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Forum Name: Cardiology Symptoms

Question: Worries of heart rate And Heart Failure


 Blackrain99 - Sat Mar 08, 2008 8:44 am

Hello,

I should start by saying I am 22 years old I weight about 182lbs roughly and am about 1 cm shy of 6 feet tall, (I smoked off and on from nov 04 - feb 06 when I quit and have not smoked since could that have caused any damage?) So I no longer smoke, I do not drink never have. And my life style is admittedly very sedentary.

About a year ago I started experiencing elevated heart rates, though it is quite possible I had them before simply did not notice them at the time as from 2006 and on my main fear from my anxiety disorder was my heart, so when it happend I felt very hot suddenly shakey. and my heart rate shot up to 170 beats per minute and took roughly 2 hours for me to calm down and for my heart rate to once again drop below 100 bpm and go back to normal. I had several (3-4) more of these and I contacted my doctor- Whom only 1 month prior had given my yearly phsyical which for the first time included an EKG as I asked for it due to my own fears. It came back with a BPM of 114 but with a NSR and everything looked fine.

So when I went back in to see her she used a device to take my pulse and listened to my heart for several minutes and took my bp which was of course high (I am very nervous when I have tests done) and after all that she had a long talk with me and my father, she upped my xanax dosage which was before these events only 1/2 a mg a day to 2mg's with a slow increase and allowed me an extra 1mg if needed for bad episodes and I brought up beta blockers and CHB's to her, She said beta blockers were something she was considering but did not wish to push on me , but she also thought them worth a shot as the one she prescribed she said (Toprol) Had the effect of reducing symptoms of the Fight or flight response (panic attacks) and it would keep my heart rate under control since that was a main worry of mine and still is. I was originally on 25 mg and that was reduced to breaking the pill in half. I had a follow up with her in Sept of 07 and things seemed ok then also pulse at the visit earlier that year was 103 pulse checked at this visit was 90 which during an anxiety episode is a good improvement at least to me I think. (since starting Toprol I have only had 3 time when my heart rate exceeded 140 and they never lasted more then 30 minutes that I can THINK of.)

My questions are straight forward - Does this drug put me at risk for heart failure? because lately I have been feeling like my heart is beating .. Weaker? I used to always be easily aware of it and now that is quite hard to do.

Do these episodes seem like anxiety or panic related or more related to something like SVT ? I also get these.. heaving like feelings in the center of my chest sometimes And I was curious if these are indicative of anything heart related.

Do you think another EKG is warranted and what would you say in your opinion is my over all cardiac risk for heart failure / disease / attack and can my medications lead to or cause it?

I would ask my doctor these questions but as my insurance company and I are having some problems this is the only place I could think to turn to.

My past history includes Diagnoses from 2001-present for GERD and Panic Disorder and Chronic Anxiety.

Thank you very much.
 Dr. A. Madia - Sat Mar 15, 2008 12:07 pm

User avatar Hi Blackrain,

There are several reasons for a fast pulse rate. More common of these are Anxiety, panic, fever, low HB, SVT, atrial fibrillation, Hyper Thyroidism, pregnancy, etc. The list goes on but these are the frequently encountered ones.

Now, your EKG showing NSR means that Atrial fibrillation and SVT are automatically ruled out. I take it, you don't have frequent fevers and your HB is normal. I am sure you can't get pregnanat [lol !] hence we are left with thyroid and anxiety. I just feel anxiety is the root cause of your predicament.

Toprol [metoprolol] is one of the treatment of heart failure and it cannot be the reason of it.

I suggest you do a lot of aerobic exercises. This will condition your heart and increase the vagal tone which will reduce the heart rate. Vigorous exercises will also divert your mind to some purposeful activity and reduce the anxiety. Exercise also induces secretion of beta endorphins from the hypothalamus in brain which induces a sense of well being, euphoria and stimulates the immune system!


Apurva
 Blackrain99 - Sat Mar 15, 2008 12:23 pm

Thank you very much for your response, Dr. Madia. It is greatly appreicated, and I certainly hope I can't get pregnant lol. I will try to over come my fear of heart rates and do that exercise, I have a treadmill collecting dust so I might as well get some use out of it! My last question was this , do beta blockers cause any weaking of the hearts actual beats over time? As I have been on 12.5 mg of the pill once a day for year.

Thank you and have a great weekend!
 Dr. A. Madia - Sat Mar 15, 2008 1:03 pm

User avatar No, they do not!
 Blackrain99 - Sat Mar 15, 2008 1:16 pm

Ok. Thank you again Dr.Madia You have been of great help.
 Blackrain99 - Thu May 15, 2008 1:30 pm

Hello Dr.Madia.. I had another question I forgot to ask.. is it possible for anxiety or panic to cause my heart to race for 2-4 hours at speeds of around 130-180. Because despite taking 12.5 mg of metoprolol. I was forced to take another 12.5. As my heart started racing and It took an hour after taking it as it slowly brought it back down to the 80's.. I did what I could to monitor the rate itself. It never seemed to beat unevenly. Just VERY fast. no skipped beats that I noticed.

So is it possible anxiety and panic caused this?

In SVT are the beats uneven?

and are high heart rates like this lethal? or damaging?

Thank you very much
 Dr. A. Madia - Fri May 30, 2008 9:23 am

User avatar Anxiety or panic usually cannot cause the heart to go ar the rate of 130-180. And if the rate is irrgular, there is a likelyhood of this actually being an atrial fibrillation. You do need to get a fresh EKG, preferably taken when your heart is actually going fast.
 Blackrain99 - Fri Jun 13, 2008 1:20 am

I just went to my doctor 2 weeks ago.. She did listen to my heart while it was racing probably over 120 she listened and had me breathe for probably 5 minutes. it has never been irregular its always steady... just fast. I Forgot to ask for an EKG I was to nervous to remember.. But my Internist seems to think whats going on racing and such is all anxiety and stress related...

Do you think that is accurate enough?
 John Kenyon, CNA - Thu Jul 10, 2008 1:32 pm

User avatar Hi Blackrain99 -

I'm following up on open questions in this topic and having read through the whole thread here I am pretty well convinced your symptoms are anxiety mediated. Although a rate of 170 is very unusual for sinus tachycardia, it can happen, especially in people who already have a lot of adrenaline loose in the bloodstream and a higher-than-normal resting rate. While there is a remote possibility that your rapid rate is due to a tacharrhythmia such as atrial flutter or juntional tachycardia (the former requires some attention but is not extremely serious and usually never goes much over 150; the latter is more annoying than anything else; both are pretty regular, whereas atrial fibrillation is extremely irregular), it seems, given all the facts you've provided, that it is unlikely anything but an extreme response to intense anxiety.

Are you currently taking Toprol on a routine basis? One of the things I've learned is that unless doctors specifically educate their patients about beta blockers, people tend to lapse into only taking them when they perceive a problem, then stop when it appears to be corrected. Stopping a beta blocker, or taking one only intermittently, can actually cause a rebound effect which will aggravate the very problem you are seeking to solve. Just a thought.

The fact that your doctor was examining you during a rapid rate episode at last visit and didn't feel it necessary to perform an EKG would suggest she feels there is nothing to be revealed that way, that the heart is essentially healthy, but just running at a rate that's uncomfortably fast. This is where beta blocker therapy comes in handy, although you could of course be suffering from an overactive thyroid. Has this been checked?

I noticed also, earlier on, that you asked about Toprol making the heartbeat "weaker." In a sense, the answer is yes, but not in a bad way. What beta blockers like Toprol do is to block the body's uptake of adrenaline, a stress hormone that can make the heart beat faster and harder. The drug is used for a lot of different heart-related things, including blood pressure reduction. It accomplishes this by not only slowing the heart rate but also by reducing cardiac output -- in effect making the heart beat less vigorously than it would otherwise. This is a good thing as a rule, since the overall overactivity of the heart is far more noticeable to the patient, and usually makes one more anxious because of this awareness. So while it does decrease the force of the beat somewhat, it is bringing it more into line with what it should actually be, and that's all to the good.

If you take a beta blocker intermittently or stop it abruptly, this definitely can cause a very unpleasant response wherein the heart will start beating a good deal faster than before, and the force will also be noticeable. In addition, because of the uptake of adrenaline, one may also feel quite anxious when this happens.

You've been on a very low dose of Toprol, but hopefully you are taking it as prescribed, which is every day, not just "as needed."

Please keep in touch, and I hope this finds you feelng well.
 fallen1964 - Wed Apr 08, 2009 9:29 am

I am a 44 year old female with similar concerns. Two years ago I had a couple "episodes" that felt like a heart attack. I became suddenly light headed, so light headed I had to lay on floor, felt "spacey" and felt like heart might stop, also had profuse sweating as if I just got out of a shower.

I had a reveal loop monitor implanted a year ago but never another episode as described above. I too have had tachycardia at rates over 170 bpm.

My heart tests reveals all four valves are slightly leaky, stage one ventricular dysfunction described by my electrophysiologist as mild thickening. I am on 200 mg of Flecainide a day, one cartia XT 240 a day.

I also have dual av nodal conduction.

ECG shows no evidence of MI, however my first ECG following an "episode" showed a past MI, my heart doctor thought it was misread

First Heart Institute said there was nothing wrong, just drink Gatorade, said I was dehydrated. Second Heart Institute gave diagnosis above as well as a failed tilt table test and a diagnosis of orthostatic hypotension. I also have a hole in my heart.

Yesterday I asked my doctor about the heart wall thickening and he said it is nothing to worry about, however all my research seems to contradict that statement.

My mother has CHF, atherosclerosis and heart muscle weakening diseases.

My question is this, could my recurrent childhood pneumonia's (annually from age 15 months to age 9) caused this heart wall thickening? And how can this not be significant considering my familial history of serious heart disease.

I still have heart runs up to 140, I'm still aware of my heartbeat. I am exhausted all the time with mild exertion.

My concern is I'm not getting good advice, possibly due to being a "hands on " patient or the fact that I am on medicare and medicaid.

Please help before it's too late.
 John Kenyon, CNA - Wed Apr 08, 2009 3:49 pm

User avatar Hello--

It's a pretty mixed bag you've been handed, opinion-wise. I'll try to not make it more complex but perhaps simplify it a little with any luck.

First, those episodes you describe sound like orthostatic hypertension but more likely vasovagal syndrome, also called neurocardiogenic syncope syndrome. While benign, it can certainly be upsetting and frightening, and it is often seen in people (more women then men) with patent foramen ovale (PFO), likely the hole in your heart you referred to, a small opening that normally closes in utero, but sometimes is incompleted. This usually has no symptoms associated with it, but it can sometimes, for unclear reasons, cause or at least be associated with symptoms such as you describe. It's rarely repaired anymore. With neurocardiogenic syncope problems you can often also have inappropriate sinus tach (IST, which it seems you do at times). It's also pretty unsettling.

I always will take issue with Flecainide, especially when I'm not sure, as with you, exactly what it's supposed to be doing. Usually it's only used for control of atrial fibrillation anymore, and otherwise isn't a real good idea. There are other far more effective and safe medications to help you manage what seems to be going on. I'd really badger the doctor about the puropose and wisdom of Flecainide.

Some slightly leaky valves are often normal. Stage One ventricular dysfunction is a very vague finding, but should at least be followed up. The dual AV nodal conduction (AVNRT) is something worth consideration as far as possible ablation, as this often will correct a lot of the other problems and is routinely done now, as it is the most common cause of supraventricular tachycardia (SVT) which you have been told you don't have but seem to be being treated for anyway. This is puzzling. The finding of old MI is often in error and needs to be redone and looked at again with a critical eye, but chances are that was a mistake, as it is one of the most common misreadings done by EKG machine computer readings. Turns up all the time.

As for the childhood pneumonia: it could have had some deleterious effects back at the time, and they may have remained with you for a long time now without anything getting worse. What happens then is we just get a baseline picture of the heart's health as an adult and follow it with that considered. Again, it could account for some of the valve and thickening issues, but it's not something that's usually progressive. You have some congenital issues that could be better dealt with though, and maybe a change of doctor or second opinion might be helpful. I'd really like to know, though, the rationale for the Flecainide. Please follow up with us here espcially if you can get some answers about that. Good luck to you.
 fallen1964 - Fri Apr 10, 2009 9:33 am

My electrical study showed the dual av nodal conduction and inducible atrial flutter. My cardiologist said that ablation would result in my needing a pacemaker, because of the failed tilt table test.

I began on Flecainide last summer, during which I still had episodes of tachycardia with some SVT happening so in August they added the cartia XT240. My last recorded episode was in December at 140 bpm.

Yesterday they removed the reveal loop monitor. My son was with me and noticed that my heart rate got down to 62. Now I'm worried the medications are causing bradycardia. I asked the P.A. and he said that I didn't need to worry about that.

Unfortunately, this is my second opinion. I felt better about the diagnosis than the first who virtually said there was nothing wrong with my heart. Lately though, I'm thinking that this Flecainide could be messing me up worse. I'm always tired, have no energy and extremely blurred vision.

I have thought about requesting an appointment at Mayo as there are no more options in the town I live in.

It is hard to know what to think when a doctor tells you there is nothing structurally wrong with your heart but tests reveal that there is. What's stranger still, I only had one episode of heart problems when I was 29 and it was atrial fib/flutter??. This episode is what led me to my first cardiologist who said I had Mitral Valve Prolapse and the flutters were simply regurgitation. I accepted that, probably because nothing happened with my heart again until last year.

I too expressed my concern about taking Flecainide and initially refused to start it until I had an episode that took me up to 178 bpm. I began it out of fear and now I fear it is causing further damage to my heart. I have read the literature, I am a college graduate, however I keep being told not to worry about it.

Is it true that with my condition an ablation would make a pacemaker necessary? Is the combination of calcium blocker and arrythmic agent causing this bradycardia? Can it also ultimately lead to more severe heart problems, including CHF?

I think my doctor's feel it's best not to reveal everything because with my heart problems I have had extreme anxiety as well which of course, exacerbates my symptoms.

What, as a cardiologist would you suggest as treatment or followup?

Thank you,
Mary Ann
Lincoln, NE

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