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Forum Name: Cardiology Symptoms

Question: Abnormal EKG - Need advice


 Need advice - Mon Mar 07, 2005 12:33 am

I wrote about a month back about symptoms that I thought were heart-related but kept getting told by the doctor that it was GERD. The last time I went to the doctor's he listened to my heart again and said that it was beating fast and he refered me to a cardiologist. Went to see cardiologist and he said that yes my heart was beating fast and that he thought I had a stomach ulcer. He said that he didn't think it was heart related. But he had me wear the 24-hour holter monitor. Went back for the results last week and he told me that he had found some abnormalities and that he wanted to do more tests for structural heart disease and angina - I am now terrified that I have something seriously wrong with my heart. I am scheduled to have an echocardiogram and a treadmill test this Thursday and then I won't get to see the cardiologist until a week later. I had an endoscopy and they found some acid in my stomach - now taking medicine for that. My worry is the palpitations - yesterday I had a very scary incident where I went to the supermarket after walking up five flights of stairs and suddenly I had a pain on the left side of my chest and I couldn't even bear my shirt to touch my chest. I was also sweating. I didn't have the palpitations on that occasion. Does this sound like angina or something else? I can walk up the stairs without palpitations in the morning, but in the afternoon they appear. The cardiologist hasn't prescribed any medicine so far and I am so worried that I am about to have a heart attack. How likely is it that I have angina?
 Dr. Yasser Mokhtar - Thu Mar 17, 2005 1:13 pm

User avatar Dear Need advice,

Thank you very much for the update.

By now, i think that you already had the echocardiogram and the stress test and about or just saw your cardiologist.

How did you do on the treadmill? How long did you stay on the treadmill and what is the maximum that your heart reached? Did you have any chest pain? Why was the test terminated? Were you told that the ekg was normal during the stress test? Anything the echo tech told you about the echo? Was there mitral valve prolapse?

The probability of this chest pain be due to coronary disease is still very low. You are in a female in the child bearing age. You don't have any major risk factors for coronary disease. Your chest pain is atypical. My prediction is that your stress test is most probably going to be normal.

If everything turns out normal (the echo and all), i recommend that you have a neck x-ray/ct scan to rule out neck spine problems.

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

Yasser Mokhtar, M.D.
 Need advice - Sat Mar 19, 2005 1:19 am

Hi,
Thanks for getting back to me - I did the echo and they said nothing was unusual. Then I did the treadmill test and they said it was stable I had no arrythmias during the test. I then went back to the doctor for the results of the echo and treadmill - should have mentioned that I am from England but I am currently teaching in South Korea - bascially he said he couldn't find anything in the two tests so he went back to the EKG and now he is convinced I have WPW syndrome and Atrial Fibrilation. He said i was being sent to the main cardiologist for EPS and they would do an abalation. Of course I totally freaked out and my parents were on their way here - he had said it was fatal, so I was thinking that I was about to drop down dead at any moment. Saw the most senior cardiologist in Korea yesterday and he looked at the results and said that he thought that such an arrythmia in a young person is nothing to worry about. He hooked me up to the 24 hour holter again last night and I have to go back for the results on Monday.
 Dr. Yasser Mokhtar - Sat Mar 19, 2005 1:50 pm

User avatar Dear Need advice,

Thank you very much for the update.

Those must have been some horrifying few days till you met the cardiologist.

wpw (Wolff-Parkinson-White) syndrome is not a fatal disease. There is of course some potential fatality in any disease but i don't think that this was the way to tell you so.

wpw is a condition where there is an abnormal electrical accessory pathway (connection) between the upper chambers of the heart, called atria (where the electrical impulses of the heart normally arise) and the lower chambers of the heart, called ventricles (that pump that blood to the lungs and body). If this pathway is functioning, which it is not in many cases, the electrical impulses of the heart pass through it from the atria to the ventricles in a shorter time interval. Normally, when the electrical impulse passes through the normal electrical pathway, there is a normal delay in passing the impulse from the atria to the ventricles which in a way protects the heart from very fast heart rates.

If it so happens that a person with wpw has a functioning pathway and develops an abnormally fast heart rate, all these fast impulses are going to be delivered without delay from the atria to the ventricles and this means that the heart will, in some cases, not have the time to fill with blood and hence no blood is pumped and the patient loses consciousness and if the arrhythmia does not brake by itself or the patient treated immediately, then death might happen. This happens very rarely. The incidence of suden death was 0 - 0.4% in several large case studies. If the patient is asymptomatic, never had any arrhythmias before, the incidence is virtually non-existent.

Having atrial fibrillation with wpw is not a good thing, because with atrial fibrillation, abnormally irrgular fast electrical impulses arise from the atria at a rate of 300 or more per minute, normally, 150-200 are only delivered to the ventricles in case of normal conduction. But, in cases of wpw, and with no delay in conduction, all of them reach the ventricles and then the heart could stop. i am sure that is why, when you doctor thought that you had wpw with atrial fibrillation, he told that it is a fatal condition and set you up immediately with the cardiologist.

Did the cardiologist tell you that you really have wpw and atrial fibrillaiton or what was his diagnosis.

Some patients describe palpitations (their feeling of their heart beating in a fashion that they are not accustomed to as chest pain and this could be what is happening to you here. You are getting palpitations and you are feeling it as chest discomfort or pain.

Regarding palpitations and especially in young healthy persons, please feel free to go through some of the posts here in the cardiology forum that dealt with this issue, and if you still have any questions or concerns, i will be more than happy to answer them. Start with this post.

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

Yasser Mokhtar, M.D.
 Need advice - Mon Mar 21, 2005 7:56 pm

Hi, Thanks for your information. I did the 24 hour holter and went back to get the results yesterday. The doctor ruled out WPW syndrome just by looking at the EKG results. He said that I did not have it and that the machine at the other hospital could have been faulty. He did however say that he had found two arrthymias - one SV Tach that lasted for 5 beats and one V tach that lasted for 4 beats. He said that while the V tach is normally dangerous, due to a lack of abnormalities in my heart and because my heart is structurally ok, these beats will not hurt me. He advised me to lose weight, cut out caffeine and to cut down on alcohol. He didn't prescribe any anti-arrythmia medicine but he did give me some medicine to slow down my heartbeat. He said to go back in a month.
 Dr. Yasser Mokhtar - Tue Mar 22, 2005 3:28 pm

User avatar Dear Need advice,

Thank you very much for the update.

This sounds like a good plan of action to me. Hope that you had the chance to take a look at the posts here on the website as well.

You are young and being committed to a life time of anti-arrhythmic medications just for one episode of v-tac is not a good thing as your cardiologist pointed out. Follow the doctor's recommendation and make sure to be at that follow-up appointment.

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

Yasser Mokhtar, M.D.

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