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Forum Name: Valvular Heart Diseases

Question: having bad palpations and pounding w/ chest pains


 annie38 - Sat Oct 04, 2008 10:05 am

i've been having chest pains,tighness and pain inmy chest sometimes i have to grab my chest,i have palpations,heart pounding,fluttering,dizziness and lately i gotthis cough that wont go away..i had a holter on for 30 days and these where some of the reading..
atr flutter 3:1 w/ mostly rapid vent response
sinus rhythm single pvc artifact
sinus rhythm/mild sinus tachy w/ identifiable ectopy
sinus rhyth sinus tachy w/ 2 runs of idiovent tachy w/ rate up o 180 bpm
sinus tachy w/ no ectopy atr flutter bbb wanding baseline
sinus tachy w/ occs interpolated pvc excessive artifact

a little about my problem i started out feeling my heart rate got thru roof lik e in 2,2008 was in hospital for 5 days had ablation may ,2008 for avnrt my rate was almost 300 after that started feeling it again but not as much put started getting worst and worst so they gave me mointer for 30 day and thatswat came out but lately been feeling alot of pain in chest left side but few couple of day been feeling pain in my right side of chest also could that be my heart also very high family heart disease grand parents and 3 uncles and 2 aunts died of heart disease please can u tell me something thank you
 John Kenyon, CNA - Sat Oct 04, 2008 9:52 pm

User avatar Hello -

Your event monitor results show several different things going on at once, and these need to be explored to discover the underlying cause. Since you had AVNRT already, and had it ablated, it is not unreasonable that you might have other electrical abnormalities as well. The variety of arrhythmias recorded by the event monitor all could cause chest discomfort, pressure or pain without there being any significant coronary artery disease, but given the extremely positive family history for coronary artery disease you should be (or should have been) worked up for this as well as having been evaluated for arrhythmias.

The findings from the event monitor report are interesting but also present at least one finding that doesn't make sense. Hopefully you have access to additional information which could help clear this up. While atrial flutter with a rapid ventricular response would cause chest discomfort, palpitations, dizziness and even possibly a cough (some sufferers do report this), the finding of "idioventricular tachycardia with a rate up to 180 bpm" actually doesn't make sense. I say this because, firstly, the term "idioventricular tachycardia" isn't usually used, and idioventricular rhythms are either very slow escape rhythms or, if not slow, then are called "accelerated idioventricular rhythm" and are generally only about 15 beats faster than the regular sinus rhythm, and most often lower than 100 beats per minute. At a rate of 180 bpm, this would actually be considered ventricular tachycardia.

In the case of each of the two tachyarrhythmias above, the report doesn't mention duration of the episodes, and this could be very important. Atrial flutter not only is uncomfortable, but can, like atrial fibrillation, can cause clot formation in the atria, which can come loose and cause stroke. If it is only an occasional and very brief episode it may not be significant. If the episodes lasted any significant amount of time, however, you may need prophylactic medication to prevent this from happening.

Since you had AVNRT to begin with, it is entirely possible you might also have Wolfe-Parkinson-White syndrome (WPW), which is also correctable, usually, by the same ablation technique used to correct AVNRT. WPW is usually easily detected on resting EKG, but not always, so this should be explored, and whether or not WPW is present, the duration of episodes of atrial flutter need to be known.

The idioventricular tachycardia issue needs clarification as well. And finally, you need to be evaluated for possible coronary heart disease. I don't now how much of this has been done or is being done in possible followup, but it all needs to be addressed. Your various arrhythmias would account for the symptoms you describe, and while atrial flutter is not life-threatening it does have the potential, if it continues for sustained periods, to cause clot formation and stroke, so this needs to be addressed. The ventricular arrhythmia most definitely needs to be clarified. While both of these would account for the numerous symptoms you are describing, the rate attributed to idioventricular tachycardia really needs to be clarified. If this is incomplete or erroneous information it may not be significant, but the rate of 180 bpm concerns me both because of its potential to cause harm and because it is inconsistent with the definition of this arrhythmia. If these two issues can be clarified and coronary artery disease ruled out, you may really have little to be concerned about, but until then I really feel you should pester the cardiologist about this until you get some concrete answers.

I hope this helps or at least gets the ball rolling. If there is any other information you may have, please let us know. Thanks for bringing your concerns to this site. We'll look forward to hearing from you.

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