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Forum Name: Ischemic Heart Disease

Question: My Father's ruptured MI broke all the rules?


 Rosemary349 - Thu Nov 19, 2009 7:24 am

Hello (this was posted in a different site/forum, but it's inactive there and now i have found this site hoping someone will help!....thanks!)

I'm hoping there may be someone who can provide me with some reassurance or information.....or just tell me what you think was going on for my father. I need to understand everything.

My father died suddenly 5 weeks ago from an acute ruptured MI, haemopericarium and a circumflex artery thrombosis. He'd never shown any signs of heart disease over the years (he was 64 when he died). He never seemed to have angina on exertion and would spend long hours in the garden doing heavy work. His blood pressure was always normal as far as i'm aware (he always told me it was normal but unless i see his medical records i won't know for sure)............but i don't think he had any other tests, he never went to the doctor. He was never ill.

He'd had two days of indigestion and died on the third day. Strangely the indigestion had eased that day, but had just started up again minutes before he died. I'd phoned a medical helpline the day before and they said it sounded like a stomach bug and that we should watch out for a 'crushing chest pain,' but otherwise let it run it's course..........well we did that didn't we! The crushing chest pain occured about 20 seconds before he died.

I have many concerns and obviously i'm trying to process all this so any help you can give me would really be appreciated.

Firstly - i've been having panic attacks ever since this happened, worried that it would happen to me. I think if it hadn't happened 'out of the blue' then it wouldn't be so scary - although it would still have been as devastating.

So my question is are there usually warning signs before a heart attack? Is it usual that the person will get tested and be found to have high BP or high cholesterol, or angina first? My doctor keeps telling me that this probably didn't happen out of the blue, that my dad would have had some symptoms which might have been picked up had he been given relevant tests (but there was no reason for him to request those tests).

What i'm coming to is if you have ok BP, ok cholesterol and no angina, pass a stress test.....statistically what would be the likelihood of a heart attack happening out of the blue? I know things happen, but statistically - is there any info on this?

Also does a ruptured MI mean that the heart muscle ruptured? My doctor says yes.

Did the heart muscle rupture because the indigestion my dad was having for two days was actually a heart attack (for two days!!!) which destroyed the heart muscle?

How does someone have a heart attack for two days? Or was it unstable angina? and why was it not felt in the chest but in the stomach (with lots of belching)?

My biggest fear is to suffocate, i'm claustrophobic. In my mind a heart attack would feel like suffocating? Is this true?

I'm also very worried about what my father experienced. I know he wasn't particularly worried about the indigestion, although he was uncomfortable. He was laughing and joking minutes before all this happened.....why had the indigestion eased slightly that day?

Ok form this point on I really need to understand what dad was experiencing. He mentioned that the indigestion was back, but still not as bad as the day before...then he said there was a pain in both armpits, but he said it was mild. He had a bit of a nervous laugh. I asked to feel his pulse (i thought i might get some reassurance as he always had a strong and steady pulse)....it seemed to be racing slightly.....

he looked to see my reaction, saw the hesitation on my face and began to stand up, saying he had to call a colleague

he then launched into this phone call (did he know?)

while on the phone he suddenly started rubbing his chest, it still seemed incongruent with his general level of health so i still didn't pay much attention - although i was also watching him like a hawk

he quickly finished his phone call and then looked straight ahead at the wall, he appeared to be muttering under his breath - like someone does when they are thinking something through...

but he didn't answer me or ever speak again after this point (was he already losing conciousness?)

because he looked as though he was deep in thought, i thought he was, something to do with the phone call maybe.....

then he took a sharp intake of breath and looked around at us - at this point i realised he had come around from something and that maybe he wasn't fully concious before - though i had thought he was

no sooner had he looked at us then he turned quickly and stared back at the wall and seemed startled - something was happening in his stomach.....this was all happening so quick so i'm not sure how accurate i am being but i remember getting really frightened because it looked like something was about to burst out of his stomach.......just when i thought it might he seemed to go calm and it all stopped again....

then he leaned forward on the desk....he seemed to be trying to lift his head to our calls but couldn't, then slumped forward.

I know this is awful reading - but I would welcome any 'expert' at all out there, anyone with any knowledge to tell me what seemed to be happening.

I'd like to think that because dad seemed to be calm quickly then it must have been because he was losing conciousness. I hope so. Also earlier, at the start he didn't answer me at all but seemed to be muttering under his breath whilst staring at the wall....losing conciousness there too? and if so, why did he have a sharp intake of breath, seem to come round and turn to us momentarily? How could that have happened if he had had a cardiac arrest?

Sorry for the negative thread, but the more i can get my head around all this the easier it will be for me in the long run.

Thanks for reading, i really appreciate your time.
 John Kenyon, CNA - Fri Nov 27, 2009 10:14 pm

User avatar Hello -- First I'd just like to say in all sincerity I am terribly sorry to learn of your loss. It would have been difficult enough without having witnessed this relatively rare phenomenon. I will explain to you what appears to have happened, and I hope it will give you some sense of order to overlay this horrendous experience.

Before I begin to explain I'd like to insert here, for the sake of any passing readers, that three days of indigestion, even three hours of it, is a red flag and should be investigated, especially in men over the age of 50. If there is a long history of gastroesophageal reflux this is still a long seige of a specific symptom. Please don't let it get by as "likely" indigestion when more often than not this sort of symptom is suggestive of a cardiovascular problem. It often presents this way.

Now then: the circumflex artery, one of the major arteries feeding the heart muscle, and so one which is often stented or bypassed, serves the left ventricle usually around to the back of the heart. It takes off from the left anterior descending (LAD) artery, the one known as the "widowmaker" because the LAD is the primary trunk line for the left and bottom parts of the heart and often can shut down rather quickly. Since each one of us is somewhat different in terms of coronary vascular anatomy, some are more dependent on one artery than some others may be. For instance, some may have a dominat right coronary artery (RCA) which is large bore and reaches further than some of the other, retiring RCAs. Some may have a dominant circumflex, and it would seem this may have been the case with your father. When the LAD or circumflex artery becomes blocked or severely narrowed (myocardial infarct or unstable angina, now often called acute coronary syndrome -- ACS) the large and strong left ventricle can be weakened significantly, so that it becomes flaccid, develops an aneurysm or sometimes can even rupture, especially if the blood supply has been reduced for a period of time. Again,this is likely the case this time, as your father had symptoms for several days, but they weren't textbook classic symptoms -- and while it's great to recognize those textbook presentations, about half the time -- and especially if the injury is taking place low in the heart, it can manifest at epigastric distress often mistaken for indigestion. If this does not respond quickly to an antacid, there's a good chance, especially in males over 50, there is something else going on. I wouldn't accuse the advice line person of mishandling this, I can only say I am far more conservative and would have addressed this somewhat differently. Unfortunately advice lines do rely a lot on textbook scenarios. Your father's situation was a little different from those illustrations in a textbook. This happens. It is relatively rare but far from unheard of.

Now then: Your panic attacks are very normal given the circumstances, but the triggering fear is unfounded. While you now have a family history of heart disease and so must count that as a risk factor, the chances of having the exact same thing happen at any future time is almost nil. You're pretty young to even be a candidate for advanced heart disease, but your father was in the prime range -- and sex -- for it. The fact it wasn't a classic presentation may have been the fatal flaw in all this. You should have a baseline cardiological workup for your own peace of mind and for future comparison purposes, but not because this sort of thing is likely to ever occur again in your family or even in anyone you know. Heart disease is common (including in post-menopausal women). This particular outcome is not.

There are sometimes warning signs before a heart attack, sometimes not. Often even the signs are atypical enough (and especially so in women, who almost never have the textbook presentation) that they are often missed. This particular one was an atypical one that is known among emergency medicine people and cardiology experts, but not widely recognized generally, which is unfortunate. The problem rarely happens out of the blue, but it can show up fairly abruptly, which is how the word "attack" came into use. It's not there, then it is. Your father actually had two days or more of warning symptoms, but they're not classic, so they were missed. No one can be blamed for this in a system which is evolving slowly toward greater awareness and caution. No one wants to make anyone a cardiac neurotic, but sometimes this is avoided at the patient's peril.

The "out of the blue" heart attack, even following comprehensive cardiac workup including stress test is almost legendary. The reason is sudden rupture of plaque in a major artery, suddenly blocking or narrowing it. This happens quite often. It doesn't reduce the value of the workup, but is something we are still learning about as we go. Knowing this happens has already taken some of the mystery out of the problem of the apparently healthy person falling prey to an attack like that. In your father's case a regular (annual) exam might or might not have picked this up, but there was no justification based on prior symptoms, at least any he'd reported (and might not have recognized anyway).

A rupture of the myocardium means precisely that. If it is found on autopsy or angiographic exam, it's a literal rupture of the muscle due to prolonged or profound lack of blood supply. This is not always even painful, let alone classically so. In men it is more often, but not always. So much depends on the way the vessels are laid out in an individual. And yes, the "indigestion" was almost anginal pain manifested that way as it often is. The heart muscle was being compromised a little more each minute this persisted. These drawn-out events are the ones most likely to cause the most harm if there is no intervention. An MI is often a culmination of several days (or weeks or even months) of vague symptoms. The belching is caused because the part of the heart affected often lies near the diaphragm and affects the phrenic nerve. Swallowing of air to relieve the discomfort (presumed to be indigestion) also contributes to the belching.

An acute heart attack may quite often -- but hardly always -- be accompanied by shortness of breath if not actual sense of suffocation -- but also vague or classic discomfort ("crushing", "squeezing", "vise-like", "constricting" are words often used to describe the pain, as well as "indigestion"). Prodound fatigue, shortness of breath, palpitations, all these can be symptoms -- or not. Women tend to have more often atypical and rather vague symptoms, but a sense of something being wrong is often another strange red flag. It can be "just" anxiety, but it also is often reported in conjunction with vague symptoms. Pain in both armpits is slightly atypical but not as much as one might think. It's always something that should grab the attention.

The final events you describe sound to me like someone just realizing something may be terribly wrong and trying very hard to figure out just what to do and how to do it so as to avoid causing an uproar. This is extremely common whether the "attack" is "massive" (a much abused word) or placed so as to do minimal damage, and it is very difficult to guage the severity by the intensity of the discomfort. Some terribly painful, classic presentations wind up causing minimal to no damage, while some very subtle ones can wind up causing terrible consequences. This is why they all need to be treated the same -- with a healthy dose of concern but not panic.

Your dad was very likley losing consciousness near the end, but even cardiac arrest isn't always absolute, and sometimes a person will simply have a very disrupted heart rhythm which corrects for a time. In the case of myocardial rupture there is also sometimes a "grace period" when blood is trapped inside the pericardium -- then slowly puts so much pressure on the outside of the heart it can't function any longer or the damage simply becomes too large.

There is a terrible immediacy to the experience you had, and if there is anything positive in it that would seem to be your father's concern for you that he not upset anyone, and that he was very aware of you and was simply put in a position where there was no quick and easy answer available by the time he realized what was happening.

It is terribly sad, yet there is this strange sort of bonding that can take place in events such as this. I feel this is what happened.

You are in no special danger of having the same thing happen to you but even if that were not a concern of yours you have undergone an enormously traumatic experience. It might be well to have someone with whom to talk this through. Panic attacks are common in survivors of these sorts of events.

Again, I am terribly sorry for your loss. I hope I've helped clear up some of the mystery involved and that you will seek some assistance in dealing with the aftermath of this loss. Please follow up with us here as needed. My very best to you and your family.
 Rosemary349 - Sun Nov 29, 2009 7:35 pm

Hello John

Thankyou so much for your comprehensive reply. I really appreciate it.

Unfortunately i've had numerous panic attacks since i typed out my post and before it got accepted and i got your reply. You reply was very reassuring but there is one thing that's bugging me.

I get a lot of 'indigestion,' myself. It's so mild that i wouldn't even have normally noticed it or called it indgestion. Rather it's a feeling like there's a bubble or pressure building up in my chest, I feel it rise and then my throat makes a funny noise (lol that's the best way i can explain it), sometimes that will be followed by one hiccup and then it's relieved.

I cannot emphasise how mild this is and i'm only talking about it because i'm concerned now that the only possible symptoms that dad had over the last few years was 'indigestion' - and belching. He didn't have anything nearly so uncomfortable as he had in his last few days, but he would occasionally say he had indigestion, belch and then after about 10 mins it was gone.

So i've started looking back in my memory to see if dad had any of these symptoms on exertion. I can't remember any but the only thing i can remember is that when i used the computer at his house, it was upstairs, I would call him up and i was always aware that after climbing the stairs he would often belch. Wierd memory i know but i remember it.

So now i'm worried that this 'bubble' feeling i get in my chest/stomach/throat area is similar. An atypical angina? As i say i would never have even noticed it, it's not distressing apart from the worry of what it means. I don't belch, it's just something i hardly ever do, but i get a feeling of a bubble inside my chest that needs to burst....and then i get a feeling that it has and it's relieved.

I've checked to see if i get it on exertion and I do seem to. often during the day if i am out walking to my mothers' up a hill i notice it. I'm not short of breath - in fact i feel fit enough to run but i'm only walking, but i do feel this sensation then. It does seem to lessen if i stop walking, but it doesn't go away after 10 minutes, more a gradual thing....and there are other times i will exercise and not get this sensation.

I remember having it bad at a wedding once years ago, after eating creme brulee. I was driving a friend home and was so uncomfortable. I attributed it to indgestion then, but now it would really scare me. At the time the only thing that seemed to help was, oddly enough, going to bed and lying down.

Sometimes i find just calming down and resting helps.

My primary physician feels it is unlikely to be angina, more just normal movements of air in the oesophagus. I'm just hoping that my dad's side of the family haven't got some rare disorder where they don't feel chest discomfort, just indigestion. My dad's mum had terrible indigestion and belching in the last 5 years or so of her life, she died of a heart attack....the only one, never any other symptoms. My doctor says it's not relevant because she was 81 when it happened.

Anyway, sorry for the long post....i'm really worried about this sensation now. What do you think based on your experience? I now you can only give your opinion. It's the lack of classic symptoms in my dad that bothers me.

You mention the chances of having the exact same thing happen to me as what happened to dad are almost nil.....do you mean the lack of classic presentation? or the rupture? or the suddenness of the attack? When you say this sort of thing is unlikely to occur again in my family or even in anyone i know - again what do you mean? a heart attack? or the kind of heart attack that dad had? The reason i ask is i found what you said reassuring but not quite sure in what way i should be reassured (ie what do i tell myself when i am in the middle of a panic).

My doctor has agreed for me to see a cardiologist but told me that after seeing one i need to allow myself to be reassured, as he thinks it's likely they will reassure me. He has also arranged for me to receive CBT for the anxiety.

A related issue i do get irregular heartbeats from time to time. Tonight when i was walking home my heart was racing and when i took my pulse i noticed that at times it paused before resuming the beats. I felt 'fluttery' in the chest. I've had a heart monitor on before now (before my dad died actually) but i know it didn't happen when i had the monitor on. I keep being told these ectopics are normal but until i've had a doctor actually see them on a monitor I'm not happy. They seem worse just after my period. Strangely enough i feel better, more calm, resting heart rate is about 68, but i notice the irregular beats more. Premenstrually my heart beat seems more regular but also more forceful and resting at about 80 bpm. Do you have any thoughts on that?

I'm sorry this is a long and rambling post, i really appreciate you reading it if you have....and thanks again for your post above it really has helped me a lot.
 John Kenyon, CNA - Tue Dec 08, 2009 12:35 pm

User avatar You're very welcome.

This bubble sensation in your chest: From the description it really does sound like air trapped in the esophagus, and of course you can feel and hear it move upward, then relieve it with a belch. Here's the whole deal about that, and it may be very important, your understanding this: Most of the gas causing belching is due to swallowed air, during eating, drinking, and especially in anxious people during sighing, which is something almost never done awares by the subject. It is also something people do, just as you've been doing, to relieve trapped gas or feelings of indigestion, so it tends to keep the cycle going. We swallow air consciously in order to belch, thus replacing some of what we just released. In your father's situation not only was his MI likely near the bottom of the heart (so innervated by the same sensors as the diaphragm), so likely causing some epigastric discomfort resembling indigestion (which he would naturally try to relieve by swallowing air to belch), but he may also have felt some shortness of breath on the stairs, which would cause deeper respirations and more swallowing of air. Anxiety also plays a role, to varying degrees, in those symptomatic of some sort of heart problem and is commonly seen in people who suspect, viscerally, they may be having a heart attack but lack what they feel is evidence for that.

It is also common and normal to suffer from anxiety and panic disorder following an experience such as you've had to endure. One part of this would be increased air swallowing. It's almost impossible to notice we're doing it. It's okay though.

Now then, to try and clarify more what I said about you needing not worry about having "the same thing" happen to you as did your father: Specifically what I meant was it is statistically highly unlikely you would have the same vessel, located in exactly the same place, become the culprit vessel in some future possible heart disease; it is even more unlikely, if you were to develop heart disease, even in the same vessel, for anyone to have myocardial rupture because of this. The chances of there being some sort of statistically near-impossible anatomical anomaly passed along is literally incalculable. That being said, we know you have a family history of heart disease (your grandmother and father), so it is prudent to live a healthy lifestyle, manage stress (starting with the terrible anxiety you're currently feeling), and have regular medical checkups that include an EKG. Fairy simple, really.

Atypical presentation of symptoms is farily common, so you could say there is a second-tier of semi-classic symptoms, especially for women, who are far more likely than men to present with more vague or at least less classic symptoms. They also seem to tend to get more advanced warning with these as opposed to men. This almost always occurs in postmenopausal women, but the classic signs are good to know and the less-classic ones are too. They include profound fatigue for no apparent reason, noticeable shortness of breath (very difficult to parse out in an anxious person, unfortunately), prolonged nausea (also common with indigestion and GI viruses of course), and mainly pain in places remote from the center of the chest, such as the shoulder tips, upper arms, neck, jaw and upper back. It should be borne in mind any pain or soreness that can be duplicated by motion, manual pressure, postural change, deep breathing, etc., is not cardiac related. A dull ache in one of the mentioned areas, along with unusual fatigue, nausea or shortness of breath, especially in a postmenopausal woman, should be considered a yellow flag. Classic symptoms are always a red flag.

The need for reassurance should, in theory, be helped by receiving reassurance, but what happens is the "what ifs" get tinier but they keep showing up on the radar, because of course we cannot eliminate all risk from the experience of being a live human. It becomes an obsession if not worked through, so I do, for the sake of your emotional quality of life, urge you to seek help with that. It's not an easy do-it-yourself project!

Your doctor is essentially correct in that your grandmother's having died of a heart attack doesn't "count" because of her age. For her generation she had lived quite a long time. Your father's dying was a little closer to premature. This does not indicated a trend, but rather what might be considered a statistical accident. Nevertheless, we now would "count" your father's relatively early death due to heart disease as positive family history. It may well have been a totally freak event -- certainly parts of it were -- but you're not likely to forget it, ever, and the reassurance of doing the most to eliminate th potential of heart disease in yourself should be worth a good deal, at least so long as it doesn't in itself become obsessive. The goal is actually to live normally and reasonably (stay at a healthy weight, keep saturated fats low, treat naturally-occurring high colesterol under control with statin drugs if necessary, exercise and enjoy doing it, etc.).

I also concur with your doctor about you having a cardiology consult, which should be a good way to establish a baseline of knowlege of your cardiac status, reassure you, and become a useful part of your medical record for future comparisons (and continued reassurances).

Your heart actually is more likely to be more regular (fewer PVCs) premenstrually. We don't know exactly why this is so, but it is a thing noted a good deal and has been found in at least one formal study. Even so, the slower the resting rate the more likely a PVC will sneak in here and there. In most People (there are some who do the opposite), increasing the rate lessens the likelihood of a noticeable premature beat. For this reason many people learn to get up and do somethng physical when they are bothered by PVCs at rest.

No need to apologize for the long post! It's all helpful to others and this reassurance process can be quite complex, as I've pointed out above. I'm happy to do what I can to help clear up things, but do bear in mind you've suffered a remarkable emotional trauma and undoubtedly are suffering a degree of PTSD. Some formal help will likely be necessary to break you out of the cycle of finding new possibitlities to question. It's normal. I'm happy to work with you this way.
 Rosemary349 - Sat Dec 12, 2009 9:00 pm

Thankyou John

I really do appreciate your time. You are the only person that's really gone through things with me comprehensively.

Since i wrote last i've probably had less panic attacks. I've started taking B vitamin complex and .....well i don't know yet but it seems to be helping, along with the advice you have given.

I have had one worrying symptom recently. I've told my doctor. I had a list of symptoms which i said i wasn't worried about if they didn't mean anything bad (the 'indigestion' that i describe above is one of them).....but one symptoms was dfinitely physical and completely unpsychological in my opinion.

Basically i was laying down on a sofa and someone asked me for a telephone number. I jumped up and walked over to a desk to get it. I felt fine but by the time i reached the desk i was dizzy, almost blacking out, and heaviness in my chest, neck and both arms. I just kept telling myself to breathe and i would eventually get enough oxygen. This was the case and the symptoms disappeared within about a minute to two minutes.....or maybe a lot less, not sure.

My friend was totally oblivious to this. I was able to continue functioning normally despite not feeling normal.

The chest and arm heaviness made me feel that my heart couldn't keep up with me, with what i'd done.

I think i have had this in the past, as well as when i was a lot younger.....but of course i have never thought of it as heart related before now.

Dizziness i'd understand as postural hypostension....but the chest heaviness and the arms....?

The doctor said it most probably is postural hypostension and also said he'd be more worried if the heaviness was only down the left arm. Well i expect in the past when this has happened it has just been the left arm. It has never worried me because i've never related it to the heart functioning before and always thought i'd 'got up too quick.' It's possible i've had milder versions of this if i over did things strenuously, like charging up flights of stairs at work, i mean a few floors. At those times i linked it to my lungs not expanding enough because at times i have a bit of asthma, usually mild, but probably i don't treat it when it should.

My doctor said he feels confident there's nothing wrong because I passed the stress test and i didn't have any symptoms when doing that. Also i've been back to my martial arts class and am coping there ok, although i notice fleeting dizziness there if i jump up from kneeling too quick (but it's fleeting, not like what i described above....possibly because i'm already exercising at the class and not in a completely relaxed state?). Generally i'm coping well at the class and going there has done a lot of good for my anxiety.

However what i described above was intense heaviness in the chest and both arms and shortness of breath. I was not having any type of anxiety or panic at the time.

I've also noticed that when i get home from work (i'm on my feet all day at work), and stand from my seat on the train, i get a headache. Sometimes it lingers for about 30 minutes. All this i've told my doctor.

I'm convinced my doctor thinks i'm crazy at the moment. I'm just being vigilant. I cannot just unquestioningly trust anyone at the moment that's all. I will email my doctor and empathise the intensity of those symptoms.

Meanwhile i was wondering what you think? Is angina like symptoms part of postural hypotension? I can't seem to find much information on that. I don't get these symptoms usually when exercising and actually really enjoy exercise. It's definitely sudden exertion and mainly rising after sitting....

Thanks again John! I do hope that others are being helped by reading this too and i do appreciate your time.
 Rosemary349 - Sat Dec 12, 2009 9:23 pm

Just briefly, sorry for a second post, I thought i might add that my cholesterol was measured at total = 3.6, LDL = 2.0 and HDL = 1.19, ratio (don't know which) was 3.0. My doctor tells me that is low and not a risk. However I've noticed that the HDL is lower than the LDL.....should i be trying to change this, or is it the ratio that's important?

I should also mention there are times when i feel that i can't get enough air in my lungs, and i sigh a lot and yet my peak flow is ok....this is usually premenstrually. I could test out whether taking some of my asthma medicene helps i guess? I don't get any chest heaviness then, but because my peak flow is ok i've often wondered is it related to the asthma or not? At those times i just wish my chest would expand wider when i breath in, but it doesn't. I'm pretty sure at times i have taken asthma medicene and it has worked, even though it's not classic asthma.

thanks again!
 John Kenyon, CNA - Fri Jan 01, 2010 11:48 pm

User avatar Hi there and you are entirely welcome.

What you describe as the unusual incident of chest heaviness, weakness or weightniness in both arms and presyncope (near-faint) upon getting up and having walked a short distance before feeling all this is absolutely classic for orthostatic hypotension. I know, that doesn't sound right, but what often happens (not every time, but occasionally) is the upper body (head included, of course) starves out momentarily, and some people actually get quite a distance before this hits them and some of those actually wind up on their knees or their faces. It is especially provocative to stretch upon getting up then walking -- at least without standing in place for a second or two -- since this is often done unconsciously, feels really good til the drop hits, and essentially is a Valsalva maneuver, which causes the heart rate to slow as well as the blood volume to drop precipitously. It won't happen every time, but coupled with your experience of jumping up from a kneeling position during martial arts classes. Why this is more mild is simple enough: Your cardiovascular system is already working more efficiently because you're in the midst of something physically and mentally challenging.

These symptoms, graphically described by you, do not match up with what would be considered angina or otherwise cardiovascular disease, surprisingly enough. What you've experienced is a very unpleasant variant of orthostatic hypotension, and again, one would be well advised to stay for a moment before bouncing off across the room after rising, and especially if there is an involuntary, unconscious stretch included in the getting up. Trust me on this, it's classic, and while it's not the heart that causes it directly, you certainly could fall and hurt yourself (speaking from experience here). Best to get up, wait a sec, then if it still starts to happen, slow down, stop if necessary, bend forward at the waist or simply get down on the floor before you fall down. It shouldn't happen too often, but frequency varies. It also can be worsened by inadequate fluid intake.

On the upside I am very happy to learn your panic attacks seem to be on the wane. You're doing really well. I don't think this most recent issue is one to write off to anxiety, either. It's a very real phenomenon and can be quite scary, all by itself. I'm glad you came back here to ask about it. It's not at all unusual, but if it's not explained clearly it can be a very worrisome thing. Not dangerous in itself, but no one likes to pass out (at least I wouldn't think so).

Good to hear from you, happy you're doing better, please do stay in touch. Take care.

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