Follow up on potential Angina/PVC's

[dplp]

Follow-up from my last post.

As mentioned, I get frequent PVC's and Jaw/Face pain.  My concern was that this was heart related due to a poor family history.

In addition to a stress echo, they gave me a 64 slice CT which was clean.  My cholestorol is high, and I'm 36 years old.

I guess I have to assume that my heart is OK, but it's strange. The PVC's and Jaw pain are usually interlated. If one is bad, the other is and vice versa. No real pattern, at times at rest, at times during exercise, yesterday for instance when I started exercising I had jaw pain from hell, but then half way through (30 minutes) it basically went away as my intensity continued to pick up. Both are generally better after I exercise but come back. (pvc's hit within hours, and jaw/neck/face/shoulder pain eventually).  

1. What are the chances that these PVC's and Jaw pain are related to a heart problem of some sort, that went undetected?

2. Could stress really cause both?  It's SO strange they come on together. Klonopin was of no help.

3. Is Cardizem LA reasonable for PVC's (180mg) I tried a beta blocker (inderal LA) couldn't get my HR above 82% when exercising.

4. Really strange - could this be vagal nerve related.  The reason I ask is that if the left side of my neck hurts and is tight, I get more jaw pain and PVC's. Could something be compressed? (I'm despirate here).

5. Both the pain and PVC's are better when laying down and when I wake up, they ramp up throughout the day.

Thanks, I've put a lot of life decisions on hold in case I really do have a problem

[Cleveland Clinic]

dplp,

Thanks for the post.


1. What are the chances that these PVC's and Jaw pain are related to a heart problem of some sort, that went undetected?

Highly unlikely especially with an adequate CT study. Im not trying to dismiss you, but it would be more likely that the symptoms are more likely related to an undetected anxiety disorder. It common for people with palpitations to have symptoms, often these become the focus of a great deal of anxiety and the spiral begins.

2. Could stress really cause both? It's SO strange they come on together. Klonopin was of no help.

Yes. There are other medications for anxiety and I would look at some of the nonphamacologic ways others have dealt with their palpitations in this forum.

3. Is Cardizem LA reasonable for PVC's (180mg) I tried a beta blocker (inderal LA) couldn't get my HR above 82% when exercising.

There is no perfect medication for PVCs. Cardizem has few side effects -- so if it works -- great!

4. Really strange - could this be vagal nerve related. The reason I ask is that if the left side of my neck hurts and is tight, I get more jaw pain and PVC's. Could something be compressed? (I'm despirate here).

The vagal nervous system has a great deal of influence on the heart. The vagus nerve itself is not the problem and doens cause site specific pain.


You need to get over this and move on. If you cant do that despite the testing and reassurance you need to get help in ways to cope with your anxiety and fears, lifes too short!

good luck

[LukeL]

You could be clenching your teeth and facial muscles at night and be unaware of it. You could also be doing this during the day as well. When I was paranoid about my heart I kept clenching my chest muscles which lead to moderate chest pain.

I guess you could push for a cath if it would put your mind at ease.

[dplp]

Yeah,

Don't really want to get a cath, if there is no reason other than my "paranoia" to have one done.  Always risks involved.  That said, it's strange how the jaw pain and PVC's seem to be at least somewhat related.

Last thing I want is someone poking things into my heart if I don't need it, that said I don't want to leave the wife and kids fatherless if I should have pushed harder...

[woodruff]

"when I started exercising I had jaw pain from hell, but then half way through (30 minutes) it basically went away as my intensity continued to pick up. Both are generally better after I exercise but come back. (pvc's hit within hours, and jaw/neck/face/shoulder pain eventually). "

There's a theory that after a certain period of time doing intense exercise, we produce our own endorphins, which kill pain and make us feel better.  The effect lasts for several hours after exercise ceases.

" What are the chances that these PVC's and Jaw pain are related to a heart problem of some sort, that went undetected?"

You have had a stress-echo, and a CT scan.  Sure, we've all read of people who pass one or the other of these and drop dead the next day, but the fact is that cases like this are rare.  Your heart has actually been visualized while you were being stressed by exercise, and it did just fine.  Several educated people with specialized training--the tech who was scanning you, and then the doc who reviewed your pics--were seriously looking for bad stuff to be going on in various parts of your heart, and nothing turned up.  The likelihood that something went undetected is very, very small.  Medical professionals really make it a point to look not only for big stuff, but also minute, itty-bitty things that could be wrong.

"Could stress really cause both? It's SO strange they come on together. Klonopin was of no help."

I have pvcs (sometimes 4800 per day), and I have found that they are related to stress--though not necessarily caused by stress.  What I have learned is that I feel them more when I'm anxious or tense.  There are way better drugs than Klonopin for long-standing anxiety.

" Is Cardizem LA reasonable for PVC's (180mg) I tried a beta blocker (inderal LA) couldn't get my HR above 82% when exercising."

I have no experience with Cardizem, but am familiar with the very common low heart rate thing with inderal or other beta blockers.  Some people have better luck with different BBs.  Some cannot tolerate any of them.

"Really strange - could this be vagal nerve related. The reason I ask is that if the left side of my neck hurts and is tight, I get more jaw pain and PVC's. Could something be compressed? (I'm despirate here)."

I see that you've looked at an anatomy chart and have seen a diagram of the passage of the vagus nerve in your neck.  The funny thing about the vagus is that it is what's called a 'mixed nerve."  It has both motor and sensory fibers, and many, many branches serving things like your larynx, part of your external ear, and many different portions of your intestines and abdominal organs, as well as the famous relationship to the heart rate.  If the nerve were compressed in your neck, you'd almost certainly have a bunch of other very interesting symptoms that you haven't read about, but would find really, really noticeable.

One of the interesting things about our psyches is that once we know the symptoms of a disorder, we are perfectly capable of developing some or all of them--in the absence of the disorder.  This isn't voluntary; I mean, you aren't manufacturing these symptoms, but the brain is probably kind of supplying the info to support your fears, and that can be a symptom of anxiety.

I forget if you are actually seeing a cardiologist.  If not, you should find one and discuss your worries with him/her.

Chances are, you'll be given the old clean bill of health once again--and it will probably be valid.  Rather than "put your life decisions on hold" and keep looking for a cardiac cause for your symptoms, I'd suggest making an appointment with a good psychiatrist to discuss your symptoms.  Shrinks are MDs, and can actually prescribe meds. However, they can also help you to find ways to deal with the anxiety that can make ordinary pvcs so hellish for some people.  

[mrbh]

I share the view expressed by Woodruff here.

I'm not a doctor, but idling your life away over PVC's, in view of your previous testing, seems rather extreme. So many other things might be causing the jaw pain, and a review by an internist or cardio doc should clarify the issue and allow you to move ahead with your life.

Take care.

[dplp]

thanks all, good comments.

It's that the jaw pain and pvc's seemed to come on around the same time, and seem to come together still that worries me.  That said, great comments. thanks.

[TristanDawn]

i get jaw pain too and chest pain....this can be on a pvc or not. ihad alot of jaw pain today oddly enough. who knows why. ifeel wheni get pvcs that i will durly die. the LONG pauses , breathlessness and dizzies scare me...anyone get theses???

[tickertock]

I'm sorry to hear you're not feeling well. Hope you feel better soon. Maybe its time to think bypass or because of your young age the doctors are steering clear of that.

I know a woman who had triple bypass at 30 , 15 years ago and today she is still doing absolutely remarkably well without any symptoms or recurring blockages. Oh well just a thought. The key is to get bypass before damage has been done to the heart.Good luck.

[woodruff]

I'm sorry you're having to deal with this, Al.  It must surely be both physically and emotionally exhausting, perhaps more so because you are both knowledgeable and young.  But these are also your strengths in dealing with your medicos--who probably need to talk with you right about now.

[jmike1_]

Hey!!! Sorry to hear about the rough time you are having.  You've provided some excellent advice, and wish I had some to give you.  Only thing I'd share is to not delay if your symptoms are getting worse.  As per our last "conversation", I was putting off med care in spite of worsening angina to avoid getting boarded out of the army.  I was in the middle of my move on leave at my parent's house, and it simply got so bad I couldn't avoid it.  Had to go to the ER (in a small country town), and the only interventionist there (luckily was a good one) insisted on doing my 5th cath since MAR 06.  Ends up, one of my original non-drug eluding stents blocked at about 100%.  They did angioplasty (apparently bracchy sp??? therapy is no longer an option), and that was it.  I pushed it too far, and could have ended up in a bad situation (luckily no heart damage).  So, my only advice is to not wait the six days til your appointment if it gets bad.  Go in, and get the help you need.  I wish you the best, and hope you get the help you need/deserve.  I had to go again to the ER last week, and now I'm back to square one as the new cardiologists again don't think my pain is cardiac related.  Hope you find a treatment option that ends your long bout with angina.  God bless and best of luck to you.  Keep us all posted!

[yoshi74]

One of the interesting things about our psyches is that once we know the symptoms of a disorder, we are perfectly capable of developing some or all of them--in the absence of the disorder. This isn't voluntary; I mean, you aren't manufacturing these symptoms, but the brain is probably kind of supplying the info to support your fears, and that can be a symptom of anxiety.

Thank you so posting this...this is sooo true. Especially about me. This forum has done so much for me, but there are times when I read about something, that I really start to feel ill and my palps really kick in and then I am convinced I have what I just read and that I am getting ready to die! The mind is such a powerful thing and I think that most of us who suffer from these PVC's/PAC's, are really suffering more from our own hell that we are putting ourselves through. I just really like your post and I will try and keep that in mind next time my mind starts to play tricks on me!

[woodruff]

Thanks, yoshi.  After watching this board for a while, and my own pvc history for a while, I am beginning to suspect that many of us who suffer from pvcs and other funny beats have unusually sensitive or hypervigilant nervous systems.  Our stories are often astonishingly similar.

[suzzie1]

Hi Al, just back from my holiday in England to see my sister... Im  sad to see your having a bad time with your angina etc. You give such good advice to all on this forum and I wish I could give the same back to you. Unfortunately I cant, but wanted to let you know that you are in my thoughts and prayers.

[suzzie1]

Thanks Al. I saw my cardio in my local hsptl just over a week ago who said I should "go home,continue on my medication (dilzem & emcor) and 'SOLDIER ON' yes he actually said 'SOLDIER ON'. I said 'I dont want to just soldier on, I want to feel well and enjoy my life, and be here for my kids, but he said I cant be stented etc as my angina(and he is not convinced it is angina) is probably caused by spasms)..I 'tried' to tell him how tired I feel etc and he said "well I dont know what that is"..He didnt discuss whether my meds should be altered in any way...I kid you not..he was very dismissive and I felt that he just wanted me out of the room (it was lunch time) and hopefully he would NEVER have to see me again. Well he never will, because I will not go back to him again, NOT EVER!!!  I had some 'dodgy' days in England and had to take it easy, and when I saw how fit and active my sister (who is older than me)is, I realised how little I can actually do. So basically Im back to waiting for an app in A bigger hsptl in Dublin.. I hope you had a better day today. Best Wishes!!!!!!!

[Duchess47]

These posts have all been vey intelligent and informative.  I'm trying to make sense out of my own symptoms and have a few questions.  I have been having pain that radiates from my left side of neck down shoulder, arm into hand and fingers, (sometimes jaw) sometimes debilitating.  I saw Orthopedist and he did an MRI on shoulder. He says I have shoulder impingement and tendonitits but feels that the pain is more from my neck, such as pinched nerve.  Now, I also have these heart palps, and irregular beats lately.   I have Graves Disease and so  rapid heartrate is always something that is possible and I have been on beta blocker before.  But this is brand new.  I have skipped beats and extra beats all going at the same time for about an hour then that's that.  Any of this round related?  What does angina actually feel like and what brings it on?  I have had stress echo last year that only revealed hyperkinetic heart based on who knows what!!  I am a 49 y.o. female on Lipitor for high cholesterol and that's it.  I'm in remission from Graves at the moment.  I am totally out of shape too.  Thanks.

[suzzie1]

Hi Duchess47....you asked about what angina pain feels like!!! For me it feels like a heaviness or crushing in my chest, then a tightness radiates up into my neck and across my sholder (a couple of times it went down my arm), sometimes it comes out in my back..I will be nauseous, with a cold clammy sweat and short of breath. It comes on merely by walking or occasionally at rest. I get some irregular beats as its coming on, but they are different to the ones I get just about every day, all day long!! Believe me when you get angina pain you know it..I find a strange sense of forboding comes over me as if my psyche knows this is my life force in trouble...I know that sounds dramatic but I get it every time.

Best Wishes :)

[suzzie1]

Hi Al,  Just wondering how your doing these last few days???  I saw  on your post of 8/14  you said you had an app with your cardio in 6 days time, so I figure thats tomorrow.....just wanted to wish you well and hope you get the help you need !!!  Best Wishes.

[suzzie1]

Hi Al, Im glad to hear that your app with your cardio went well, and they are taking steps to find out whats going on for you. Hopefully you wont have to wait long for the heart cath. You never know this could be 'it', the one to make a difference to your quality of life..(especially as youve got a NEW cardio.)..I certainly hope so!!
Iv got an app with a new cardio also. Its on 19th Sept so a bit more 'waiting' to be done, but at least Iv got the app. Just have to keep my spirtis up and take it easy (as ever) until then.

Kind thoughts and wishes :)