My grandmother passed away at the age of 50 from CAD. My brother who is 5 yrs older than me has had 2 heart attacks and 4 strokes in the last year. I am a 38 yr old female, 5' 7" 148 lbs. I have been having the following symptoms, fainting, light headed, rapid heart beat, extreme fatigue and shortness of breath. I am on 100 mg of Metoprolol which I was instruction to continue on my medication even during testing. Should I seek a second opinion?
My stress test results were as follows:
Total Time: 6 min 37 sec
Resting Blood Pressure: 110/72
Blood Pressure at Peak Exercise: 142/80
Baseline Heart rate: 122 (what i seen was between 84 - 112)
Max Heart Rate Achieved: 190
% of Age Predicted MHR: 104%
Rate Pressure Index: 270 (I have no idea what this means)
Exercise Capacity: normal
Exaggerated heart rate response to exercise
Normal Blood Pressure response to exercise
Holter Monitor: 23 hrs 59 min
normal sinus rhythm at an average heart rate of 100, min of 70 and maximum of 179
Rare PVC's were noted 240 beats PAC was noted Longest R-R interval is 1.1 second
Echo cardiogram showed all was normal except Left Ventricle Mild Septal Hypokinesis and trace mitral regurgitation.
Tilt Table Study
Tilt was initiated according to protocol at 70 degree inclination from baseline. Baseline blood pressure was 109/60 Heart rate was 92 Observed for 20 minutes in the upright position. Blood pressure remained stable. Sinus tachycardia at 2 minutes into tilt. Her baseline HR was 85. Developed sinus tachycardia at 120 and went up to 134 bpm. This then transitioned to sinus arrest with a junctional escape rhythm briefly . She did have syncope. Blood pressure went to 74/43 and her heart rate 184 bpm. Lost postural tone and consciousness. Regained consciousness with moving the tilt table back to the horizontal position.
This is positive tilt table for vasovagal but also had componets of orthostatic tachycardia.
I am interpreting your post as having essentially two questions so I will try to answer them both:
First, as far as whether or not coronary artery disease (CAD) is genetic, the answer is yes and no. As with many (if not most) medical conditions, CAD certainly has genetic components. However, this does not mean that a person with a family history of CAD will develop CAD and the same goes for those without a family history of CAD. Genetics is one piece of the puzzle. The known CAD risk factors, such as high cholesterol, elevated blood pressure, diabetes, tobacco use, etc are as important if not more so than the family history. Thus, while you can not pick your parents, you can adopt a healthy lifestyle and preventive measures are clearly proven to reduce the incidence of CAD, heart attacks, etc even in those with a family history.
Second, as far as your symptoms are concerned, among all the tests you describe, the only one that was “abnormal” was your tilt table test. You seemed to have done well on your stress test and I suspect that your echo was normal as well (hard to know what to make of the septal hypokinesis—it is likely nothing). Thus, on the basis of the information provided, it sounds like you have a tendency to become what is referred to as “vasovagal.” Although this is a benign condition and not inherently life threatening (unless you faint while driving, etc), it can certainly be frustrating for some patients. The general approach to patients with vasovagal symptoms is focused upon lifestyle modification and avoidance of certain medications or other known “triggers”. Avoidance of dehydration by increasing fluid (and sometimes salt) intake may be helpful as well.
I should also emphasize, however, that extreme shortness of breath can not be explained by a tendency to have vasovagal syncope. If you tend to have anxiety or panic attacks, your symptoms are consistent with this (and perhaps you have been getting worked up over your family history, your brother’s condition, etc). However, if you are not an anxious person, I would encourage you to continue to be evaluated for your shortness of breath.
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