Stomach or cardiac problem?

[ceejay1025]

My problem is I get a feeling of pressure and lightheadedness when I overexert myself and also have a rapid heartbeat (120 beats per minute)-- resting pulse about 75. The only thing I have been diagnosed with is mitral valve prolapse. The pressure is located in my chest. I saw my cardiologist and an echo was done a month or so ago, which was normal, except for a small amount of leakage, but nothing worse than when the test was done several years ago. I have not had a stress/echo taken, but my cardiologist recommended it. I just have not set it up yet. The mystery to me is that (and I'm embarrassed to tell my doctor this -- I know, dumb!) when I have this pressure, after burping about a bazillion times(maybe not quite that many), the pressure goes away and I feel much better and my heart rate also returns to normal. I have no pain anywhere and no heartburn. I'm 57 years old, female and all of my health problems started happening when I got a terrible virus that was in my bronchial area this past spring with fairly violent coughing. I seemed to never recover completely from this virus. I've had blood work done and everything came back normal, except for an elevated bilirubin which I was told was "Gilbert's syndrome" and nothing to worry about. I have had an anxiety condition and take xanax (.25) as needed, but sometimes that helps and sometimes it doesn't. I really just don't feel like myself at all and am wondering if I should go ahead with the stress/echo (even tho our insurance will not pay for this test). Or do you think it's more stomach/esophageal related with the burping thing that happens.  My blood pressure has always been good, low if anything and I recently went off atenenol (25mg daily) because my internist thought maybe I was having asthma related symptoms from this beta blocker. I'd been on this med for about 10 years. My cardiologist said this was probably the reason for the rapid heartrate and it should subside after my body gets accustomed to being off the beta blocker and it sometimes takes a month or so. (I've been off of it for approximately 2 1/2 weeks). Otherwise, I take no other medication, except for vitamins (multi, E, C, and calcium and just started on 100mg of magnesium, plus a soy-protein drink that I mix with soy milk and fruit.) I eat very well, have no heart disease in my family and my parents are still alive. My dad is 84 and in good health and my mom, 78 and reasonably good health. Sometimes I have a little discomfort in my left chest area, but I always think it's gas too. I have exercised at least 4 times a week for the past several years, with weights, or doing an aerobics tape, but I cannot seem to get back into doing my regular routine without having a problem. Okay, my questions to you, am I being stupid by not scheduling the stress/echo to rule out something with my heart?  And should I have any kind of test to see if this is related to a digestive problem? Any ideas on what's going on with me? Thanks! CAROLE

[Kevin Pho, MD]

Hello - thanks for asking your question.

Without examining you, I cannot make any personal recommendations whether you should be taking specific tests or not.

A stress-echocardiogram is a very good test to evaluate whether coronary artery disease is causing your symptoms.  By taking this test, you should be able to reasonably rule out your heart as a cause of these symptoms (the most definitive test would be a cardiac catheterization).  The decision of whether to take this test or not rests with with and your primary care physician.

As for the increased burping and gas, there are several considerations - including GERD or the various causes of dyspepsia (i.e. peptic ulcers, inflammation of the esophagus or stomach, or gall bladder disease).  A reasonable approach would be to inquire about an upper GI series and/or an upper endoscopy which can evaluate for most of the upper GI causes of your symptoms.  

Regarding the rapid heart beat/palpitations, another tests to inquire about would be an event monitor.  This is a device that allows you to record your EKG tracing (by pressing a button), whenever these rapid heart beat episodes occur.  

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.

Thanks,
Kevin, M.D.