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heart palpatations after strenuous excercise
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heart palpatations after strenuous excercise

I had blood clots in my lungs after a leg operation nearly 2 years ago.
Since then I get heart palpatations after I do any strenuous excercise.
My heart then feels weak and sore, and I feel very unwell for hours afterwards.
Could you please advise what sort of tests I should have, to find out why
this is happening.
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17 Comments Post a Comment
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690060_tn?1247845341
Tony, if you have remaining clots in your lungs, maybe they'd do a pulmonary arteriogram or a MRI to find them. Do you have symptoms of a pulmomary embolism, like lung pain etc?

Or maybe these are new embolisms that traveled from the legs. They'd maybe do a compression sonogram on the legs to identify a source,

The simplest they might do would be a D-dimer blood test, to look for substances that occur when your system is naturally breaking down any clots.
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367994_tn?1304957193
Have a chest X-ray looking for any evidence of pulmonary emboli (clots), masses, adenopathy, atelectasis, etc. all which could cause your symptom, and an EKG with a perfusion stress test looking for any vessel blockage with exertion.  You should see a cardiologist.
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690060_tn?1247845341
there are any number of references stating that a chest x-ray is of little value in diagnosing a pulmonary embolism
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367994_tn?1304957193
What do you want and looking for an argument?  I didn't specifically have emboli in mind although images may or may not relevant for emboli.
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367994_tn?1304957193
QUOTE: "Could you please advise what sort of tests I should have, to find out why
this is happening".
__________________________________________________________-

>>>I don't mind going sidebar with the issue whether a chest X-ray is appropriate for competent evidence and whether or not there is or has been pulmonary embolism....we all can learn.

I was specifically answering OP's question regarding TESTS to diagnose a possible pulmonary disorder. "First your physician asks you questions about your general health, medical history, and symptoms. In addition, your physician conducts a physical exam. Together these are known as a patient history and exam. to confirm the diagnosis of pulmonary embolism, the physician may order specific tests", which may include some of the following.
The protocol:
Chest x-ray;
"Electrocardiography (ECG) which measures your heart’s electrical activity;
D-dimer enzyme-linked immunosorbent assay, a blood test that shows an increase of a type of protein that may rise after a pulmonary embolism;
Lung scanning, which measures blood flow in your lungs and your air intake;
Spiral computed tomography (CT) scan;
Pulmonary angiography, which shows x ray pictures of the blood vessels in your lungs;
Duplex ultrasound, which allows your physician to measure the speed of blood flow and to see the structure of your leg veins; and  
Venography, which shows x-ray pictures of your leg veins."

Proposition a chest x-ray is not appropriate:

>>>>If a blood test, as suggested, is positive it would require further testing and that would include a chest x-ray to determine if there are co-existing issues and whether or not there has been damage to the pulmonary tissue such as an infarct...etc.  I believe the proper protocol would be chest X-rays first and not assume anything as your suggestion appears to do.

" A chest x-ray may reveal subtle changes in the blood vessel patterns after embolism and signs of pulmonary infarction. However, the x‑ray results are often normal, and even when they are abnormal, they rarely enable doctors to establish the diagnosis with certainty.
Pulmonary artery angiography (also called pulmonary artery arteriography) is done by injecting a radiopaque dye into the PULMONARY artery and using CONVENTIONAL X-RAYS  to view the dye in the lungs. Angiography is used most often when pulmonary embolism is suspected, usually on the basis of abnormal lung scan results, and is considered the BEST TEST  for diagnosing or excluding pulmonary embolism".

Increasingly, angiography of the pulmonary arteries is being done instead with pictures obtained from a CT scan (CT angiography). CT angiography is less invasive, because in this procedure, radiopaque dye is injected into a small peripheral vein rather than a central pulmonary artery.

You suggested looking on the internet to dismiss chest X-rays for establishing pulmonary embolism,  and I had suggested tests to help dx a pulmonary disorder that may be chronic caused by an embolism, whatever.  
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690060_tn?1247845341
here's your original statement: "Have a chest X-ray looking for any evidence of pulmonary emboli (clots)...[etc]"

here's what I responded: "there are any number of references stating that a chest x-ray is of little value in diagnosing a pulmonary embolism"

then you again quoting Merck: "However, the x‑ray results are often normal, and even when they are abnormal, they rarely enable doctors to establish the diagnosis with certainty"

so you yourself prove my point

simple enough
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367994_tn?1304957193
I wasn't making any point regarding pulmonary embolism detection.  My point was and has been the procedure and a response to the OP's questions regarding what sort of  tests to find out what is happening?  Chest X-rays can detect embolism (it can be)...but the reason I suggested chest X-ray is based on the probability of a pulmonary disease and the proper starting point for an analysis of any pulmonary distress.  

You are attempting to make embolism the issue as you have apparently assumed PE and then go directly to a blood test.  Say for instance the blood test was positive, wouldn't it be the correct procedure to then test with images?  Say the blood test was negative, wouldn't the next procedure be images?  I believe the correct protocol for a workup for a pulmonary problem is the procedure I have provided in my prior post for your convenience.

Why go immediately to a blood test when images are needed regardless of the result of the blood test.  Reread my answers and OP's post...its not complex or complicated so take your assumption of an embolism out of the equation until the proper procedure is followed. That"s my point!  If the correct procedure is not followed,  there can be a lawsuit for negligence because if you, a doctor, are relying on a blood test and the test is negative you would write it off.  Proper medical procedure is always not to assume anything and follow the correct procedure otherwise it would appear there is some confusion and open for a lawsuit in the event of a mistake....that goes for all public professionals, not just the medical field.   IMHO.
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Avatar_m_tn
If an individual has a pulmonary disease or symptoms of the same any competent doctor would do a workup beginning with chest X-rays.  I don't read anything said on this thread that acknowledges a chest X-ray is the appropriate test for PE, nor does it appear there was an attempt to do so based on the submitted posts, but it does appear to be an issue in the mind of NBT.  However, there can be evidence of previous embolism seen by a chest X-rayand signs of a pulmonaryinfarction.
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Avatar_n_tn
Thank you for your comments & advice. I had a blood test today, and tests showed no clots. What I am really trying to find answers to is, while I am in a restful state, I get very strong palpitations, I then feel like the blood has rushed out of my body, and I feel cold and weak, and afterwards my heart feels sore, and I feel very unwell for a long period of time. I also get these strong palpitations after strenuous work, such as digging in the garden. So whether I am resting or exerting myself I get the palpitations. I have been to cardiologists, heart specialists, had ultra sounds, ekg, etc etc, and no one has been able to tell me why these palpitatons are happening, or whether they are life threatening. This only started happening after I had an operation on my leg, and developed lung clots. Worferen was prescribed and I was on that for some weeks, until they said the clots had gone. It's frustrating when none of the doctors can give me any answers.
Tony_1973
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