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Forum Name: Arrhythmias

Question: Junctional Rhythm Mild Regurgitation and Chest Pains


 Bennasdwarf - Mon Dec 29, 2008 11:56 am

Hello. I am a 33 year old smoker, 108 lb female who's been experiencing chest pains for the last couple years. However, it recently (the last year) gotten progressively worse.

My symptoms, (although I'm not sure if they are all related) are:

starts as like a squeezing in my chest about an inch and a half to 2 inches from the top center of my chest (a couple inches down from the end of my collar bone. I don't know how to describe it other than that... it isn't sharp- it kind of reminds me how my arm feels in a blood pressure cuff)
difficulty getting a deep breath
left shoulder aching
then the left arm tingles almost like it's falling asleep, but not quite as it goes numb
lightheaded- which have led to fainting
sweaty and sometimes queasy
sometimes, only more rare, sudden headache at the bottom left side of my head

I went to my GP and upon my arrival, he was quick to dismiss it as anxiety. Finally, He put an EKG on me and sent me to a cardiologist that week siting signs of a junctional rhythm.

At my cardiologist, his EKG there revealed a dip before my my QRS wave and a long pause after my S.( I think he said) He said he wasn't sure what it meant. Said he wanted to see the results of the 24 hour before deciding. 24 hour came back as follows: (the overview)

The average heart rate was 78. The maximum heart rate was 122. Pauses greater than 2.5 seconds were 6. Ventricular ectopy was 565 with 18 V-Runs and 43 V- Pairs. Ventricular Bigeminy events were 1 and ventricular trigeminy events were 0. Superventricular ectopy was 88 with 0 SV Runs. 0 Superventricular Bigeminy events. 0 Superventricular Trigeminy events. Total A-Fib were 0 Mins 0 Secs. ST episode minutes totaled 4. The maximum Delta ST change was -1.4.

During my follow up to go over these results, the doctor did not have the results available, he had to get them faxed over, did not look at my blood work until I suggested it (which only showed a high sugar level of 108) and seemed rushed, so much so that he didn't even print the results of the EKG until I asked him to. After that, he proceeded to tell me all the areas that looked erratic were most likely artifact. And that the reading had to have been wrong or a computer glitch.
He said he would do a stress test to make me feel better, but seemed relatively unphased by my concerns about these things I am experiencing. My father has heart disease, and strokes, and dimentia and had a triple bypass in his late 40's. My grandmother had medication for a high pulse rate as well as my great grandmother. My mother has a mitral valve prolapse, although mine seemed normal.

My GP requested a 30 day Holter Monitor from my Cardiologist. I am ok with that, and am going to the second part of my nuclear stress test tomorrow. My echo only revealed a mild regurgitation.

I worry that something is wrong, as when it happens, it can last minutes, or it can last hours. When it lasts hours is when it's most frightening as I'm worried it won't stop or that it will worsen. It has progressed to being something I experience on a daily basis, rather than every couple weeks. I don't want to have one of these things come on when I am driving or whatnot... the loss of consciousness frightens me.

Do you have any advice your insight you could offer? I'd greatly appreciate it.
 John Kenyon, CNA - Wed Dec 31, 2008 10:26 pm

User avatar Hi there -

The symptoms you describe are disturbing enough, but are difficult to attach to the EKG/Holter monitor findings. The description of the resting EKG, as passed along by you, suggest you may have some sort of pre-existing damage (that "dip" before the QRS complex sounds like a Q-wave, which can show up for no good reason, but often suggests prior injury). The dip also could have been a delta wave, which would indicate a less worrisome, but still problematic electrical problem that is readily fixable, called Wolfe-Parkinson-White (WPW) syndrome. The pause between the S and T waves indicates an electrical abnormality, which is certainly borne out by your Holter monitor report. It's difficult to say what exactly is going on, but there is something abnormal in electrical pathway. How this ties in with the symptoms is difficult to know at a distance.

You have a family history of early heart disease, which is never a good thing. This may have absolutely nothing to do with what's happening to you, but it's always a big red flag, and nothing you've told us here would suggest your problem is anxiety-based, although you're probably feeling some very reasonable anxiety as to what may be wrong.

You may need to find another cardiologist. This one's attitude toward you, which is often seen in regard to young, otherwise healthy women, is not a good start. He's been dismissive and less than attentive. I'm also curious as to how you're having a nuclear scan/stress test done in two parts on two different days. Could you explain this to me? I'd really appreciate it.

You could have something as simple as mitral valve prolapse (MVP) even though it didn't show up on echo (it often does not), but even if you do, this sounds as though it may be a more complex syndrome than usually seen with that. The family history
concerns me, and of course loss of consciousness always concerns me, as does relatively typical chest pain. The EKG abnormalities (I'd love to see the actual tracing) concerns me. The Holter monitor report is problematic. There is plenty enough here to warrant a one-day, comprehensive nuc scan/stress test at least. You may need a consult with an electrophysiolgist as well (specialist in arrhythmias). Something just isn't right. It may not be terribly serious, but it's definitely disruptive and you deserve proper care, diagnosis and management of anything this disruptive, serious or not.

I hope this is of some help. I don't mean to cause you to worry more, and please bear in mind that this has been going on for a while without progressing much, so it's probably not anything terrible, but it certainly deserves a long, hard look and the appropriate tests and exams. Please update us on the "second part" of your stress test (that really troubles me) and follow up with us as needed. Best of luck to you. Hopefully you'll know a lot more real soon.

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