Symptoms related?

Posted by karen on June 14, 1999 at 13:54:32
Hi~ I'm a 28 year-old female who exercises daily.  I was diagnosed this year with bradycardia, which the doctor is unsure if it's caused by fitness or whether it's sick sinus syndrome.  He put me on 400mg Theophyline/day to try and raise my rate, as it does cause dizziness and fatigue.  My normal resting rate is in the low 40's, and sleeping it drops into the low 30's. I do wake up every morning with a raging headache, which a sleep doc told me is from lack of blood flow to the brain.. Increasing salt intake has helped manage the dizziness.  A stress test, echo and holtor monitor all came back ok, although on the stress test my rate dropped from the 160's back into the 50's within about 50 seconds.
Lately, for about a month now, I've been experiencing daily headaches, along with increased fatigue and lightheadedness.  I feel like when I move my eyes or head it takes a second to focus, which generally leaves me feeling sort of woozy and sometimes nauseous.  Also, I got a pretty bad nosebleed about a month ago which is recurring daily when I blow my nose (usually in the morning).  The fatigue is the worst part - working out has become nearly impossible since I don't feel the energy to get my legs going let alone sustain them long enough to get my heart rate up.  The doctor does not want to pursue a pacemaker since I am so young.
My question is - if the bradycardia is indeed sick sinus, how long would it take to get worse and are these the kind of symptoms I'd be seeing?  Thanks.

Posted by CCF CARDIO MD - CRC on June 15, 1999 at 08:46:01
Dear Karen,
It's pretty unlikely to be sick sinus syndrome at your age and theophyline is a rather unusual treatment for bradycardia in an adult.  I would suggest seeing a specialist in adult internal medicine for additional testing.  Perhaps you are hypothyroid or less likely have an autonomic disorder.  In any case a good internist should be able to sort it out and refer you as needed.  Best wishes and let us know what they find.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
Posted by karen on June 15, 1999 at 15:55:05
Thanks for the input.  They did do thyroid tests which came back normal, along with a sleep study to rule out sleep apnea causing the fatigue.  Also normal except that, like I said, the sleep doc noticed that my heart rate drops pretty low overnight.  We're in the military, and when my primary care doc here on base got the report from the cardiologist, he referred me to internal medicine at the base hospital.  That doctor said she's reluctant to agree with the cardiologist's diagnosis of sick sinus because of my age.  She gave me the choice of proceeding with an EP study or montitoring every six months with a holtor monitor.  She strongly advised the holtor route so that's what I agreed to.  I've got another three months before I'm due for that.  What is an autonomic disorder?  Thanks!  K.

Posted by karen on June 15, 1999 at 15:59:44
I forgot to mention - not that it matters from what I understand - my grandmother had heartblock 4 years ago for which they put in a pacemaker.  She had a sister who died in her teens from some heart related difficulty (I don't remember what.)  My mom has mitral valve prolapse (I don't, just some insignificant leakage from what the heart doc said) and my sister was diagnosed with a murmur, ironically enough, when she was about my age...does all that constitute a genetic thing?

Posted by CCF CARDIO MD - CRC on June 16, 1999 at 09:07:18
The family history probably has little bearing in this case.  The autonomic nervous system controls blood pressure and heart rate and can be damaged but this is usually in older people.  I think the Holter is a good idea.  The key is to document in a diary the date and time of any symptoms (lightheadedness, fatigue)while you are wearing the Holter.  If there is no correlation between the symptoms and a low heart you can basically ignore the heart rate and focus on other causes of your complaints.
I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.