Diastolic function...SOB/tachy

[windbeat]

Hello.
I'm a 28 y/o male. I'm generally in good health but often have tachycardia and shortness of breath. I am the first to admit their is an anxiety component...but I'm not sure if the anxiety follows the symptoms or is the cause of them...or both.

1. my heart rate is often around in the mid 80s-100 at rest...especially while standing. I do not get dizzy while standing, however, and have normal BP. I often feel mild-moderately short of breath...especially while standing...and this is also when my heart is in the 80's-90's.

2. My heart rate can bounce into the 140-150 range at the drop of a hat if I become anxious.

I have no anemia and had lung function testing which was normal (I smoked for 7 years and quit 3 years ago).

I had a stress test/EKG which read: mild right axis deviation, incomplete right bundle branch block and early repolarization phase variant. The cardiologist gave me the impression these were nothing of concern.

Regarding the echo it stated resting EF around 60% with normal regional and global systolic function, no exercise induced dysrythmias and normal physiologic response to exercise...negative stress echo.

May I ask:

1. There is no mention of diastolic function on the report. Would this be obvious on the echo to the Dr. or is it something that might be missed if not looked for?

2. Could my tachycardia be related to the early repolarization variant?
3. Is it abnormal for my HR to jump so high when anxious...my primary doc said my increase was not normal.
4. Re: RBBB & early repol--should I avoid any medications/etc?

[Cleveland Clinic]

windbeat,

From what you describe, I would have a hard time to attribute your symptoms to the heart.  I think you realize anxiety is a prominent factor in your life.  Overall, if you've had a negative workup, I probably wouldn't pursue too much else.  

1. There is no mention of diastolic function on the report. Would this be obvious on the echo to the Dr. or is it something that might be missed if not looked for?

There would be no reason for someone your age to have significant diastolic dysfuction.

2. Could my tachycardia be related to the early repolarization variant?

No.

3. Is it abnormal for my HR to jump so high when anxious...my primary doc said my increase was not normal.

Its very common.

4. Re: RBBB & early repol--should I avoid any medications/etc?

No.

Maybe a second opinion would help alleviate your worries.

good luck

[Toneman]

I can't really comment on your heart rate or Tachycardia, but I can tell you than my last Echo in March also showed mild diaostolic dysfunction, which was also said to be be of no real concern. Diastolic dysfunction is broken down into three categories I believe with mild being the lowest. It just means that your heart muscle is a little "stiff" during it's diastolic phase, or when it refills meaning that it is more difficult for blood to return into the heart. It has many causes, mostly hypertension, heart valve problems and even the natural aging process. But with your EF rate at 60% it can't be too bad. My cardiologist and family doctor told me that diastolic dysfunction is a dignosis that is becomeing more prevalent as more is know about it and in fact it has been increasing at such a high rate that 28% of patients with echos will come back with a report of diastolic disfunction.

I also have had an incomplete right bundle branch block my entire life, it has shown up on all of my EKG's. I learned about it after my last Echo when I needed to give my surgeon a copy of the report for an upcoming gallbladder surgery and I read it. I asked both my family doctor, who had done several EKG's that showed it, and my cardiologist why they did not tell me about it and they both said that they typically don't because it is of such little consequence in a healthy heart that it usually causes the patient more concern than is necessary, which was backed up by my research on the internet. It just means the electical signal going down the right bundle branch of the heart has an incomplete block and is a bit slow.  It is common for it to be present in people with healthy hearts and does not sound like anything to worry about, but the doctor will have a better answer for your concern. A left bundle branch block is normally more likely to be associated with heart disease.

I'm sure the doctor will give you the answers you are looking for, thay have been great for me!

Good luck!

Tony