Re: Heart changes

Posted By CCF-CARDIO-MD-APS on May 14, 1998 at 14:38:03:

In Reply to: Heart changes posted by Lucy on May 12, 1998 at 01:02:36:






Hi It is great to have such a program which makes it accessible for us. I would like to hear from you about my heart. First in 1975, I was prescribed birth control pills as a hormone supplement. Shortly after, I experienced several ecoptic heart beats according to the EKG diagnosis. I was reassured that it was nothing to worry about. I was 25 when that happened. I did not worry about experiencing it on and off for years. Again in 1981, I had an EKG test because of the chest pain. The EKG test revealed a problem with T-wave. "Nothing to worry about it", the doctor said. I myself diagnosed it as too much gas pressuring up against the diaghram (sp). I learned to manage it and had had no problems ever since.  Then in 1989, I had an pre-day surgery EKG which again identified a t-wave. I assumed it was nothing to worry about. I was placed on Prozac due to depression. I found it really helpful and it helped me get out of the slump.  After six or eight months, I started to experience really huge gallops and squeezes in my heart. No short breaths or pain. It often happened when I was asleep. The llast one was really bad. I felt as if the heart collapsed almost all the way and expanded, just like the pump in the OR. . It was not like those ordinary skipped or ecotptic skips. Sometimes, I would experience a string of ecoptic skips (just like a burst of bubbles coming out of the hole). It scared me into stopping Prozac. Never reported it. No pain. I also experienced 50-60 beats an hour. for a long time.
In 1996, my gyn gave me a full exam which was routine for me as I am on hormone replacements (Premarin and Provera). He found that "The chest was clear to auscultation and cardiovascular system revealed both sounds were normal, with a 2/6 systolic ejection murmur."  It was the same again this year.  
This year, I was diagnosed with Graves' Hyperthyroidism based on the blood results and some hyper- systems.  It was a surprise to me because for years, my TSH levels were elevated, but not high enough to require supplements. I had to read as much as I could about Graves to understand it better. One of the symptoms I found was the 2/6 systolic ejection murmur. It was mentioned several times in different literatures and in Internet. I experienced mild palipations this year. Now, it has eased, thanks to the anti-thyroid medications and RAI. I also notice that
I tend to inhale deeply from time to time as if my lungs need some oxygen. I never experienced any hyperventilation or short of breath. My heart would pump hard especially when I walk up the hill or steps.
I don't drink or eat any caffiene (coffee, tea, chocolate) because I cannot tolerate it due to the acid influx (?) since I was ten. I am now over 45. I am 50 pounds overweight. I walk 10-30 minutes five times a week.
Question 1: What is a 2/6 systolic murmur?? Is it damaged? Will it get worse when I eventually become hypothyroid? Is it related to the ecoptic heart beats or T-waves?  prozac-induced skips? Is there a way to get rid of the murmur?
Question 2: Why did the heart really collapse and then expand especially when I was asleep (when I was on Prozac)?
Question 3: What does my body need to inhale deeply from time to time? My heart beats seem OK.
II hope you will answer my questions to help me understand what is going on with my heart. I am sure these symptoms are not serious enough to seek a cardiology consult. It would be some peace of mind for me.  Thank you for your time to read my post about my odd heart.



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Dear Lucy,
A murmur describes an abnormal sound heard by the physician as he listens to the heart.  It usually indicates an abnormality in one of the valves such as a leaky or stenotic(restricted opening)valve.  A murmur however is not always indicative of an abnormality as any patient who has increased flow across their valves will likely produce a murmur; medical conditions that might lead to this would be pregnancy (when the blood volume is increased), anemia, and hyperthyroidism (this is likely the cause of your murmur.)  Without knowing where your murmur is the loudest on exam and what other physical exam findings accompany this finding, I can not comment except to say that if the murmur is present only while you are hyperthyroid it is most likely benign and not a damaged valve.  In any patient who has a new or changed murmur, and in those without an easy explanation for the murmur an echocardiogram is usually performed to evaluate just the things we have been discussing-the different valves, any leaking or stenosis or abnormal stucture of the valves.  If the murmur is from your hyperthyroidism, it should get better(back to normal)with resultant normothyroidism and if it does not, an echhocardiogram should be performed to evaluate for other causes of the murmur.  Premature ventricular and atrial beats (PVCs and PACs or 'ectopics')are benign (do no harm) and are not usually related to murmur development.  PVCs and PACs actually are very common, it is highly variable however whether the patient even notices them; as well some patients find that certain drugs and foods and emotional stress will increase the frequency of the "skipped beats" as you call them (also called 'ectopic beats'.)  IN general it is recommended that caffienated products, foods with chocholate or other stimulants be avoided in these patients (this includes smoking, and drinking alchohol.)  The patient may even benefit (reduced symptoms and occurence) from relaxation exercises.  If the patient has fairly frequent ectopic beats and no known stimulaters, it is useful to check the TSH level as hyperthyroidism can be a cause of these and the ectopics will not get better without treatment of the hyperthyroidism.  If ectopics increase on any new medication and there is no other explanation for the increased symptoms and beats then one should assume that it is the new drug that is causing the change.  In your case Lucy this is all very complicated as you not only have hyperthyroidism, but you also appear to have benefited significantly from the prozac, hence stopping the prozac might not be an option.  I think it would be best for you to wait until the hyperthyroidism is treated and reevaluate your symptoms and frequency of ectopic beats at that time.  Something else to consider is that the patient and physician need to weight the benefits of one treatment against the side effects of another, keeping in mind that ectopic beats are benign and depression is not.  I do not mean to imply that depression is life threatening although it can be if bad enough and ectopics are not.  The symptoms of ectopic beats are variable and do include such sensations as "my heart felt like it was jumping out of my chest" and "my heart felt like it stopped", etc.  Assuming that all you have is ectopic beats that increased with your hypothyroidism and a murmur secondary to the same disease process, then no, your heart is not collapsing and this is just the way you percieve the abnormal beat.  Of course if the heart does "collapse" this is incompatible with life and in no way does that ever occur as a result of ectopic beating of the heart.  It may be of interest to you to know that your increased occurence of symptoms at night may be because the prozac levels are highest then and are instigating your ectopic beats or the emotional stress of everyday life culminates at the end of the day and this is the cause of increased ectopics with their inherent symptoms.  Mind you, if any shortness of breath occurs in the sleeping or daytime hours you should seek a cardiology consult as this portends a more significant problem.  Regardless Lucy I think a cardiology consult and at least  an echocardiogram would be reasonable as well as very reassuring to you.  Also I assumed that you have had a holter monitor for 24 hours to get a better idea of what kind and how many abnormal beats you are having on a daily basis; this test also is useful in correlating symptoms with the actual ectopic beats.  As for your need to take deep breaths, this is a normal physiologic occurrence- everyone deep breaths and or yawns many times daily- but usually one is not conscious of this reflex.  You may just be more aware because of all your other symptoms or you really are short of breath, the latter condition is concerning, and the former not.  I hope that this information has been of some help to you.  Information provided in the Heart Forum is intended for general informational purposes only, actual diagnosis and treatment can only be made by your physician(s).