Test Results

[nlfolds]

On Xmas Day, I went to the ER with a rapid heartbeat. Diagnosis was Sinus Tachycardia  with PVC.  A later Holter report showed Sinus Tac Rates 64-130BPM, Rare PAC, Moderate PVC . Echo report shows LAtrium is upper normal limits, LV is mildly enlarged, Perserved LV, Mitral Regurgitation 1+..Mother died at 59 from heart attack.  Father had major heart attack at 69 with 5/way bypass surgery.  I am 49yr.Female.  Should I see a Cardiologist.  Internal Dr. told me everything was ok.  Don't want to hear in 10 years I should have done something to prevent something major.  I do take Blood Pressure med.   On XMAS day, I felt the skipping of beats in my chest.  I wake up several nights with an ache in my chest, (not pain).  Just an ache deep in my chest.    Past 2-3 months have noticed shortness of breath at times, pain in upper middle back between shoulder blades.  I truly like my Internal Dr., but am considering going for a second opinion with a Cardiologist.   What do you think..Thanks for this wonderful board.

[CCF-M.D.-RCJ]

nlfolds,

Thanks for your question.

I'll summarize the available information first:
49 yo female with history of hypertension of unknown duration presents to ER with palpitations.  She has noticed 2-3 months of sporadic shortness of breath, upper back pain, and several nights of chest pain awakening her from sleep.  Family history is notable for coronary artery disease.  Physical exam is unknown.  EKG is unknown.  Holter showed sinus tach with PAC/PVC.  Echo is consistent with hypertension changes.

I am less concerned about the ER visit than I am about the 2-3 months of shortness of breath and chest "deep ache".  These findings could be from long-standing high blood pressure, but also from coronary artery disease or aortic disease.  Unfortunately, the summary you provided leaves out important information -- some of which you cannot provide through the internet medium.

You have two basic viable options.  The first is to go to your trusted internist and tell him of your symptoms and concerns.  He/she knows you better than I and could provide further counseling, testing, or referral.  Alternatively, seeking an opinion from a cardiologist is also a viable option.  Doing this without your internists knowledge, however, may strain your relationship with him/her.

Hope that helps.

[matty_boston]

Not a doctor, but I believe that you should definately see a cardiologist. In my opinion, you have nothing to lose and everything to gain. Even if he or she tells you nothing is wrong, maybe it will give you a piece of mind.

Good Luck!

[nlfolds]

Thanks for answering....Have decided to see a Cardiologist.  Got all the reports from all my recent tests and will bring them with me.  Really don't want to end my like my mother...One week she was fine and the next she was dead..We had no warning..Really don't want my kids and grandchildren to go thru that.

[matty_boston]

I also know that for me, the more I worry about my condition, the worse it will get, so I try and not worry about this. Hopefully after seeing the cardiologist you will feel the same way. In the meantime, try not to worry too much about it (I know easier said than done).

Good Luck!

[Richard_W]

I would seek out the best cardiologist you can find, and I would so advise your internist. (But you are ultimately the supervisor of your health so I would be less concerned about what he thinks)  I would want to get my own copy of the medical records.  I would want a complete blood workup and I would want a stress echocardiogram.  

If you find you have artery blockage, then surgery or an angioplasty might be warranted.  It may not be that serious and you could go into a cardio rehab program where you are monitored properly. Or you may need to change your eating habits, lose weight, stop smoking (if you do), and exercise regularly.

The last thing I would do is to ignore it.  You may have nothing wrong, but you need to get to the bottom of this situation. I'd want to know the structural integrity of your heart (the echo should tell you that), and I would want to know those arteries are clear or if they were blocked.  The "gold standard" to determine that is the angiogram but that is both expensive and carries risk.  

Let us know how this turns out.

[nlfolds]

Thanks for all of your comments.  I have made an appointment with a Cardiologist for next week and will be bringing copies of all of my test results.  I really don't want to sound like I "want" something to be wrong.  I am not that type of person. I just feel like something is not exactly right.  I just don't want to end up dropping dead of a heart attack that could have been prevented. Again thanks for all of your comments.