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Forum Name: Arrhythmias

Question: Chest pain - symptomatic bradycardia


 Mike Rickard - Tue Jul 13, 2004 2:56 pm

I was hospitalized June1,2004 exhibiting-
chest pain, symptomatic bradycardia, syncope.
Lab data:
sodium- 135,
potassium- 4.1,
chloride- 99,
CO2 of 27,
glucose- 91,
BUN-11,
creatinine 1,
ALT of 29,
alkaline phosphatase- 77,
AST- 17,
CK of 89,
magnesium 1.7,
LDH- 145,
cholestrol- 157,
triglycerides- 77,
HDL- 47,
LDL- 95,
CKMB- 0.3,
troponin- 0.03,
WBC count- 10.3,
hemoglobin- 14.1,
hematocrit- 41.8,
platelets-220,
granulocytes- 67.2,

INR of 0.9,
PTT of 29.
EKG- sinus brady, 47 per minute, no acute ST-T changes.
Stress test- Normal
Nuclear Perfusion Study, Normal wall Motion, Resting- normal, Exercise- 12 minutes, peak heart rate 90, stress- normal.
CT chest- Benign Calcified Granulomas in right middle and right upper lobe as well as Calicified Mediastinal Lymph Nodes, no worrisome airspace opacities identified, Minimal scarring in the lung bases.
Chest PA & Lateral- Heart is not enlarged. Apical pleural thickening on the right. Lungs mildly hyperinflated. No air space opacity. Heavily calcified granulomas, in right middle lobe.
CT head- no significant abnormality.
Transthoracic Echocardiography- Left vent. septal thickness- 0.91, Left vent. Posterior-0.85, Left vent. Internal diameter Diastole- 5.8, Left vent. intern. systole-4.0, Aortic Root- 3.4 Left Atrim-3.6, Valve Structure- Aortic- slightly thickened, Mitral- normal, Tricuspid- normal, Pulmonic- normal.
Doppler- Mild tricuspid regurgitation.
Estimated systolic pulmonary pressure is in the order of 30-35 mmHg.
Can you see any other tests that needed to be done before they discharged me with no treatment.
Holter monitor showed 39 hr for low and 55 for high. My condition seems to be worsening, chronic fatigue, and pale skin color, headaches are increasing. Is there something they are missing? Thank-you for any input you may have.
 Dr. Yasser Mokhtar - Thu Jul 15, 2004 7:45 pm

User avatar Dear Mike,

It looks like you were not taking any medications that could affect your heart rate.

Are you an athlete? Do you perform heavy and strenuous regular exercise? What was your heart rate both resting and during exercise before all that started to happen? How long have you had these symptoms?

i think a thyroid function test called tsh should be performed if not already done as an underactive thyroid gland is well known to cause bradycardia.

It looks like they ruled out the major causes of bradycardia. Stress test, echo and ct scan were done.

One thing to add. Even though i don't think that this is the case, the granulomas in your lungs together with bradycardia could be caused by a disease called sarcoidosis that affects the lungs and heart. But it should have been picked up by the ct scan and the echo, so it was ruled out as well.

Since no other abnormality was detected and you are still symptomatic, i guess that you are having the begining of early degeneration of the electrical and conducting system of your heart. i think the next best step to do is to see a cardiologist specialized in the electrical and conducting system of the heart called an electrophysiologist. If he thinks it is necessary, he will conduct an electrophysiologic study of your heart to study the electrical and conducting system of your heart and then decide whether you need treatment or not. In such cases, treatment is a pacemaker.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 Mike Rickard - Fri Jul 16, 2004 9:34 am

Thank- you for your reply.
I have worked as a framing carpenter most of my life, and kept very active, the chronic fatigue and syncope has only been occassional since haveing Bells Palsy in 2001. At that time my heart-rate at rest was 65, stress unknown. Holter report while hospitalized for duration of 15:30:00 Heart-rates were: 39 Mininum, 53 Average, 83 Maximum, 0 beats in tachycardia, 43371 beats in Bradycardia- 88% total. BP 100/60. Thyroid levels were: T4 Free- 0.94, TSH- 4.30. EEG was normal. I am awaiting insurance acceptance before referral to cardiologist. My fatigue has increasingly gotten worse, am I in any immediate danger from what you see in the test results? Thank-you,
Mike Rickard
 Dr. Yasser Mokhtar - Wed Jul 21, 2004 1:39 pm

User avatar Dear Mike,

i don't think that you are in immediate danger from what the test results said.

i would suggest that when you feel the most fatigued to try and take your pulse see if it is really slow.

i did not mention that in my previous reply but there are sometimes brain problems that can cause bradycardia and near syncope. So, i would suggest that you have a ct scan of the brain and a carotid/vertebral dupplex done to rule this possibility out. Some people also are investigated by an eeg (brain electrical activity drawing) if they lost consciousness but if you have not, there is no need for that.

Otherwise, there is nothing else to do except wait for that visit to the cardiologist. Most probably you will have a tilt-table test and may be that electrophysiology study that i mentioned before.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped and keep me posted.

Yasser Mokhtar, M.D.

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