Doctors Lounge - Cardiology Answers
"The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician."
Forum Name: Cardiology Symptoms
Question: Fluttering arteries or muscle spasms?
|moldvictim08 - Thu Jul 23, 2009 1:05 pm|
Hi. I am a 31 year old male who is currently being worked up by cardiologists for chest pain and erratic heart beats. I am 5' 8" and weight 155 pounds.
I have been noticing lately that I have fluttering or erratic beat sensations in my neck and in my wrist areas right where the arteries are and I am concerned that my arteries are spasming or passing a blood clot of some sorts. My d-dimer has been somewhat elevated in the past few months and that's why I think "blood clot."
Today, I was feeling my pulse on my left carotid artery and it was steady. At the same moment, I was feeling the right carotid artery and it was sputtering and beating erratically. Is this even possible to have one artery pumping at one rate and another at a different rate? Should I be concerned that this is cardiovascular or just a muscle close to the arteries? If so, I'm afraid this could cause a problem.
Please let me know if you have any thoughts on this.
Thanks so much,
|John Kenyon, CNA - Wed Jul 29, 2009 1:01 am|
Hi there --
First, the elevated D-dimer finding is one thing and warrants further watching, but the heartbeat irregularities (palpitations) are essentially normal and routine, but do occur more often in people with mitral valve prolapse (MVP) which shows up in your history along with anxiety, which is also frequently a corollary of MVP and does tend to increase the frequency of premature heartbeats.
About this latter (premature heartbeats, which are extremely common in otherwise normal hearts), they may originate in the upper or lower heart chambers and generally have no clinical significance even if frequent and complex in the absence of left ventricular dysfunction. We all have them from time to time, and certain things can make them more frequent (and so disturbing), including caffeine, nicotine, post-exercise relaxation, post-meal relaxation and digestion (always more frequent during digestion), stomach upsets, anxiety, certain medications, and the list just goes on and on. The important thing to bear in mind is that they are essentially innocent even in a critical setting, let alone in a healthy heart.
The fact you've been exploring possible causes of chest pain is the probable reason for the D-dimer test, which is usually only done to determine if there has been a clot or clots present over the preceding few weeks. This doesn't mean there is one anywhere now, however, as they often dissolve on their own. Knowing if there'd been one could be useful in preventing future ones, however, and while this is a potentially serious problem (but only if there is a clotting disorder, for which you have also probably been tested by now), heartbeat irregularities are rarely related to this and are extremely common. The only real exception would be that when lung problems exist this sometimes causes atrial fibrillation (A-fib) and A-fib can also predispose to formation of clots, although they rarely wind up in the lungs.
Your doctor is doing what seem to be appropriate tests, and would want to rule out A-fib, which is different from premature heartbeats. From your description of your palpitations it sounds more like premature heartbeats, which is far less of a concern except when it provokes additional anxiety. They become difficult to ignore in anxious people, which leads to a vicious -- but physically harmless cycle.
Your observation of a steadily beating carotid artery and a seemingly erratic radial would suggest a muscle spasm in the wrist area, something one might not normally notice if one were not trying to check one's pulse in two places at once. The carotid is always the more reliable of the two, and rarely has overlying vouluntary muscle spasm, unlike the wrist, where it happens frequently. And no, it's not possible to have two different pulses in two different arteries. The radial pulse was being obscured by twitching voluntary overlying muscle.
I hope this helps allay your concerns and perhaps answers your qeustions. Please follow up with us here as needed. Good luck to you and please let us know what, if anything, your doctor finds.
|moldvictim08 - Wed Aug 26, 2009 10:55 am|
Thanks for your reply. I wanted to update you with what was going on and see if you could provide any opinions.
An ultrasound was done on my carotid arteries and was found to be normal. Most of the spasms in my neck have disappeared, but I've had a lot of pain in my jaw and pulsating pain in my left shoulder and arm that concern me that there is still some kind of blockage going on in my arteries. I've been to the ER several times and cardiac enzymes come back normal, however I'm wondering if they can do a non-invasive test to check out my arteries.
I am also very confused as I've been to a couple different cardiologists and electrophysiologists and they have varying opinions based on looking at the same event recorder strips. What they all agree on is I have an Incomplete RIght Bundle Branch Block that occasionally shows up on EKG. Some say I might have Sick Sinus Syndrome as they've seen episodes of Tachy-Brady, but others say it's good vagal tone. I also am troubled by tachycardia everytime I go to urinate standing up, particularly in the middle of the night. My heart rate sometimes reaches 120 bpm then returns back to normal when I'm done. If I sit down and go, it stays around 72 bpm. They also recorded a brief 5-beat run of Ventricular Tachycardia that was auto-captured, but they are not concerned. I thought this was not normal and potentially dangerous?
I'm concerned something is still happening. I get a burning sensation in my mid-chest which make me short of breath sometimes that doesn't go away, even after taking liquid antacids. I do this to rule out GERD but I'm fearing that I have a blocked artery or something else going on.
Any thoughts on this? I wonder if there's something neurological going on affecting everything...
|John Kenyon, CNA - Fri Aug 28, 2009 8:16 pm|
The ultrasound (US) of your carotids is a very good indicator of the condition of the arteries in your neck, head an upper body, so that should eliminate most concerns about arterial problems. The pains you describe sound a lot more, by now, like they are either nerve related or possibly orthopedic (probably cervical vertebrae-related if so). The chest pains, as suggestve as they might be, are largely discountable as cardiac due to your having been evaluated thoroughly for cardiovascular disease.
The incomplete right bundle branch block (RBBB) is such a common finding among healthy people as to be virtually meaningless. It is by no means a de facto companion of sick sinus syndrome (SSS) which is fairy rare, and strong vagal tone could easily account for the bradycardia. The tachycardia of brady-tachy (SSS) is usually pretty marked and is often in the form of atrial fibrillation as well.
Finally the mild tachy during nocturnal urination -- this is extremely common in males, is often even associated with otherwise normal fainting (syncope of micturition) and one good way to avoid this problem, since the bathroom is a dangerous place to fall in, is to sit down to urinate during the night if you've experienced any lightheadedness. Otherwise is a normal phenomenon.
It would seem, due to the unusual monitoring results you've had, that you do a lot of self-monitoring and wouldn't know of these findings if you didn't do this. Since symptoms are the most importan herald of disease in most cases, I'd suggest trying to desensitize yourself, not check your heart rate so often (as hen up at night to urninate) unlss you're feeling a specific symptom. It actually sounds like you'redoing quite well.
|moldvictim08 - Wed Sep 23, 2009 12:22 pm|
Thanks again, John, for your insight. It's good to know that a lot of this might be vagal tone. I did want to update you on my current diagnoses and ongoing problems.
Just last week, my electrophysiologist said that after reviewing extensive event recorder strips, he believes I have Sick Sinus Syndrome. He's the 2nd cardiologist to suggest this. He mentioned that it wasn't the type that required a pacemaker since I seem to be having what he calls "Inappropriate Sinus Tachycardia." The doctor noted several pauses, less than 3 seconds, where my heart might be going let's say 90 bpm and then suddenly drop to 60 bpm with no gradual slow-down. When I used to describe this sensation to him, which happens a lot when I'm first waking up in the morning, he thought that I just wasn't feeling the premature beats, but now he sees differently. He also mentioned a junctional escape beat - not sure what to make of that. He said there was also evidence of atrial component, as well, since I had runs of PACs and PAC Couplets. Some of the strips had a gradual increase in speed of the heart that went up to 170 bpm. He mentioned that it was hard to tell from the strips whether this was sinus tach with the P-waves hidden or whether it was Paroxsymal Atrial Tach with a gradual warm-up and that the only way to tell was by doing an EP study, which I'm not ready to do as of yet.
He mentioned that he believes there could be an autonomic component to this, as well. A lot of times I will get the jumps in speed when changing position. For instance if I'm go to stand up after waking up in the morning, my heart had four PVCs seperated by 5 sinus beats within a 7 second period. Sometimes I feel like my heart starts fluttering for 2-3 seconds over by my upper left ribcage area about 20 seconds after standing, but this feels like a new symptom and I am no longer wearing a monitor, so I'm scared that this might be the short runs of VT like the 5-beat run I had a year ago.
So, here's where I'm confused: I don't understand why when I feel a PVC or a PAC I feel it right in the center of my chest, but I feel most of my arrythmias in the left chest area and sometimes in different spots, where I can actually visibly see it through my t-shirt. Is there a way I can tell this? I'm also curious whether outside of having a tachycardia, whether the atrium or ventricles can just start pumping on their own at a normal rhythm. Since a lot of my symptoms happen in the early waking hours I'm concerned I'm one of those candidates for an early morning heart attack.
One of my major concerns is that my mitral valve prolapse is also degenerating. My 2007 echo (adequate quality) reported I had posterior leaflet MVP, as did my Sept 2008 echo (fair quality). Between Sept and December of 08 my symptoms got worse. When I had an echo in January of this year (Excellent Quality) and again a couple of weeks ago (Good Quality) it said "bi-leaflet MVP" on both - The dimensions of my left atrium also seemed to get larger over the report period, but not outside of normal ranges. I still have Mild Regurgitation with Trace pulmonic regurgitation and triscupid, but I'm concerned that there is some process going on. When I have the fast-slow arrythmias, I'll usually get a bit of pain in my left chest area immediately following it slowing down, which makes me wonder whether I'm feeling pain from pooling blood because of the sudden rate change or from the valve. I also feel a click-type sensation sometimes while my heart is beating.
I had an episode of near syncope on Sunday night where I was sitting and the room began to spin and things got dark. When I checked my pulse in my left neck, it was extremely faint. I've been walking around lightheaded ever since and my doctor thinks I have an inner ear infection. They mentioned that such infections could also cause arrythmias which makes me wonder whether that could be my problem all along since I've had this weird popping, ringing and vibrating sensation in my ear and behind it since probably last December. While doing an EMG on me yesterday the neurologist said he found some peculiar irritable muscle reactions and that it was an abnormal test, but he wasn't sure how to write it up in a report because it was that unusual. So, of course I wonder now if I have some kind of muscle disease that is attacking my heart muscle, too!
This is a lot to digest and I'm overwhelmed. Any thoughts on what to make of all this? It's depressing being told at 31 years old that I have so many problems.
|Dr.M.Aroon kamath - Tue Oct 13, 2009 5:29 am|
It is possible for example, one carotid pulse feeling weaker than the other. But it is not possible for different arteries to have different rhythms!. What you felt must have been muscle twitches(fasiculations/fibrillations).
Don't worry too much about D-Dimer values.D-Dimer is not specific for DVT. It's main use is in its 'negative predictive value".If DVT is strongly suspected, but D-Dimer is negative, it virtually rules out DVT.
Trust this info is of help.
|| Check a doctor's response to similar questions|
Are you a Doctor, Pharmacist, PA or a Nurse?
Join the Doctors Lounge online medical community
Editorial activities: Publish, peer review, edit online articles.
Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.