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Palpitations with chest pain and Shortness of breath
Dear Dr.,

I am a 27 year old male, non smoker with average built. I had no past history of a heart / chest related issue. My problem started almost one year back when I was sleeping in the night - I woke up out of breath and was restless. I felt my chest and found that my heart was beating very fast (much faster than the palpitations you get after a long run). The symptoms eased after almost a couple of hours. Next morning I went to a Doctor. The doctor checked my pulse and said its too fast. A few days later I did an ECG / EKG which said: 1) Sinus Tachychardia 2) Right Atrial Enlargement 3) Borderline ECG. I took the ECG report to another Doctor and he ordered an Echo to confirm the "  Right Atrial Enlargement". the Echo report said: Mild concentric WH, LVEF 65%, Mild MR no AR no TR - NORMAL STUDY. The Dr said Echo is normal and gave me a propranolol + alprazolam combination for 15 days and to take the medicine as an SOS after 15 days. Since then I had 10 - 12 such attacks of (palpitations and sevire shortness of breath) and I took the medication as an SOS for the last one year. In the last year I did almost 15 EKGs almost all of them said "SINUS TACHYCHARDIA" baring a few, and in none of the EKGs my heart rate was less than 85 (the minimum was 85). The Doctors also tell me that the "P wave is pointed in lead 2" in most of the EKGs taken. I did another Echo last month which said: All chambers are normal in size, trivial TR no MR no AR LVEF 65% - NORMAL STUDY. I got blood work done as well (thyroid, sugar, Lipid profile) every thing came back normal except - low level of good cholestrol (around 30).

Over the past 2 - 3 months I have been having left sided chest pain sometimes sharp sumetimes dull ache which lastes 2-3 hours and at times almost the whole day. I also have severe shortness of breath sometimes. Did an entire heart test last month all tests - EKG, ECHO, TMT came back normal. the Drs still see the tall P waves in the EKGs.

> What is causing the P wave to point? When the Echo says All chambers in normal size?
> Why is my heart rate so high all the time?
> Does a high heart rate cause shortness of breath?
> Does a sustained high heart rate has negative effects on the heart in the long run?
> Is it OK to take propranolol as an SOS?






This discussion is related to Atrial runs and chest pain.
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Has your doctor not suggested that you have a cardiac angiogram to detect if you have any blockages in your heart's arteries?  I would speak to my doctor to see if this should be done expecially given your shortness of breath and chest pains and the length of your chest pains.  I am not a doctor, however, I had triple by-pass surgery six months ago and some of your symptoms resemble mine.  
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