Palpitations and Chest Pain

[becca]

I am 25 and have been diagnosed with neurally mediated syncope.  It is believed that the syncope is caused by rapid tachycardia (170-180bpm); however, my normal resting pulse is in the upper 40s and will periodically drop into the high 30s (measured before I began taking a beta blocker).  I will more than likely have a pacemaker implanted in a few weeks so I can take a high dosage of beta blockers to combat the syncope.   Anyways, 8 days ago, I had a pretty bad tachycardic episode in which I did not faint, but my heart all of a sudden started beating +150bpm and lasted for about 20 min.  About 5 minutes after the tachycardia ended, I have began experiencing palpitations that have intensified over since the attack.
   Two days after that tachycardic episode, chest pain developed along with the palpitations. This feeling of pressure in the center of my chest is always accompanied by the palpitations and will sometimes last only 3-4min and other times for several hours (especially in the evenings).  I do not have SOB with the pain, but I do have some difficulty catching my breath after doing anything like walking up a flight of stair.  The center of upper left back burns which is especially noticeable when I wake up in the morning.  My neck has been bothering me, and there has been a lingering tingling sensation in my upper left arm.  And in general, I have been pretty much consumed by fatigue since that tachycardic episode.  The fatigue, of course, is not being helped by the fact that at night I am not sleeping well and will sometimes wake up with these intense palpitations and a slightly tachycardic heart beat. It has finally stopped getting worse, but it does not seem to be improving.
I finally called my cardiologist after 3 days of this, and all he told me to do was to increase the dosage on the beta blocker I was taking.  However, even with 3 times the dosage of the beta blocker, my symptoms are only temporarily allievated. I went to the ER after the 5th day, and they completely disregarded my complaint because I am only 25 years old and simply sent me home.  
My FH does include Coronary Heart Disease and high BP but only in relatives 60+ years in age. My cholesterol and BP are low and before I began having syncopal attacks, I would exercise daily.  Considering my age and life style, I seriously doubt that AMI or related ischemic disorders could be the problem.  However, I do not know how to interpret these symptoms.   This is very uncomfortable, and I am getting very discouraged because no one seems to take me seriously.  Could this be pulmonary or musculoskeletal related? (I do not any have congestion, and I can't remember doing anything to cause injury to a rib or any surrounding tissues.) Could some damage have been done to my heart during that initial tachycardic episode 8 days ago that could have caused all of this to happen? Could this be MVP?    Any comments would be greatly appreciated.

[Cleveland Clinic, MD]

Dear Becca,
I don't think you would have any damage done to your heart from this episode.  As far as what is causing the episodes this is not as easy to answer.  It could be due to the neurocardiogenic syncope, inappropriate sinus tachycardia, POTs syndrome, AV node tachycardia or another type of tachyarrhythmia. These conditions would need to be diagnosed with a Holter monitor test or an electrophysiology study.  The only way to diagnosis Mitral Valve prolapse (MVP) is with an echocardiogram.   Hope this helps.

[james]

Becca you sound like me. I am only 23 but have been ill most of my life. I am in bed most of the time now because my symptoms have been so bad. I know what youre going through. I am so angry at the doctors because they don't think young people can have these things. Statistics prove otherwise. I would like to hear hoe you get on as it could help me. I am from the UK and often have periods of beats at 180+. It can last for over an hour some days even when though Im often in bed.  my heart rate also drops from 186 to 40 within a few seconds which freaks me out. I also have an irregular heartbeat quite often. Its ruined my whole life. I am 24 in a few days and all the dr has done was listened to it after begging her. She told me she could hear a murmur but because of my age it was harless. Even with my other symptoms and the fact I am physically drained all the time. They have sent me to 3 different shrinks, but won't test me. I think it sucks What about you? or anyone?

[mairey]

James I am from the UK but living in the US. I had all these symptoms you describe starting about your age. I know that the NHS is very hard to deal with but insist on an ECG, Echocardigram and holter.  All these are available under the NHS. I too was told my symptoms were from anxiety and felt like a hopeless freak. If need be and your symptoms are very bad go to the emergency at the hospital or call 999, they will at least do an ECG. At 23 you need some answers and maybe medication to improve the quality of your life but hang in there and don't take anxiety as the answer without being fully  evaluated. If it is the reason there are meds that can help. I now have kids your age and a grandson. Have been diagnosed with PVC's which are annoying but not life threatening and come and go so please insit on reclaiming your life and don'tlet the NHS ruin for you. PS (my son's name is also James)

[Beth (to Betty)]

James, I feel you frustration.  (FYI, I have a murmur as well, and it does scare the hell out of me when my heart jumps from fast to slow within seconds.) I physically do not know how much more of this I can take.  Don't you just hate it when no one believes you. I am so tired of being told that I am having anxiety or that I should go see a shrink.  Just because of your age, many doctors disregard you symptoms without thinking twice. What really baffles me is that I have worn an event monitor (used to record arrhythmias) for a couple of weeks, and several of the recordings made did show atrial tachycardia and one even suggested degree II A-V heart block.   But, because nothing could be stirred in an EP study, I was told that it had to be a neural thing.  
  
At this point, I would settle for any doctor believing me.  I do not know what has to happen to be taken seriously.

[Carol A.]

Becca,
   Your symptoms sounds so much like mine. I was diagnosed with Sick Sinus Syndrome with Tachy-Brady Syndrome. I am 39 yr old. The Dr's told me that it was probably caused from a viral infection. I still have the Tachycardia which is controlled somewhat with beta-blockers. I also have trouble with low B/P with the beta-blockers. We need to increase it but can't because of the B/P. This was diagnosed in Aug. of 1999. Had a pacemaker inserted on Oct. 15th of the same year due to my pulse went down to less than 20 per minute. You are not alone. If you would like to discuss this more I would be glad to.
                                             Carol A.

[Beth (to Betty)]

Carol,

[Beth (to Betty)]

Carol (Sorry about that previous message),did you have chest pain that accompanied the SSS? What were your symptoms other than the irregular heartbeat?   Did the pacemaker improve the quality of life (I hesistate getting one because I am only 25.) Thanks
--Becca

[From James To Becca and Mary]

Thank you so much for understanding. I Find it hard to deal with and talk about, so what you said I will take on board. Because My symptoms are getting so bad, I honestly think my future is limited. I am in bed for over 20 hrs a day and have an appointment at the end of the month with a neurologist. I can feel my life gradually being taken away. My episodes which happen many times a day are damaging my heart even more. I know something is seriously wrong. Tell me if these could be something other than my heart. 1. A female friend of mine came to see me the other day and sat in my room at the far end of my bed. She could hear a faint thumping sound and asked me if i heard it. She couldn't believe it when I told her it was my heartbeat. She took my pulse and it was 194. Is this sort of speed damaging my heart? It lasted for over 40 mins. When she took my pulse she said she could clearly hear both beats. Is this common with other people? Also I get more irregular beats the following few days. I also heard it beating in sets of two. Like a lubdublubdud       lubdublubdub          lubdublubdub    type of sound. There is a pause between the sets of double beats which varies from 1 to 5 seconds. The longest this tends to last is only under 5 minutes so I am not so worried by it. After these sets of double beats my heart sometimes makes a fluttering noise. It sounds like it is shaking rather than beating. I have another month of being in bed before I see the neurologist. I hope he will let me see a cardiologist quickly.
Anyway, I think I have run on a bit too much so sorry. If you could help me with my questions or have any more advise, I would really appreciate it.

If you have read this,
Thank you.

James

[Gatal]

Coming from the UK my advice (as unethical as it may be) would be to goto your A&E and they will do an ECG and get you a referral to a cardiologist quickly.  But maybe you would be better to change GP first? what part of the country do you live in?

[Karen]

I totally relate to the mentality of some doctors regarding the age issue.  I am currently in a situation that seems like more should be done than has been.  I am 33 yrs. old, have Ehlers-Danlos (T-1, T-4 , with a smattering of most of the other types).  My symptoms of EDS are not as severe as my daughter's, she has the severe classical signs, (ie. her skin does not hold stitches any more and she has Medullary Sponge Kidney). I sublax and dislocate often and have had some internal prolapsing problems. Over 2 years ago I had an echo done and  it showed trivial regurgitation in the Mitral, Aortic, and Tricuspid valves and the EKG was fine.  Last June I had another EKG done for Severe chest pain/pressure (it was done a week later, my fault). The nurse called the next day and said it was normal, but  during the follow-up, my doctor said I had LAE and poor R wave progression, nothing to worry about.  I had a holtor monitor (palpitations, chest pain, fatigue- I also have Fibromyalgia) and the nurse called today and said it was normal. Who knows? The scary part is that my dad (who had EDS-posthumously diagnosed)died at age 30 from a cerbral aneurysm.  But according to the doctor, I have a great cholesteral  level, so my heart is fine.       ARGGGH!!!!

[Carol A. for Becca]

Becca, I did have some chest pain, but mostly Shortness of breath, and synocope symptoms. I had no energy or stamina. Could not walk up stairs without stopping to catch my breath. I had this for about 2 months before we figured out what it was. And had to qualify for the pacemaker. There is certain guidelines that have to be met to qualify for it.  
    I had no choice with the pacemaker because I would not be here without it. My pulse dropped to below 20 and I was rushed to a regional medical center to have one put in. I should have passed out at that time, but thanks to God I was able to get help and get to the doctor's office and he transferred me to the regional medical center. I live in a small community that has a hospital but does not do these kinds of procedures. As far as my quality of life it is much much better than it was.  
                                               Carol A.

[Beth (to Betty)]

For anyone still reading this question/forum, I thought I would further comment about my situation.

Anyways, the chest pain got really bad a few days ago and I was having increased difficulty breathing, so I went back to the ER, even though I was hesistant after my last journey to the ER. It turns out that I do have Mitral Valve Prolapse (MVP) and that it has been causing moderate mitral regrugitation which explains the angina.

I am a bit infuriated at the moment because I first complained of this kind of pain (though fleeting at the time) to my cardiologist back in June, and he disregarded it.  Then, when it started to get really bad a few weeks ago, he again disregarded it and so did the ER doctors on my first trip there.  Presumably, this is all related to the fact that I am only 25 years old.  So, I am a bit frustrated because I don't feel I can trust my doctors.  I'm NOT a doctor, but I do think that it would have been hard to miss such a problem, especially because valve replacement has now been suggested.  I do not plan to seek compensation for these errors, but I do hope that one day, doctors can have a little more confidence in their younger patients and not always assume that problems are "in their head."
  I would love to hear any comments or advice from anyone else.   BEST WISHES TO ALL ---becca

[To Becca from Karen]

One thing that I had to learn the hard way was that doctors are not omnipotent.  They make mistakes, some pigeon-hole symptoms- just like some laymen make decisions without looking at all the facts, in essence, they are human. Always go with your gut instincts regarding your health and keep searching for a doctor who will search out and follow through on your symptoms and concerns until you are satisfied with the results.  I have three children, my middle child was 2 years old when she was diagnosed with Ehlers-Danlos. I have been told that she will not live to be 5 (she is 7 and doing relatively fine, thank-you), that her condition will not progress (it has), and that she can not have Medullary Sponge Kidney because it is not related to Ehlers-Danlos patients nor in any one this young. She does and it is related.  My youngest son has Ehler-Danlos Syndrome (very mild)and he has Urticaria Pigmentosa.  I was told that it couldn't be UP because it is almost impropable to have two "Zebra  disorders". He does and research backs it up.  It took many, many different doctor visits for both my children. Because of the  bruising associated with EDS, my daughter has been checked for Physical and sexual abuse instead of actually trying to find out what is causing her bruises and broken blood vessels. But I continued to search for any doctor that could tell me what is happening to her. (Because of the severity and form of her EDS, she is a "Make-A-Wish Child"- fantastic organization). I asked a doctor if she was familiar with Ehlers-Danlos and she replied that Yes, she does accept that insurance.  Only YOU know YOU! I am so glad you kept after your doctor. (I should do the same- but I am a wimp when it comes to me).  Praise the Lord that their are wonderful, knowledgeable doctors out there. Just please help me to find one!

[Victoria]

Becca, how did they find your MVP? Diden't they do some kind of stress test firstly in the ER??

[Beth (to Betty)]

No stress test....In brief, a chest x-ray was done and found enlarged heart (LV hypertrophy). The Dr. then listened more closely to my heart and heard the MVP/MR.  With a family history of MVP and sudden cardiac death and personal history of syncope and palpitations, an EKG and echo followed and both indicated MVP/MR.

[Jill]

I've read with interest everyone's comments. I have palpitations fairly regularly but have recently started to wake up at night feeling quite strange and as if my heart isn't beating at all, then it starts to race and I feel like I'm going to faint.
My pulse feels very faint, skips beats, then starts to bound.
I also get chest pain that comes and goes. I've had an ECG as my Dr thought I might have pericarditis after a virus but the
ECG was normal. As the symptoms are vague, and now and then, it's difficult to get them taken seriously. (I'm 37).
Even I wonder if it's anxiety, although it happens mostly at night.
Any thoughts out there on this??? Thanks.

[Victoria]

keep us updated

[Victoria]

cut and paste from carol:  

I've read with interest everyone's comments. I have palpitations fairly regularly but have recently started to wake up at night feeling quite strange and as if my heart isn't beating at all, then it starts to race and I feel like I'm going to faint.
My pulse feels very faint, skips beats, then starts to bound


sleep apnea?

[Jill]

Thanks Carol, I have suspected this also. Could be central sleep apnoea or mixed obstructive.
Sometimes I have these symptoms through the day so it is baffling, but I am fatigued alot of the time (another sleep disorder symptom.)

[Liana]

Hi, I was reading forum  and want to say that I am very unhappy with doctors attitude. I do have chest pains, I do have palpitations and doctors can not recognize serious cardiac condition. They said it is mild MVP, nothing to worry about. I made a number of tests and they all turn out negative. Some doctors say it is  reflux disease, I am taking prilosec for acid control. And I still have chest pain, elbow pain, left feet pain and calf pain. With palpitations a little bit better I am taking Valeriana Root Drops ( it is european medicine provides better sleep and relaxes), Valeriana drops is a harmless (if taken as says on the bottle) as all it is a natural root extract. Before I start taking it I was waking up at night from my heart pounding and severe palpitations. I have normal blood pressure . Do not take it if your blood pressure is not normal, and better talk to your doctor  even if they never heard about natural medicine they still can say if it is ok for you or not. The reason why I write about Valeriana is because these stupid american doctors do not know about it, they always trying to give you medicine that has a lot of side effects. Believe me I know. You can get Valeriana in drug store or health food store.
Some doctors told me that I have chest pain because I worry too much, anxiety related pain, well I am taking valeriana and at least sleep better.
Good luck to everyone

[C.N.]

Wow, it is incredible to read all of these common experiences with doctors who don't take young people seriously.  I totally, totally related to your stories.  I am 31 and still after all I've been through am afraid to bring up problems with my doctors for fear that if they are not readily identified by them, they will be discounted and I'll leave feeling stupid.  I ended up getting a pacemaker last year for sick sinus syndrome.  I told my doctors I was feeling lousy after an ablation, they said it was probobaly just nerves.  I was continuing to feel bad, my ankles were swelling and I gained 15 lbs. in one week.  I refused to call my doctor for fear of feeling stupid again.  I went in and they couldn't figure out the problem.  I told them that my heart rate would get very slow, they didn't listen.  After a couple weeks of passing out and feeling worse, they finally put a 24 hr. monitor on which revealed up to 7 second pauses between beats and a rate as low as 17.  They said they were sending an ambulance to my house. It was at that time I received a pacemaker.  That has only been the beginning of my rhythm problems though, and I am still reluctant to tell them, because as soon as they start to believe you're hyper sensitive they stop taking you seriously.  

I'm sorry to go on so long,  I didn't see this post until just today so I don't know if anyone will read it.  I just can't understand why for the most part young people are labeled as anxious just because they can't come up with an immediate explanation.  I'm sorry for all of you who are out there fighting to be heard, it is so frustrating.  Just don't start doubting yourselves.  If you're anxious you know it yourself, you don't need a doctor to tell you.  Well good luck to all of you.  I'd love to hear from anyone.

[becca]

To Chris:  Well Chris, as you can see you are not alone with your troubles.  Those damn doctors... I hope things get better for you.  You know, we, as patients should not have to fear criticism from our drs.   Under the Hippocratic Oath they took to become physicians, they pledge to treat patients unconditionally...

Still more bad news for me. I am going to have a valve replacement done soon, but now I have to deal with pericarditis/effusion (of course, of unknown origin).  What a mess, and I can't help but wonder if any of this could have been prevented had my doctors listened to what I was telling them weeks ago!

[C.N.]

Becca,

I'm sorry about your pericarditis.  I have had that a couple of times and it is very painful.  Are you in pain?  When are you having your valve replacement?  Did your doctors say that all of the symptoms you have been having are due to the valve?  If so it will be a relief to get this done, and hopefully feel better.  It is so hard to think about what the doctors should have done, or what would be different had they addressed your problem sooner.  It only fuels the anger.  I now have chronic atrial fibrillation because my doctor ignored me for so long when I said I was having palpations, that by the time they started treating me it was too late to reverse the problem.  Well, Becca good luck to you!  Be sure to let us know how you made out with your surgery!

[kim]

I sympathize with all of you .My husband is 42 he had his first heart attack at 35 so far he had 2 attacks,75%heart damage he had ptca twice had 3 stents in june this year, and now is currently in hospital had another attack 2 more stents put in same artery but he also suffers from anxiety he will tell you this if you think something is wrong with you and your doctor does not beliebe you look for another dr. and keep looking till you find one who does his heart damage came with his second attack because a dr. told him it was in his head to go home also after he had a stress test that he passed and he waited to go to hospital till it was eight hrs into heart attack,but i will also say if you have anxiety attack you will think your havin a attack it is very hard to tell difference sometimes when you panic you rob all the oxygen from your body and it very overwhelmin when your already scared it causes the chest pain i have watched tis for 6 years very awful to live with for anyone.

[Terry]

I too had a perfect stress test, thallium scan and echocardiogram.  I had low blood pressure and perfect cholesterol numbers.  I started having severe palpatations with very bad pain.  I was told it was acid reflux.  My EKG's were perfect.  The pains got worse at night and then started coming all the time.  Finally, my cardiologist did a angioplasty and found I had a 95% blockage of my LAD.  My first two stents re-stenosed but, knock wood, it has been over a year and the third one seems to be holding.

I was 48 at the time, had not been through menopause, am thin and exercise every day...

The Doctors can still not believe what they found.  My point is everyone is different.  Keep pestering the Docs till they find out what is wrong.