Daughter with chest pain,palpations,HTN,tachycardia,PVC's

[emtpam]

My 26 yr. old daughter has been having chest pain,palpations,HTN,tachycardia and PVC's since she was ill with severe strep 1 yr. ago. At that time, she had a high fever and developed a rash that did not go away for over a month. Lately, her symptoms have increased in frequency and intensity. Yesterday, I took her to ER with chest pain rating an 8 on a scale of 10. Her B/P was 177/112, her HR was 122, resp. normal. They did an xray and 3 sets of enzymes over a 10 hr. period,which all came back normal. She was also given Toradal and 3 Nitro. They were only trying to R/O an MI (which we never thought she was having). While being monitored, she would have severe pain and each time she would have a PVC...sometimes muliples. Also, for a while she became hypotensive before her B/P and pulse stablized. She was also very lightheaded and has recently passed out during one of these episodes. It was decided that she did not need a cardiology consult because she was in no immediate danger but, she was not given an indication of what was causing the problem. She was told to follow up with her family doctor and to have an Echo. They think she may possibly have MVP (no murmur was heard) causing the PVC's which I know are usually benign (I also have this condition).  
My question is: Could the strep and rash she developed have caused MVP? My sister had rheumatic fever as a child and has had her Mitral Valve replaced 3 times since she was in her 20's. Also...I am mostly concerned about her passing out and the tachycardia and HTN during these episodes. Should she have further testing?

[CCF-M.D.-CRC]

Dear emt,
Although strep can cause rheumatic heart disease the end result of this is mitral stenosis not mitral valve prolapse (MVP).  Also with antibiotics today rheumatic heart disease is uncommon.  I do think she should have additional testing but I'm not sure that the cause of her symptoms will be found to be cardiac.

[debra21784]

My first thought and concern is the valve my have become damaged from the strep infection.It sounds like your daughter needs to see a good cardiologist and get an echo done.If the valves are effected that can account for both the chest pain and PVC's

[emtpam]

Thanks Debra. That's what I'm concerned about,too. The hospital didn't do an echo and the PA taking care of her thinks she needs one soon. Her palpatations and pain have become increasingly worse over the past couple of days and she's throwing many more PVC's even while resting. She's tachycardic most of the time now, also. I think she needs a diagnosis SOON!!

[emtpam]

Ok..if it's not cardiac, what else is it? Stress? She was on an antibiotic when she had the strep and then broke out in the rash so, the doctor had her stop the antibiotic after only 2 days...thinking it was the cause of the rash. It didn't go away and, in fact, became worse...spreading over her entire body. I hope she doesn't have valve disease and it is only stress. It's much more easily dealt with. Further testing? What tests?

[debra21784]

Get a cardiac consult.She needs to have additional testing by a qualified physician and not by a physician's assistant(PA)

[Tigger2]

I was just reading about your daughter. Wondered if you found out anything.  Here is my story.  I am now 32.  Problems started about 5 years ago.  Same symptoms.  palpitations, tachycardia, PVC's, PAC's.  My first quest for answers was horrible.  Nobody would believe it could be my heart, because of my age.  I was constantly told I was just overreacting to benign extra beats.  I knew something was wrong.  I suffered terribly for 2 years, to the point of having to quit my job.  I do admit,anxiety became a vicious part of the cycle, but mainly because of trying to get help.  What I find interesting, is I believe all of my problems are related to a severe strep infection and rash, fever when I was 20.  Probably rheumatic fever, although it is hard to get anyone to admit this. I saw 5 cardiologists until I got somewhat of a diagnosis.  At least it confirmed I wasn't crazy.  Many times I was told to see a psyciatrist.  The electrophysiologist I see now diagnosed me with SVT about 3 years ago, along with many pvc's, pac's.  He says it could be related to a strep infection or virus that did damage to my heart.  Not the function of my heart, but the electrical system.  He is wonderful and has tried very hard to get me feeling better.  Two years ago he did an ablation for my SVT.  I have also tried many meds, some of which made me worse which compounded the problem.  I am in constant sinus tachycardia, struggle with pvc's, pac's constantly and now have developed atrial fibrillation with rapid ventricular response.  No matter what meds I use they can not control my rate. I am taking propranolol 10mg 3 x day now.  It has been the best at helping my sinus tach, pvc's, chest pain,and anxiety, with the least side effects of any I have tried.  I just wanted to share my story with you, because if you believe your daughters problems may be cardiac, don't give up!!!!  It took my 5th Cardiologist, almost 3 years and a hospital stay to get the help I needed. The Cardiologist who told me I needed to see a psyciatrist was one of the top in our state.  It just proves even a great DR can't help if he/she won't listen to their patient.  The DR I am seening now is in the same group, but happened to work with younger patients, and pretty much figured out what was wrong on my first visit, then confirmed it with a 6 hour EP study and ablation.  I hope your daughter gets the help she needs and doesn't have to suffer as I did for so long.

[emtpam]

Hi Tigger..thanks for your input. My daughter is feeling a little better right now...less tacycardia, less PVC's, less pain. But, as previously experienced...this is only temporary. She's had these "lulls" before. So far, she has not been able to have a cardiac workup (she recently changed jobs and has yet to find a new primary care physician accepting new patients).
I still feel that her strep infection last year has been the cause of all her problems. No one has given a diagnosis of SVT because her heart rate hasn't been seen in the "classic" SVT range.....only running in the 120-130 range when she has a flair up. Right now, all they're saying is "chest wall pain"...costochrondritis. Could be...I know people who have this condition...but, somehow, I don't think that's my daughter's problem. Chest wall pain wouldn't cause her to throw PVC's...benign or otherwise.
It sounds like you had a very frustrating and scary couple of years. I'm glad you finally found a doctor who believed you actually have a problem. I get frustrated when doctor's think it's all in your head and give you meds for stress/anxiety. Of course, you're anxious..who wouldn't be!!
Anyway...we're still at square one. I hope, once she finds a competent doctor and has some testing done beyond what was done in the ER, she'll get a diagnosis and treatment. The unknown is scary for her....and me!
Thanks again for your input.

[roseann1964]

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