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Heart Disease (Expert Forum)
chest pains
Answered by
Cleveland - OH
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chest pains
by KC135, Jun 15, 2005 12:00AM
Good Morning! I have some questions regaurding my health. Approx 2 1/2 years ago I began to have upper left shoulder pain. An upper GI showed nothing along with a stress echo which did show mild LV enlargement. Acouple of months after these tests the pain moved in mid of sternum,following lightheadiness,and nasua. I had a nuclear stress test which was also negative. In Jan of 2004 I had a heart cath that showed nothing. I have worn a holter monitor that showed pacs and pvc with 1 bout of SVT. My question is that with little excertion my heart pounds and I still have chest pains.I do smoke and blood pressure is usualy around 135/85.I also have thoracic subluxations of the spine. Does this sound like heart related with all tests or something else. Just another question is when I smoke my chest hurts behind the sternum. Sorry for being long winded but any suggestions would be kindly appreciated
Doctor's Answer
by Cleveland Clinic, Jun 15, 2005 12:00AM
, Jun 15, 2005 12:00AM
KC,
Thanks for the post.
With your workup, it really sounds like your pains are coming from something else. As someone who has been through t a lot of testing, you should realize hopefully what a huge impact smoking is going to have on your overall health. Some of your symptoms now may be related to some reactive airway disease, and many of the invasive test you've already had -- you probably will be experiencing again many fold if you don't quit now.
My 2 suggestions beyond following up with your doctor are:
1 -- quit smoking
2 -- quit smoking.
good luck
Thanks for the post.
With your workup, it really sounds like your pains are coming from something else. As someone who has been through t a lot of testing, you should realize hopefully what a huge impact smoking is going to have on your overall health. Some of your symptoms now may be related to some reactive airway disease, and many of the invasive test you've already had -- you probably will be experiencing again many fold if you don't quit now.
My 2 suggestions beyond following up with your doctor are:
1 -- quit smoking
2 -- quit smoking.
good luck
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I have been smoke-free for about 3 years now and something that worked for me my be worth a try. I started by cutting back one cigarette per day. When I was down to one per day I smoked it only by the puff. That helped me wean myself sort of speak. Everyone is right, quitting will help you feel so much better! Good luck.
Smoking is the worst thing a person can do in regards to one's overall health, I never did smoke so I guess its hard for me to understand how addictive it can be.If something caused me to get pain and I could pinpoint it as a possible cause , I would definitely give it up.Good luck.
Do you have it all the time,or just when you exert yourself?
I have mild LVH,and had the same problem,but only occasionaly if I walked to fast especially in the cold.
I had all the tests you did,but they could not find the source of the pain.
I still get it but I am not sure it is related to the LVH.
One thing you really have to do is stop smoking.
I hope you get some good answers to your problem,and good health to you.
I've posted comments in some discussions, but to repeat, I'm 41, female and I've had PVCs since at least age 18. At 30 I did a 24 hr holter and it showed 450 PVC an hour. Cardio said no problem, didn't think beta blockers would help, benign, forget them.
It's confusing to figure out if the symptoms of dizziness, lightheadedness, shortness of breath, fatigue, are from anxiety or from the PVCs. Symptoms are occassional and generally mild, except the full blown panic attacks, but I know them well.
Anyhow, for 10 years weren't too bothered until recently, so I wore a 48hr holter, same thing, single unifocal PVCs some bigemny, however now 1220per hour--every hour! Yikes. But still counselled they are benign. MD suggests beta blockers might help, but does agree might make them worse. And does say BB primarily for people with fast HB, or high blood pressure. (my pulse is good at 65-85, and BP is good at 120/70. I don't want to be a zombie on BB,I'm looking for people who have really high PVC frequency and hoping to chat. I've also heard momto3 might have some comments, but I haven't been able to hook up with her. Any thing is helpful.
Hello,
I am one these persons that have PVCs in episodes for about that last 15 years although I have always had the occasional PVC accompanied somtimes by a tachycardia, somes docs called it PAT or paroxysmal atrial tachycardia.
I have PVCs in thousands daily for months at a time, but they always disappear for years then return again for no rhyme or reason. My PVCs have been captured on ECG and stress testing. I only wore a holter 18 years ago because of a rapid heartrate, it only showed a few PACs and PVCs mostly PVCs.
This is longest time in 15 years that I have been nearly PVC free for about 4 years now , only the odd thump every day or every few days. I am on 100mg atenolol, I would say it helps.
momto3 has a much longer experience with pvcs than I have and she has 2 ablations for them from what i can remember reading , apparently successful ones at that. My PVCs tend to wax and wane over the years, I am not a constant PVC sufferer,but had my share, i am sure if momto3 sees your comments she can be of more help. I hope you find relief , your pvcs according to your comment are very frequent, hope you get relief soon. good luck.
How many of your PVCs are you aware of? Do you get anything besides the PVCs? I have been getting PVCs for 20+ years, but not to the extent that you do. I hope you find a solution. Have you cut out things that can cause them? I have found that some of the things that cause ectopics for me are: Stress, caffeine, alcohol, spices, garlic, pollens, indigestion, etc ... I have eliminated these and have seen a reduction in ectopics.
Have you been on medication, atenolol, and still experience the high frequency palpitations? Or are you taking the meds for any other reason?
It's good to hear, but not good to happen to you, that you've had times when you've had PVCs in the thousands per day, that lasted for months, and then went away. Again, it makes me feel a little better, but I'm sure it sucks for you. Sorry. Hope you get more time without than with.
And there's nothing you can pinpoint that brings on these occassions?
Hi,
I take atenolol with an ARB for mild hypertension and also the palpitations, I can't say I notice anything in particular that trigger the prolong episodes of PVCs. I know that bending , taking a deep breath, empty stomach and eating too much will trigger the occasional one and when i have the frequent episodes these things just worsen the problem for the time being, not to mentione being stressed out with anxiety.
For now i'm really glad for the long break from them, got to admit , i don't look for forward to the day when they return with a vengence, which i suspect they will, but whos knows they might never get any worse, if thats the case, i can sure live the few i feel nowadays. Take care.
I quit smoking 6 years ago, yippee. I quit caffiene and red wine about 8 weeks ago, but no change at all to the PVCs. I haven't found any foods that bother me, that I'm aware of. I actually don't notice the PVCs all that much, a couple of short time periods a day, mostly when I'm resting. And I may or may not get any symptoms when I notice them.
I think the symptoms might be from anxiety, but it's hard to tell. They are mild. I haven't seen a cardiologist with the latest holter, but his report said frequent runs of single PVCs when I recorded symptoms in my diary, and frequent runs of single PVCs when no symptoms were noted. So they think symptoms are random and may or may not be due to the PVCs. I feel better when I exercise, heavy exercise, but I don't think it decreases the PVCs, just increases my heart rate (maybe 130-150bpm) Strange that it would make me feel better, but I guess it burns off stress.
I can say for certain, stress really increases the PVCs, and so does fatigue. I found out I was severly anemic, so that might have brought on this current state. Also my cholesterol, which has always been below 180 shot up to 230 in less than one year. Connection? And for women, I'm thinking hormones play a part too, I may be, and have read a couple of discussions where women who are premenopausal get more PVCs. But since I've had PVCs since age 18, well, hormones may be only one part.
Hope you get some relief of yours.
I had a long history of frequent pvcs (tens of thousands/day) and up until a couple of years ago they were considered benign. I'd be glad to share my story or answer any questions that may help you. In 2003, I had two successful ablations and now I only get occasional ectopics. Those of us who deal with pvcs really do understand the anxiety that goes along with these dreaded extra beats. You are definitely among friends on this board : )
I keep wondering how many of us have tried anti-anxiety meds (me!).
If you have trouble posting here, you can reach me by email at ***@****.
Hope you are having a great day!!!
Connie
wmac
But I did, until recently. I had a couple of real thumpers. My recent holter shows single ectopics 1220per hour (every hour) and even though it's still condered benign, I can't help but wonder how much higher can they go??? Pulse is 65-80, BP 120/70
You mentioned that your PVVs were considered benign as well until recently. What was the change? Is the long term high frequency a problem? Did you try BB to bring down the frequency? Did it help? Was the ablation recommended because the frequency was so high and BB didn't work? Did you have a lot of symptoms with high frequency? So many questions!
My symptoms seem mild, occassional slight dizziness, feeling a little short of breath, very fatigued (but recently found I'm very anemic)and of course I wonder if all my current symptoms are just more anxiety attacks. I don't feel the PVCs all the time, and mostly they don't bother me. I'm reluctant to try BB because, well, I'm just anti-pill and don't want to yo-yo from med to med. Besides, from all I've read in the pharmacy and online, I could feel just the same anyhow. My EKG only showed the PVCs, but I wonder if I should get further testing done to evaluate the health of my heart for anything else.
Any comments are greatly appreciated.
Before I foget, please tell VA TONY I said HI!!! He is a great contributor to the forums, what a wealth of knowledge!! I used to visit heartcenteronline more often, but because I mostly use "dial up" it takes forever to load the pages...I'm considering DSL or cable modem real soon ; 0
Back to your questions...I definitely had a LOT of pvcs. It all began (sounds like a fairy tale) back in the late 70's when I was told I had the heartbeat of a 70 y/o man. I didn't give it a second thought because dr. said I was fine, just had a different heartbeat and a murmur...not to worry. Also had anxiety...seems par for the course ; )
In '82, OB insisted I see a cardio. Up until then, I had not used any meds for palps (didn't really notice them). From 1982-1998, the ectopics became more noticeable, though they waxed and waned over the years. Sometimes they were barely noticeable and other times they were absolutely awful!! Tried anti-anxiety meds and BB's for symptomatic relief. The BBs worked for awhile, but eventually seems to aggravate the palps.
In 1998, I went to the doctor b/c the palps were driving me NUTS again! I knew I had a leaky valve and I had periodic echos to keep tabs on it. My internist refers me to another EP...I can't stand it anymore...they're driving me crazy!!
I went to the new EP who turns out to be fabulous! She gets pvcs so she understands!! Though I am having lots of them, she is not concerned. Echo still OK. I decided to start using the BB's on an "as needed" basis and that seemed much better for me.
In 2002, the day after a periodic check on the valve, the doctor called to tell me that my EF had dropped to 40%. She didn't thing it had to do with the leaky valve, but rather, she felt that it was b/c of the number of PVCS!! The doctor took my records to several conferences around the country and consulted with a number of echocardiographers and the consensus was that the pvcs were causing a cardiomyopathy!!! Benign....not anymore!! At least not for me. My BP and HR were excellent! I never felt tachycardic and BP was 100-110/55-70. I could not believe it!! Apparently, this is a rare occurrence.
The ablation was recommended when I decided I did not want to be on anti-arrythmics (a MUST) for the rest of my life. No, I did not have a lot of symptoms....(fatigue and SOB, but I don't think they were necessarily relative to the EF problem). I think anemia can affect the heartrate, etc. Are you taking medicine for the anemia? What does your doctor say?
Interestingly enough, when I asked my EP if the palps were a result of anxiety, she emphatically said, "NO." Apparently, they can tell by the patterns on the EKG strips.
Have you had an echocardiogram? Stress test? Echo stress?
Sorry this was so long....I hope it helps to know that there are others who understand : )
Connie
I had an EKG before my latest holter, and the MD only commented on how frequent the PVCs were, didn't mention anything else. But I should investigate that further. I haven't had anything else done but the holter this go around.
10 years ago I did the treadmill stress test and numerous EKGs and while I can't remember the results, except high PVCs the cardiologist didn't seem concerend.
I haven't seen a cardio this time around, only my MD. The cardio report with the holter didn't give the impression of anything but "lack of concern".
My MD suggests a low dose of 12.5 mg of Toporal because I'm sensitive to meds. She is not sure it will reduce the PVCs but that it is cardio-protective because it reduces the workload of the heart (lowers HR and BP). I'm not sure I'd like to try it because "you have to be on it for the rest of your life" statement. And because the side-effects sound as bad or worse than what I'm already experiencing on an occassional basis.
So I'm curious about your RX for BBs "as needed". I wonder if I could take the Toperol "as needed". You mentioned you were on them before the cardiomyopathy developed is that correct? Or was it just for a short time due to the side-effects?
.12 xanax "as needed" seems to help so far, but of course doesn't do anything for the PVCs. I would forget about them, as I did 10 years ago, except they seem so high, not always noticeable, just HIGH.
Do you recall if they thought your case was rare for the high number of PVCs or that because the PVCs were so high they "eventually" caused a cardiomyopathy.
What do you think is the best test to investigate a change in heart function indicating a problem starting?(I pay out of pocket for everything on a high deductible plan but would rather pay for periodic checks of heart health than for medications which may or may not help).
Glad you found such a compassionate and understanding doctor. We need more of them. Sorry this is so long also, but I thank you for your detail.
I also take 1/2 to 1 of a .25 Xanax as needed for anxiety. Fortunately, not too often. My EP said the Xanax didn't do anything for the ectopics, just made it so I didn't care. I've been using it this way for 7 years and as long as I can take it as needed, I'm OK with that. At one point my internist wanted me to take it everyday, so I tried it...UGH!! It was only two weeks before I noticed I needed a higher dose and more often....YIKES! I stopped that right away!! I much prefer to take an RX on an "as needed" basis.
It sounds like you are having the same experience as I had....LOTS of PVCS, but they weren't painful or intense....just FREQUENT. Maybe the BBs would work for you the same way. I do however, remember that eventually they just didn't seem effective. Tambacor and Rhythmol really worked, but I don't think they are generally prescribed for benign pvcs.
From what I understand, it was the frequency of my pvcs that caused the CM. Prior to 2000, I'm not sure how many pvcs I was having - never asked. January 2000 was the first time I had a copy of the results and there were 22000 ectopics (all ventricular). Even then, my EF was 55%....EF was normal until sometime between late 2001 and December 2002 (up to two years later). My HR and BP were normal the entire time.
An echocardiogram is great for determining all kinds of information about the heart chamber sizes, function, valves, etc. I'm not sure of the cost, but if your doctor thinks it's a good idea, maybe her office could find out what it would cost you. I can't tell by my statements because there are several line items that have something to do with the echo (color doppler, 2-D something or other, etc.)
Please keep us posted!! Feel free to ask any questions you like. We'll all do our best to answer.
Are the ectopics bothering you? I know that sounds stupid, but I had NO idea I was having as many as I was....just curious.
Take Care
Connie
For the most part I don't feel the PVCs. I do feel an occassional one here and there, every day, but they are sooo mild. I had no idea they were this high, almost regular bigeminy, until about 4 months ago I had a pretty good episode and decided to get it checked out again (last check was 10 years ago)
The increased frequency now is what is freaking me out. I'm not concerned with the PVCs, just the frequency. From all the discussions, there are only 2 or three people who seem to have PVCs at this frequency. So it's a concern. But I also know that in my history, like yours and tickertock's, they can decrease just as easily as they come.
I believe, but I'm not certain, that I may feel mild symptoms just before or just after I feel the PVCs, but I'm wondering if it's just anxiety. Anxiety has been a constant companion to me since I can remember. I also find that 1/2 to 1 of .25 mg of xanax makes me not care about the PVCs, but does nothing for the PVCs themselves.
I think I will inquire about the echocardiogram to put my mind at ease (I might have to save up, but I think I have time on my side considering my PVCs are "benign" ha ha).
I find it a little bit of a concern that my MD didn't recommend it. But maybe since my symptoms are so mild and infrequent she's not concerned. Actually I find it so odd that no doctor ever considers ectopics a concern at this high frequency. Or is it just because it's so rare to be this high they don't have much to work with in knowledge of outcomes or recommendations?
connie
Mine can come and go, they seem to be stress related and get worse with alcohol and heavy food.
My main concern is that I seem to experience soreness with mine. the more i get the more I have soreness, and when they are harder they increase the soreness as well.
Sometimes the soreness will extend to my hand.
I have tried to see if other people in the forums were experienceing this and with little luck.
Does anyone out there share this experience?