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Forum Name: Cardiology Symptoms

Question: Hypotension, bradycardia, Atrial fibrillations and syncope


 emmtre - Sun Mar 16, 2008 3:46 pm

I am female, 37 years old, 173cm and 88kg.
I´m healty and fit, do cardiovascular exercise 2-3 times weekly, normal diet.
I´m a government official and have an office job with some travelling.

A few years ago (4 years ago first time, 2 years ago last time), I experienced atrial fibrillation on 4 occations, observed in the ER and leading to hospitalization and further tests. All 4 times they ended by themselves. It was observed at the hospital and a following 24h Holter-monitoring that I have extrasystoles most of the time at rest, but it was explained that this is fairly normal, and not dangerous. Absolutely nothing was found wrong with me - I was found to be in excellent health and fit, normal bloodpressure, very healthy cholesterol etc.
The reason for the atrial fibrillation was deemed to be stress.

Since this (2 years ago until 1 year ago) I´ve fainted or near-fainted on several occations. Once during exercise, once walking on the street, once having lunch, once reading a newspaper at work. My previous history led to re-testing, and again I was found to be in excellent health, but the same story with the extrasystoles. I went through 24h Holter-registration, a one-week registration carrying a monitoring device, echo, stress-test without any findings.
But it has been observed that my resting pulse is low (between 30 and 40), my blood pressure varies between low (eg. 85/48) and normal. I have not done any long term monitoring of blood pressurse, btw.
I´ve been to the cardiology dept of two different hospitals to do these tests.
Again, stress was deemed to be the reason.

Last year, I was hospitalised with severe chest pains and checked out for embolisms in my heart and lungs. Again, nothing was found wrong through 3 days of hospitalization and testing, except indications that I had some kind of virus. I was told the symptoms and tests indicated a possible virus on the lung sack. My low blood pressure, slow resting pulse and extra systoles were again pointed out to me.

A a result of these incidences, I reduced my work hours to 6 per day, and try to make sure to get 6-7 hours of sleep per night.
I make sure to eat right, and to get enough salt and water. I exercise, and walk/stay active whenever possible. I have never smoked, and only drink on rare occations. I drink 3-4 cups of coffee per week,
I have a handicapped son, and this takes quite some effort on the home front.

To bring a long question to end:
Since last summer, all has been well. The last two months I´ve noticed more of the extrasystoles, normally a sign that my stress-level is increasing.
Today, while painting a wall in our house, I must have fainted - as I woke up on the floor. I was standing while painting - no changes in posture. I don´t know how long I was passed out, but on previous occations it has been only minutes, followed by drowsiness.
When I woke up, I was extremly drowsy, and a bit heavy if breath. My husband took my blood pressure - for the next half hour it varied between 85/55-ish to 122/100-ish, and finally stabilised at 115/65-ish. My heart rate ranged from 32 with the low blood pressure and up to 100 with the high blood pressure, and it has stayed between 90-100 since - that´s higher than normal for me.
After about half an hour I was more or less back to myself, but very tired.
I´ve been eating and drinking normally today, and have used the same paint before without any problems.

I didn´t want to contact my primary doctor on this occasion, because he seems to think I have stress induced panic attacks when I experience these episodes, since nothing is wrong with me. The fact that there is no panic, fear, or awareness of any attack at all does not seem to faze him.
The hospital feedback is not in this direction - rather it has been indicated to me that this is almost certainly not a reason for what happens.
I also don´t want to contact the ER, since they always tend to send me to the hospital in an ambulance just to make sure. Since I´ve done all the tests before and anyhow feel better now than earlier today, that seems a bit of an overkill, right now.

Is there anything that could explain what my heart is doing and why?
Do I need to get checked out again, or should I just note it down to all is well, but I need to stress down?
Any advice?
 Dr. A. Madia - Mon Mar 17, 2008 10:25 pm

User avatar Hi,

Atrial fibrillation [AF] by itself is a serious arrhythmia. Low pulse of 30-35 [as you say it is] is also something to worry about.

AF has several causes. Rheumatic valve disease, hyperthyroidism, Coronary heart disease, degenerative heart disease etc. However it is more common in females and sometimes none of the above causes can be found. In this case it is termed 'Lone Atrial Fibrillation' and the cause is attributed to stress or sympathetic overactivation.

The fact that you passed out while painting the wall suggests that you have a problem maintaining good Blood pressure in the upright position. With your frequent drop beats, history of AF and this I am of the opinion that a consultation with a cadiologist with a Tilt Table test and electrophysiologic study is necessary. Holter is commonly normal even though there is an abnormality and its diagnostic yield is very poor.

I hope this is useful to you,


Apurva

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