue Feb 27, 2007 10:58 pm

User avatar Hello - I personally would rather see a doctor be conservative like this and give you the peace of mind you deserve by ruling out - or even in - structural heart disease and/or coronary artery disease. It's a win-win situation because while it seems unlikely, women do often have atypical presentations of heart disease and again, this is a sound, conservative approach that can do no harm but certainly can make both you and the doctor feel better about whatever is actually going on.

Good luck with this and please do update us on what you find out.
 Gena79 - Mon Mar 26, 2007 6:59 pm

Im not a DR or a nurse ... I just was reading over your symptoms and they sounded like how I felt when I had a thyroid disease. They treated it with medication and I was just wondering if you had checked into this.

At the worst point of me feeling sick, I had to crawl down the hall just to make it to the restroom. Just making my daughter a sandwich was very hard for me to do. I always felt weak and dizzy, plus due to my body working so hard just to do small and simple tasks.... I felt like my heart was going to explode because it was beating so hard and I was very out of breath.

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