Upcoming Cardio Test Anxiety

[Cterkey]

Hello,

I am a 26 year old, slightly overweight female, former smoker.  I recently had an EKG that showed sinus arrythmia & consider left atrial enlargement.  I had this ekg because of prolonged periods of fluttering in my chest.  An EKG 2 months ago showed only Sinus Tachycardia.  Other symptoms I have are fatigue and intermittment shortness of breath.

My GP is sending me for an echo & 48hr holter tomorrow.  I am very scared that something is very wrong.  What is the significance of the EKG findings, and why would things change in such a short period of time?  What would it mean if my atrium is enlarged?

I have very severe anxiety, that is debilitating, and this is making things much worse.

Also, what are the chances that a SNRI like effexor (I am weaning off 75mg) could cause this problem?

Thanks Doctor.

[CCF-M.D.-MJM]

Hello,

It is very normal to worry about medical testing -- no one wants to be sick.  The reason to order additional tests is because EKGs give only indications that a chamber, like the left atrium, may be enlarged.  The echo offers a direct measure of atrial size and is much more accurate.  Atrial enlargement can be from many causes like leaking valves, tight or narrow valves, etc.  I would not worry about the list of causes until you know that you have an enlarged atrium -- in my opinion, this can just feed into the worrying process.  There are probably a hundred things that can cause atrial enlargement, the most common is a leaking mitral valve.  Atrial enlargement is caused by increased pressure or volume load in the left atrium and can be associated with atrial arrhythmias like atrial fibrillation.

Weaning off an SNRI or SSRI can cause increased anxiety and may be playing into the problem.

I hope your testing goes well.  Thanks for posting.

[sandrabel]

Can anyone explain me the difference between SVT and NSVT.  For what i understand is that SVT appears in the atrium en NSVT in the ventricle. (so SVT are pac's in a row and NSVT are pvc's in a row?)  Is this true?  And when it appears in the ventricle over a periode of more than 30 seconds it is called sustained?  Does it appaers always on a high heart rate (+150bpm)? Are SVT or NSVT dangerous?  I ask these questions because sometimes i have the feeling that i have more then one pvc or pac in a row when i do sport.  I'm a professionel bicyclist so my haert rate is often more then 150bpm.  Thank you very much for the answers.

[sandrabel]

Is this the right order?  NSVT (pvc's) can go in sustained NSVT (but very rare and almost not in a normal heart), sustained NSVT can go into V-tach (still very rare) and V-tach can go into V-fib (only when you have a sic heart)?  And is it always with a fast heart rate?

[sandrabel]

Sorry for all these questions.  But can pvc's go direct into a v-fib or will they first follow the right order (pvc-nsvt-sustained nsvt-vtach-vfib)???

[CollegeGirl143]

there is no sustained nsvt... nsvt stands for Non-sustained Ventricular Tachycardia... Svt and NSVT are two totally different entities, even though the achronymes sound similar..  In the absencse of any abnormalities, nsvt will not convert into vt.. Many people think nsvt is just vt that doesnt last more than 30 seconds, but in reality its very different than VT, you lack the abnormalites (electrical, congenital, scarring) to sustain an abnormal ventricle beat. Try and calm down and see a cardiologist if you are overly concerned

[anacyde]

Just wanted to say that I can relate.  I fear medical tests more than anything!  Like you, I recently had some heart enlargement, which needless to say scared me half crazy.  It turned out to be caused by my pregnancy, and within months of diagnosis it returned to normal size.  And I managed to get through it sane ;)  You will too.  I understand first-hand how scared you are right now.  I know what it is like to go in with palpitations and hear your heart is enlarged.  Very fortunately there are so many treatments for almost anything your heart can decide to do.  Hang in there!

[sandrabel]

A few weeks ago i had a fast heart rate (around 240bpm)for a few minutes.  Could this be a v-tach?

[jkfrench]

I get that about twice a year.  Mine has been documented as PAT. I would spell it out but don't know how.  I'll try
paroxymal atrial tachicardia,    It is scary especially when pvc's are thrown into the fast heart rate.  I always get a long pause before it kicks into the fast rate.  That's is scary too!
The whole thing is not life threatening but sure feels like it.

[CollegeGirl143]

was the heart beat during exersize or was it spontanious?

[sandrabel]

it was during exercise.  Is it true that in a normal heart pvc's do not go into v-fib?

[CollegeGirl143]

elevated heart rate during exersize is completely normal as im sure you are aware, being an athlete.. In a structurally normal heart, it is true that pvc's will not turn into vfib.. If they did, everyone on the planet would be a walking dead man.

[sandrabel]

Thx for y'r answer.  I know that an elevated heart rate is normal during exersize.  But is 240 also normal in a person with the age of 37.  Normaly i have a max heart rate of 207.

[sandrabel]

Another question.  Are there different types of VT.  Because i have read on this forum (answers of the doctors) that pvc in a normal heart do not go into VT.  And on the other hand i have read that pvc's during exercise can go in VT.  So this is very difficult to understand.  Can anyone explain this please.
This is what a have found on this forum.

2. what keeps PVC's (in a healthy heart) from turning into VT/VF?
You have to have the substrate to support VT like scars or temporary electrical barriers.

3. my PVC's seem to have been caused by ephedra free diet pills (not takeing anymore). are my PVC's makeing my heart more suceptible to serious arrhythmias?

Not if if you have a normal heart.

4. i get PVC's (sometimes) with exercise. is it possible for them to go into VT duing this time?

Is it possible yes, is it likely -- no. Most healthy heart VT presents with VT, not PVCs

[CollegeGirl143]

240 is high, but by no means abnormal during strenuous exersize.. the max heart rate test during the stress test is more to see if they can even get your heart rate to the max, and how quickly the rate comes back down.. People frequently go over their max heart rate during stress tests

Another question. Are there different types of VT. Because i have read on this forum (answers of the doctors) that pvc in a normal heart do not go into VT. And on the other hand i have read that pvc's during exercise can go in VT. So this is very difficult to understand. Can anyone explain this please.
This is what a have found on this forum.

2. what keeps PVC's (in a healthy heart) from turning into VT/VF?
You have to have the substrate to support VT like scars or temporary electrical barriers.

This means you have to have some kind of structural or electrical abnormality.. usually something aquired at birth or scarring after a heart attack.

3. my PVC's seem to have been caused by ephedra free diet pills (not takeing anymore). are my PVC's makeing my heart more suceptible to serious arrhythmias?

Not if if you have a normal heart.

Similar to the above question, pvc's in a structurally normal heart arent dangerous, meaning they arent a stepping stone do dangerous arrhythmias

4. i get PVC's (sometimes) with exercise. is it possible for them to go into VT duing this time?

Is it possible yes, is it likely -- no. Most healthy heart VT presents with VT, not PVCs

Dont read too much into info you find on the internet.If your own doc says you're fine, take his word for it instead of other people suffering on the internet. VT can be induced during exersize IF YOU SUFFER FROM VT.. If you dont, exersize isnt gonna make you magically have VT. Be careful how you interpret what you read.

[sandrabel]

Thank you so much for the answers.