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Pre-Syncope With Aggressive Palpitation
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Pre-Syncope With Aggressive Palpitation

Hello,

I am a 25 year old male. No family history of Heart Disease. Only Hypertension and Hypotension with my father and mother, respectively. Mother had Atrial Fibrillation which was terminated and was later found to have a very healthy heart.

I have been overweight and inactive for much of my life and began smoking at a young age with smoking on and off but have completely quit about 4 years ago. I eat healthily and drink alcohol minimally and only socially. I have done periods of exercise and activity throughout my life and now recently, over the past six months have been quite active.

My first episode of Arrhythmia was April 2009 where I experience a long bout of sinus tachycardia at 150-180 Bpm for approximately 25 minutes which occurred after smoking some very powerful marijuana.

Ever since then I have had random experiences of ectopic or premature beats, some powerful and some almost unnoticeable. All experiences were a-symptomatic with only a sensation of a palpitation with a physiological response. Sometimes my adrenaline would pump and I would experience some Tachycardia. Most of the time these premature beats occur randomly throughout the day although sometimes, and recently more and more so, I experience them during and after exercise or heavy exertion such as with weight lifting. Again no symptoms only the sensation of palpitation. I have once or twice become slightly light headed or breathless from runs of SVT that terminated rather quickly after onset. Both times were about an hour or so after exercise.

continued...      








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1495448_tn?1326846430
I'm sorry to hear about your symptoms as they sound very distressing to you.  Let me provide you with some comfort.  You sound to me like a healthy young 25 year old male.  Your episodes all sound as if they could be normal variants, meaning not caused by a disease.  The presyncope episode which has you concerend happened in the setting of bending over and then quickly sitting up.  This can cause a temporary sensation of presyncope while your brain/body re-equilibrate after the change in body position.  This is not abnormal.  The 'palpitations' you feel seem to occur with exercise or excitement.  Again, this is not abnormal.  As you get excited or exercise, your heart pumps faster and stronger to get more oxygen to your tissues.  People often feel a pounding in the chest when this happens.  The chance that you had ventricular tachycardia or ventricular fibrilliation are extremely low for someone in your demographic.  Unless you have a family history of sudden cardiac death, it is unlikely these are serious arrhythmias.  Your cardiologist appears to be doing a thorough workup and giving good advice.  The event monitor is a good idea if you are truly having palpitations as it can pick up on any arrhythmia.  However, it sounds to me like this is all normal and you are simply having increasing anxiety over the symptoms you are feeling.  Stay in touch with your cardiologist.
Best of luck to you.
8 Comments
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1019388_tn?1340854686
continuation...

Having become worried over time I decided to go to a Cardiologist and carry out an examination on May 6, 2010 (06/05/10). I did a Stress Test, Echocardiogram, a 24-hour Holter Monitor, and an Ambulatory 12-Lead EKG. The results were as follows:

Examination:
- BP was 110/70 mmHg
- Sinus Rhythm of 70 Bpm
- Heart sounds normal with normal splitting of the second sound, no Murmurs
- No evidence of Cardiac Failure

EKG:
- Normal Sinus Rhythm
- Normal PR Interval
- No Delta Wave
- Normal Re-polarization features

Echocardiogram:
- Showed good Bi-ventricular function (EF 65%)
- Normal Valves
- Mild Tricuspid Regurgitation
- Septae appeared intact and the Pericardium was normal
- No Left Ventricular Hypertrophy
- Chamber Dimensions: LV 4.6/2.9 cm, LA 3.3 cm

Stress Test:
- 10 minutes 50 seconds of the standard Bruce Protocol
- Heart Rate increase from 77 Bpm to 203 Bpm.
- Blood Pressure rose from 120/80 to 140/90 mmHg on exercise
- Rate of increase was rapid suggesting lack of physical fitness
- Test was terminated due to fatigue
- No chest pain
- There were no Ischemic-type ST segments, however, there were infrequent Ventricular Ectopics during exercise and one or two, with some SVE, in recovery

24-Hour Holter Monitor:
- Recorded Sinus Rhythm throughout with a minimum HR of 49 Bpm and a maximum HR of 174 Bpm (I did some exercise at some point)
- There were Isolated Drop Beats/Wenkebach, which occurred during sleep
- The total number of Ectopic Beats was low and there were no arrhythmias.

Blood Test (done 03/2010):
- Normal Renal Function
- Glucose 4.8
- Total Cholesterol 4.9
- Triglycerides 0.6
- HDL 1.4
- Normal Thyroid Function
- Haemoglobin 16.9
- Investigations not repeated

The prognosis was not a cause for concern according to the cardiologist as he found my heart to be healthy and my palpitations to be minimal, random, and with no symptoms.

After this examination I tried to put my worries behind me and tried to move on with things and I did. I did however continue experiencing some Ectopic or Premature beats here and there, increasingly during exercise recently, but all without symptoms. I basically felt fine.

The following is why I am posting here...

About three days ago I was at the gymnasium doing some weight lifting. I was experiencing some pre-mature beats here and there, nothing much more than the usual.

Having just finished a set, I was sitting on the workout bench relaxing and decided to adjust the seat bottom. I got up but maintained a bent-knee/bent-body position  facing forward and began adjusting the seat from behind me. My head was basically at my knee level.

As I was sitting back down form this position I all of a sudden felt a powerful and fast palpitation in my chest (a strong flip-flop) that occurred about 5-6 times consecutively and I immediately began to feel faint, I began seeing black as if I was about to black out. I quickly went to feel for my pulse on my neck and did not feel anything! Feeling afraid, I sprung up from my seat and took a deep breath. The moment I took this breath I felt my heart jolt back into a powerful yet quick Sinus Rhythm and I slowly began to feel and see clearly again. I was quite frightened as I have never felt such an aggressive palpitation with a bout of pre-syncope.

Now for the past few days I have been in a world of hell in my mind constantly worried as if I am awaiting for it to happen again...

I have contacted my cardiologist and am going to install a cardiac event monitor in a few days and will speak to him more thoroughly about the situation.

Here are my questions:

1) Is it possible that the Arrhythmia that occurred was a short-term Ventricular Fibrillation that self-terminated as I did not feel a pulse on my neck? The way I almost immediately went into syncope after such an aggressive palpitation felt as if it was?

2) What else could such a palpitation and symptom be from? Ventricular Tachycardia? Supra-Ventricular Tachycardia? For some reason I am convinced that I had a momentary Ventricular Fibrillation although my cardiologist said that is not possible?

3) With a prognosis as such from the above tests that I did, should I be worried? What are the chances that this will happen again? Is there a possibility of Sudden Cardiac Arrest if I experienced this event? I feel as if any moment I am going to go into Ventricular Fibrillation. I live alone so my worries are even stronger.

4) My cardiologist said that I should not be worried as I have a healthy and structurally normal heart although he said an investigation should be made as such an even should be taken seriously which I understand and agree with. What worries me is how could such an even occur with a normal and healthy heart. Do such palpitations and symptoms occur under normal circumstances?

5) Although I do not feel any palpitations when at rest or mostly throughout the day, like I said, I do get an increasing sensation of palpitations with exercise sometimes... Could they be linked?

I hope this write-up is clear enough and has given you a good enough picture of what my experience has been. I look forward to your input and your advice.

Cheers.
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1019388_tn?1340854686
I forgot to mention that from time to time when I experience sexual stimulation or get excited by a certain interaction, my heart begins to beat powerfully but at a normal or sometimes slower than normal rate. As if Adrenaline is pumping causing the strong beats yet at a normal or slower than normal rhythm. Do you have anything to say regarding this?

Cheers.
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1019388_tn?1340854686
After having done some further research, it may seem like I may have had a bout of Ventricular Tachycardia because I did experience what felt like consecutive and quick palpitations with a lack of palpable pulse which are symptoms of Ventricular Tachycardia... It felt like there was multiple-firing in my chest with a sensation of strong flip/flops and fluttering...

I guess what truly scared me was the fact that I experienced pre-syncope...

I apologize for the length of this post but I am trying to communicate as much as I can...

Questions:

- With a healthy heart, what could cause Ventricular Tachycardia? Could my electrolytes be off? Is there a possibility of undiscovered disease?...

- With a history of a gradual onset of a-symptomatic benign ectopic beats and now an out of the blue near syncope with what seems to have been Ventricular Tachycardia, am I at risk for something more serious?  

- What is the chance of having Ventricular Tachycardia in a healthy heart and it degenerating into Ventricular Fibrillation? My event of what seems to have been Ventricular Tachycardia self-terminated when I got up quickly and took a deep breath... Was there a possibility I could have gone into cardiac arrest or may go into cardiac arrest with another event?

- Ever since the episode, now four days on, I have been feeling fine with some ectopic beats here and there, mostly singular with no symptoms, only an 'electrical/energy' sensation that runs upwards from my chest to my head that causes a momentary sense of sight loss and heightened awareness and anxiety but no symptoms... Possibly an anxiety reflex... The only thing that really bothers me is that every time I now experience an ectopic beat I feel as if it may turn into Ventricular Tachycardia... I have had two a-symptomatic bouts of sinus tachycardia but these happened when I was feeling paranoid and anxious...

Again, I apologize for the length of this post and the number of questions but I really do need another opinion, some advice, and in truth some sort of comfort as I am having trouble comforting myself.

Thank you for your time if you have read this in full and are attempting to give your opinions...

Cheers.
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1019388_tn?1340854686
Thank you for your reply and your opinions...

I understand the bodily response to quick changes in posture or bodily elevation... I get these sometimes which are presented with slight lightheadedness or the sensation of mild pre-syncope...

What I experienced was much more aggressive than this... I felt a very powerful surge of quick and consecutive Ectopic beats that ponded in my chest out of the blue followed by a seriously near blackout... It was much more aggressive than a posture induced equilibrium shift where I would usually feel an elevation in heart rate and beat power... What I felt prior to the pre-syncope was a very obvious bout of arrhythmia...

I am not trying to negate your prognosis, In fact I thank you for your professional input and your comforting words but I just want to make sure it is clear that what I experienced was very different from what I experience during a posture induced dizziness...

Is there anything you can mention about:

1) The mechanisms of the heart in the sense of what could lead to a bout of Ventricular Tachycardia in a healthy heart under duress?
(Duress being the fact that I was weightlifting, had just quickly sat down from an awkward postural position, and actually having just had a very heavy night of drinking about 36 hours prior to the event. Could a lack of electrolytes cause such an event?)

2) The potential of cardiac arrest or a bout of Ventricular arrhythmia leading to Cardiac Arrest in an individual such as myself given my age, health, heart health etc...?

I would appreciate such input...

Thank you again Doctor.

Cheers.

  
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1495448_tn?1326846430
It is impossible to tell if this was an arrhythmia without documentation on an ECG.  It may have felt like "a very obvious bout of arrhythmia" and while there is a very small chance that it was, it is highly unlikely.  The heavy drinking likely led you to be volume depleted and dehydrated which contributed to your presyncope symptoms.  Electrolyte imbalances can cause ventricular tachycardia, but your body is very good at regulating your electrolytes especially in a healthy young adult with a presumably normal heart such as yourself.  If you continue to have these palpitations, please contact your cardiologist for further work up.

Best of luck.
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1019388_tn?1340854686
Update:

I went to see my Cardiologist after this episode (about 8 days after) and we carried out a Holter 24 Hour monitor test.

I noted approximately 20 sensations/palpitations with the time, activity, and other notes. I vaporized Marijuana and went to the Gym as well to maximize data collection.

The results of the test showed that out of approximately 110,000 beats (HR avg.= 76.4 Bpm, generally Resting HR= 60 Bpm, Note I vaporized marijuana and went to the gym) I only had 1 PVC with everything else looking good. I discussed the episode with the Cardiologist and after about 30 minutes of explanation and discussion he concluded that without documentation of said arrhythmia it can not be said for sure what occurred but that it is highly unlikely to have been VT, if anything a possible bout of SVT, and that given the positive results of my previous test, as well as the positive result of the 24 Hour test, that I should not be worried and that no further investigation is necessary.  

I have since experienced some palpitations, one of them felt like a PVC w/ a flutter and a symptom of light-headedness and slight breathlessness (i think the latter was due to anxiety), a slight tachycardia followed, and another PVC produced no symptom other tha a powerful energy wave that travelled from my chest up to my head followed by anxiety and quite a heavy bout of tachycardia that subsided with calming down.

I go to the gymnasium about 3 days per week and I usually do 30-40 minutes of cycling or rowing with an average of 150 Bpm and I can comfortably attain 90-95% of Maximum for periods of time although I generally try not to exceed 185 Bpm. I sometimes weight lift as well. One thing I notice is that after stopping post cool-down (within 5 minutes of stopping) with my HR between 110-120 Bpm, I get some fluttering sensations and I notice on my HR monitor that my HR would climb to about 130-140 Bpm and quickly return to 110-120. This happens anywhere from 1-5 times and I usually have no symptoms. Aside from the above,  all else feels well and no issues other that anxiety and fear at times.

Any more comments or opinions are always welcome.

I thank you for reading and just wanted to put this in the post to close the loop on this specific episode.

FSKnight.
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967168_tn?1343732745
I've read this happens in situations like you've described, also with binge drinking - like with marijuana.

There was an article on MSN about K2; not sure how close to K2 what you smoked was, but it could be the reason - http://health.msn.com/health-topics/addiction/articlepage.aspx?cp-documentid=100266775&gt1=31036
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