Recent Illness and hospitalisation

[Daikomyo]

After collapsing in Laos with Bronchal spasms and then being diagnosed with vasovagal syncope I was treated at a Thai hospital. I kept suffering though from what felt like a heart attack- vice like pain in the chest, difficulty breathing, the feeling of a lump behind the sternum (that also progressed to a lump in the throat sometimes) and a generally very odd feeling in my upper body. A CT scan, cardiac ultrasound and holter monitor revealed some sinus arryhtmia in the 24 hr Holter test, 3 PACS, 2 ST episodes on Ch1 of the Holter test and my symptoms correlated to NSR apparently(what is that?) and bradycardia but the doctors were not concerned about this so I assume that it is normal. The Ct and ultrasound were normal. I was discharged but these symptoms kept recurring as well as occasional and, unrelated timewise, palpitations and missed beats (usually at night). Australian doctors, after another episode, concluded the problem wasnt heart (after ECG and adminstration of a Gaviscon plus anaesthetic drink) but due to acid reflux- I had a barium meal a few years back because of consisitent thick mucuous stuck in my throat (still a minor issue) and was told there was indications of minor reflux up into my throat but it wasnt serious enough to warrant treatment so this is obviously a developing issue. I have been put on a course of five tablets called SOMAC and over the last three days havent had any serious attack although my chest frequently feels tight and somtimes the lump sensation is there in my sternum. It is causing me difficulty sleeping due to weird chest sensations and probably worry too. the other symptom that has also occurred concurrent with all of this is a very red face most of the time and feeling of constriction in the blood vessels at the side of my neck from time to time- no doctor has been able to comment on this yet- my body can be pale and my BP registers normal while these things are occuring.

Please could someone go through these issues with me- the Holter test results meanings, the symptoms current and recent and let me know whether this all seems like the correct diagnosis and treatment and whether the palpitations, red face, neck vein awareness can tie in with an acid reflux condition or even anxiety over the illness?

Thank you very much. I appreciate your advice.

Rich

[Kevin Pho, MD]

Regarding the Holter test meanings:
PAC - premature atrial contractions
ST - sinus tachycardia (a fast heart rhythm)
NSR - normal sinus rhythm (the normal heart rhythm)

If the Holter determined you were in NSR, it is unlikely there was an arrhythmia present.  Another consideration would be to have an event monitor - which can record the heart rhythm in the presence of an episode.

Regarding the red face and GI issues, one consideration would be carcinoid syndrome - which can cause flushing and GI symptoms.  The most reasonable test to evaluate this would be a urine test to measure for 5-HIAA, which is a metabolite that would be elevated in this condiation.

If acid reflux is a consideration, you may want to inquire about an upper GI series, or a 24-hr pH study (which would be the definitive test for GERD).

These options can be discussed with your personal physician.
Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b