after an ablation-another follow up

[jojojc]

Thank You for taking my question. I wrote in last week regarding my ablation and not feeling good afterwards.  Since than I wore a holter for 24hrs. My results showed normal sinus rythmm and no skips.Yet i was having symptom when I wore it.
Since then, I have started having sharp chest pains,in the middle of the chest over to the left breast slightly.  They last for 10-15 seconds. Some are sharper than others and i may get a few in a row, and then not one for 4-6 hours.  I also started getting pains in my left shoulder blade and it radiates under my left rib. This one seem to be presents most of the time. Also when I get these flutter and skips that i feel i have a lot of burping that goes with it. I take nexum everyday. I am scheduled for a Thallium Stress test tomorrow.

My questions are:
Could i be having skips and them not show up on the holter?
Do you know anything else that if it is not skips that can mimic skips to this degree.?
Can adelaline (SP?) produce this feeling? The reason I ask, at my worst i would feel a surge come over me for my stomach area even when i would not be nervous. I would have no control it.
I am 36yr old female, if i have the stress test and it comes out normal, with a normal holter, and normal ekgs can i start to relax that my heart is not the issue?
Also, can you recommend if you feel it is not the heart where should i be looking next to releive the discomfort?

[CCF-M.D.-MJM]

Hi Jojojc,

Sorry to hear you aren't feeling better yet.

Could i be having skips and them not show up on the holter?
No.  PVCs and PACs will show up on the holter.

Do you know anything else that if it is not skips that can mimic skips to this degree.?
My experience is that people with these symptoms usually have PVCs/PACs.  Panic attacks can make people feel short of breath, chest pain, and like there heart pauses, but this is a diagnosis of exclusion.  Unfortunately, there are no medical tests to diagnose painic attacks.

Can adelaline (SP?) produce this feeling? The reason I ask, at my worst i would feel a surge come over me for my stomach area even when i would not be nervous. I would have no control it.

I have patients with panic attacks that tell me they feel a surge or rush, like a rush of panic or fear, when panic attacks start.

I am 36yr old female, if i have the stress test and it comes out normal, with a normal holter, and normal ekgs can i start to relax that my heart is not the issue?
Yes.

Also, can you recommend if you feel it is not the heart where should i be looking next to releive the discomfort?
You probably should start with your internist.  It is much easier to talk a detailed history in person.  From there, the can direct you in the right direction.  Anxiety could cause a lot of these symptoms, but this is a diagnosis of exclusion and often a very difficult to one to make.  

I hope this helps and good luck.

[flip-flop]

I have a similar question as far as seeing skips on ekgs or monitors...I have been having a bad run of them for the last week and they have been frequent...several an hour. I couldn't stand it anymore and went to the ER Monday evening...they did an ekg and kept me on the monitor for a while (4 hours) did a chest xray as well and cardiac enzymes...all normal....told me my heart was fine and I asked them if they saw the skips on my ekg or the monitor and they told me NO....it was normal sinus rhythm the whole time on the ekg and monitor....I said well then why was I feeling lots of skips during all that time and how can they not show up and he said he didn't know but that I was not having any PVC's or PAC's....so what in the heck was it? What is it because I am still having them...I can't even sleep at night....What else could POSSIBLY feel like heart skips? I have had these since I was 20 (I am 48 now) and they ALWAYS show up on the monitor or ekg...these have me baffled...the dr. sent me home with Ativan...but I am still skipping....HELP!!!

[Lyn2]

jojojc,
Hi.  I just wanted to relate my ablation experience with you because some of your symptoms sound familiar to me.  When I had my ablation it slowed my heart rate down dramatically, enough so I required a pacemaker several weeks later.  BUT, prior to getting the pacemaker placed I was experiencing exactly what you said, sudden surges of adrenaline exactly the way you explained it.  I have never had panic or anxiety and these episodes would suddenly occur.  After receiving the pacemaker it never happened again.  Not until I had another ablation, and reseting of my pacemaker.  Here's my theory. I'm sure Doc. MJM will get a laugh from this, but I think that my body was so used to having an excessively fast rate that my body was trying to increase my slow rate, in turn releasing large amounts of adrenaline.  That's the only thing that makes sense to me.  Because now that my pacemaker is set at 80bpm I never ever suffer with that.  When I was having it my rate was between the teens and 30.  
As for the chest pain, I had problems with that as well after all my ablations.  It turns out I had pericarditis, which shows up on echo.  It sounds a little different than yours.  Mine was a constant pain, worse when lying down, and I was very short of breath.  Have you had an echo.?
Best of luck to you!

[wmac]

I dont understand Ive been trying to post a question and cant!! Yesterday there was only one question posted for the day and I tried to post and it said it was full. Then later yesterday I came back on and there was a second one posted I dont get it! I see that some people are able to post a question then not long later they post again. I cant even get one in whats the secret? Very frustated!I know there is a time difference Im in Idaho so what time do  I need to get up? At 4:00 am or what?
wmac

[renee in chicago]

I share your frustration, I've been trying to post a question since May. I try at all hours and am not sucessful but I am learning a lot by reading.

Peace,
Renee

[Clenn Camp]

Following my last thirty day event Kings Heart monitor I went for a follow-up consultation with my EP.  He told me I had telephoned over 100 episodes to the center.  I told him I only sent the worst ones, not all by any stretch of imagination. He told me he had good news and bad news. Good news is that all tracing copies were very good quality.  Most showed I did indeed still have some afib and lots of pvc's.  Many tracings showed my pacemaker doing the pacing and several showed my heart doing the tracing and that was good.  However, he said I had also telephoned recordings of episodes that showed I was in perfect NSR when I recorded them.  He said... "I don't think you recorded and telephoned in what you thought were episodes of heart arrhythymias just to have something to do.  I assured him that that wasn't possible, because I even hate to fool with the thing and having to phone them in.
My EP then told me that evidently I was having symptoms/sensations that felt like pvc's that were in fact caused by something other than the electrical activity of my heartbeat.  I asked what that possibly meant.  He then explained to me that the same nerves that affect my esophagus and gall bladder were of the same bundle of nerves that control my heart.

I then told him that I have had a swallowing problem since I was in my twenties. I am now 68.  I told him I had already had a swallowing test this past April and the SHATSKI'S RING needs to be dilated as that is the cause for my swallowing problem. He told me to have it dilated and it would reduce the number of symptoms of arrhythymias I have such as afib and pvc's.  He said I would still have afib and pvc's but I should realize a big reduction in the number of symptoms or sensations.

I hope he is correct.  I have an appointment this coming Monday, August 30, to have the SHATSKI'S RING dilated.

One other thing I discussed with him was why had not he or other EP's and cardiologists had ever mentioned this to me and he said because the probability was that all tracings I had recorded and telephoned in during past times of wearing event monitors had ever shown to be NSR and had always shown some kind or kinds of arrhythymias present.

I also told him our daughter-in-law who is thirty eight years old had also had a bad swallowing problem since she was a teenager and had the SHATSKI'S RING dilated three years ago that was and still is successful.  I aked him ....."why did not our daughter-in-law ever express or complain of having symptoms or sensations of her heart beating irregular"?  Which she never has had any problems with an irregular heartbeat and is not even aware of her heart beating.  I also told him my older brother who is six years older than myself had his gall bladder removed three years ago after suffering for many years from affects of it and not once, according to my brother, ever had problems or symptoms/sensations of his heart beating irregularly.

Doesn't really make sense to me but I will definitely find out.

Flip-flop I hope the cause of the sensation or symptoms you feel like heart arrhythymias can be determined and eliminated.

Glenn

[Momto3]

Last year, I had good luck posting around 8:45 a.m. EST.  Hope you are able to post very soon.  Good luck.

[jojojc]

Thanks for everyones input and especially to this site....Very helpful.  I will be checking the gallbladder route as we have a family history of gallbladder problems on my mothers side.

As far as being able to post a second time...I just tried a few times as was able to get on...its kind of the luck of the draw.  I was surprised I timed it right a second time.

Thanks Doc...I had my stress test yesterday and my cardiologist called me right away with the result, he said he did not want me to worry.  Thank God, all was normal.  So from his advice and the advice I have received here I can assume my heart is healthy. I will pursue other areas for my discomfort.  I feel like I have a new lease on life!!!!
Thanks Again!!
Joanne

[wmac]

NOW THATS ODD NO QUESTIONS FOR THE DAY AND HAVE BEEN TRYING FOR HOURS TO POST AND CANT I GIVE UP
WMAC

[WPWGuy]

When I went through this, I was told that the telemetry system at the hospital is "programmed" only to detect certain types of problems.  While still in the hospital after an ablation, I am 100% certain that I was experiencing PVC's. Yet, I too was told that nothing was present on the state of the art monitor.  

Follow up, in home, 24 hour telemetry was no better. I experienced frank episodes of tachycardia that were never provided to my doctor, even after i contacted the telemetry service to confirm that my episodes had been recorded.

After things got worse, I obtained the King of Hearts and recorded the symptoms that were of concern to me. I very very carefully recorded the sypmtoms in a diary and included time, date, and recording number for each incident.  I recorded:

- one incident with fluttering sensation under left pec.
- one incident with palpitations and left stabbing chest pain.
- one incident with no palpitations and left stabbing chest pain.
- one incident with fluttering in center of chest.

Then, while visiting my doctor, I obtained a complete print out of all recordings for my records.  I reviewed my diary and the monitor strips myself, verified that all information was present, and then was able to see what was what: left stabbing chest pain was not associated with an arrythmia, fluttering in center of chest was VT, etc...

My initial guess is that the arrythmia monitoring service performed some filtering for my doctor.  Judging from the activity in the waiting room, I have considered that my EP is so freaking busy that he does not know what to do with himself, and may be employing this filtering service as liberally as possible.  Therefore, it took my own doing to carefully record symptoms and monitor strips, as well as to do the post filter and data reduction, before I was able to achieve the level of understanding that I wanted. This level of understanding is probably far more detailed than my EP would need to do his job right (I should mention that the VT did not get filtered by the second monitoring service that we used).

[Rocko1]

Hi there... I was just wondering how long the fluttering sensation lasted... ive had that in the past and would last only about a second or two.

[WPWGuy]

When I still had the accessory pathway from WPW, the PSVT lasted as long as 5 minutes. These episodes occurred occassionally about 10 minutes into my daily run, and were sometimes brought about by "burst" of physical activity (like spiking a volleyball). They did not occurr at rest. The frequency and length of these episodes gradually increased over the course of 20 years. During this time, there was never any VT and no sensation of fluttering in the center of my chest.  

Since ablation (and elimination of the accessory pathway), there have been no long episodes of PSVT.  Short bursts of fluttering (several seconds) show up as VT or SVT on ECG.  This only occurs at rest, following several days of doing a daily 3 mi run. I do not know the response of my "new heart" due to "burst" or really strenuous exercise.

[Rocko1]

thnx for your response. Im glad you are doing much better after your ablation.

[jojojc]

well, I am back to square one, I went on Vacation to try and relax and ended up in the ER again. I was sitting reading on Monday evening and my heart started pounding.  Got up to 180 beats, by the time the ambulance got there it was down to 130.  All test showed normal at the hospital and they said i was having a panic attack.  Meanwhile at the hospital my heart rate surged up to 150.  The doc saw that and said he wanted to give me atenol for anxiety,  Well it did bring it down but it still does not make sense to me.  I did eat alot that day and also felt like the food was just sitting there and would not digest.
I am so frustrated because now my anxiety level is sky high...it is a terrible cycle.

[WPWGuy]

Hi.  Maybe your should try some LIGHT reading or simple activity that would take your mind off your heart --- this would help relieve anxiety, and leave you in a better position to cope during your recovery. I know I had some worry after my ablation, and these things seemed to help with that part of it.  I also found that I had fewer anxieties once I returned to my normal routine.  You might try to get a start on that if possible.
  
Hope you feel better soon...

[jojojc]

Well, Yesterday was a good day, last night was horrible. Woke up in the middle of the night only to have flips and skips....Of course than the nervousness starts again.  The night before I woke up to a rapid heart rate that i was able to get back down on my own.  I bared down and it brought it down.  Today my heart feels angry.  Just irritated.  beat, beat beat, skip beat, beat skip. It just feels aggitated.  I feel scared again and don't feel like leaving the house to go to a party later.  Sometimes the heart even feels like it is in my throat.
Now why after such a good day does it have to show its ugly head.
I am suppose to see the GI doc on tuesday than back to the EP cardiologist on Thursday for my follow up from the ablation.  Of course he will tell me all is fine.  I think he thinks I am crazy or just an anxious person....and probably from the sound of it, it seems like i am, but i was not before all this happened.  I also get the sensation that i have to cough and just a weird feeling in my chest.
I feel bad because my kids are seeing their mom checking her pulse all the time and always asking are you ok mom.
Oh well...

[jojojc]

again, thanks for the responses it does help.  The problem is I am trying to relax and that is when it shows up the worst.
Thanks Everyone.

[rhinoman]

RELAX!!

I know that is easier said than done.  Distraction is always a good thing, particularly having a good conversation with someone.  I think that is why at night or when you are alone it often seems worse.

I have been diagnosed with sick sinus syndrome and have frequent episodes of tachycardia and skipped beats.  I noticed some time ago that my own anxiety played a very important role in heightening the severity of the episodes.  I haven't gotten it completely under control, but the frequency, intensity, and variety of my "weird" symptoms have definitely diminished.  Anxiety breeds more symptoms which breeds more anxiety . . .   I have had almost all the symptoms people have mentioned here at one time or another, but it has definitely fallen off as i have become more aware of my tendency to be anxious.  its hard not to be anxious about your heart,  but the best evidence for your health is the heart monitoring and other tests that you have had.  i still have episodes almost every day of tachycardia and PVC's, but some days i barely notice them (days when i am very preoccupied with other matters).  in fact almost everyone has skipped beats, but normally they don't notice them.  we folks with arrhythmias however become hypersensitive to our hearts.  it can take a long time (even weeks-months) to reduce the stress level that gets built up to the point where you are having something like panic attacks.

i haven't tried this, but it seems to me yoga might help.  i think someone mentioned that slow controlled breathing often helps relax you, and i have found this helpful myself.  

one thing to keep in mind is that you have had all these weird episodes and your heart is still beating, and beating pretty normally at least from your recent EKG's.  In my case, it has been 8 years since my diagnosis, and i haven't died yet despite my premonitions of impending doom, and i still don't have a pacemaker (which my doctor says will be inevitable with my condition).  In fact, despite the frank arrhythmia in my condition, it can go for years being asymptomatic.  I didn't notice it until I had occasional painful beats during exercise.  I still exercise a lot. Two years ago at age 53 I even got down to 5:20 in the mile (I am an ex-competitive runner), despite having a heart I feared was ready to go into fatal fibrillation at any moment.  Regarding moderate exercise, once it becomes regular it does seem to have a stabilizing influence on the heart, although for the first day or so it seems temporarily increase arrhythmia during rest in my case.  I would recommend biking - easy on the body and good for the heart.