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Question Title: abnormal 24hr holter

Forum: The Heart Forum
Topic: Arrhythmia


I am a 31 year old female and have felt irregular heart beats for a few years with symptoms increasing the past several months now. They are also accompanied with extreme fatigue and lack of physical stamina. When trying to do any physical exertion, I feel short of breath and think I feel tightness in my chest. I was diagnosed on the 10th of December 1998 with PCOS (poly cystic ovarian syndrome). The Dr. put me on Glucophage (due to a poor GTT) - Spiranolactone (hair growth due to high testosterone) - Levoxyl 75mcg. [due to a thyroid level of 35.88 from a test where I was first injected with something (can't remember what it's called)] - Clonazepam 1/2 of a .5mg tab at night (for adrenal anxiety) - Generic Barroce Plus - 25mg. of Zoloft - and a weight loss drug that he formulated called Metacap (contains cytomel 5mcg, tenuate 18.75mg, spiranolactone 12.5mg, and xanax .055mg.) The sugar and the thyroid are related to the PCOS. The Dr. I saw is an Endocronologist, Internist, and Nutritionist in Pittsburgh, PA. When I was at the Dr.'s office he did an EKG and it showed skipped heart beats. When I saw my family physician to fill him in on the PCOS diagnosis, I told him of the EKG. He ordered a 24hr. holter. It came back abnormal with frequent palpitations. Please understand, I had been on no medication until Dec. 11th and had been experiencing these symptoms along with many others for a very long time.

It took at least 2yrs. to find a thorough Dr. that first of all didn't assume I had depression and secondly did a thorough physical including blood work as mentioned above. I told my family Dr. of these symptoms including the irregular heart beat on several occasions and I said I am not depressed-it is something else. Finally saw Dr. in Pitt. Well, I am glad that I do have a diagnosis for the PCOS but am now concerned with the heart stuff. I really thought the holter would come back normal or maybe with rare palpitations, but realistically, I new there was something wrong with the heart. I have been of normal weight until the last year.I gained a good 30 lbs. due to insulin resistance and probably the underactive thyroid. I am 5ft. and weighed 150 at my last Dr. appt. I was shocked!

I am sorry for the long involved message, but I thought you would need history to understand the situation. My question is, what can I expect when I see the Cardiologist next Wed.? I would like to be prepared with a little knowledge so I will have a greater understanding of the workup he does and also, I would like to have questions ready just in case. I promise to go assuming he will be thorough, but given my past experiences, I would also like to have some knowledge prior to my visit. Also, does it sound like something minor to you? Thank you for your valuable time. Your response is greatly appreciated.

_

Dear Charlotte,
It isn't minor in that it involves your health and potentially your health. After a full history and physical (concentrating on the heart of course)by the cardiologist, there will need to be consideration given to the fact that your thyroid has been overactive and could very well be the cause of your palpitations and abnormal holter. The heart doctor may want to do a stress test now or in the near future (when your thryroid is at a more normal level) in order to feel very comfortable with the status of your heart. It would be best if you could go to your appointment prepared to ask these questions after the exam:
1)What is your diagnosis and do you have any concerns?
2)What further tests do you need to do?
3)What is the long term plan?
and 4)What treatments would you suggest if any?

Keep in mind Charlotte that your heart has been under stress during this PCOS, however you are young and likely your heart is just fine now that the primary problem is being addressed.
As for the trouble you had finding a doctor that investigated you for more than just depression, I apologize for the profession (I trained in internal medicine before going on to cardiology), but I simply do not know how to correct this problem, i.e. the physicians who too easily brush off young woman's symptoms as anxiety or depression related without a full investigation for the possible other causes; full investigation meaning a full history and physical and appropriate blood tests. This is why all patients should be encouraged to seek second opinions.

I hope this information is useful. Information provided in the heart forum is for
general purposes only. Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!

If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
cardiology staff that can be used to select the physician best suited to address your
cardiac problem.

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