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Heart Disease (Expert Forum)
here they come again
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
here they come again
by LynnSB, Jun 28, 2002 12:00AM
I've been sick for 10 weeks, unexplained dizziness that started as ear pain, then moved into my left jaw.ENT doc found "nothing".MRI showed scattered "chronic smallvessel ischemic disease", my internist said was "nothing." I finallywent to the dentist,who found an abcessed tooth.root canal improved ear pain but i'm still dizzy. in the midst ofthis,palps have gotten worse. I've had them for 20 years. I've had loop monitors( last in December for 2 weeks), holter monitors, ekgs, echos.the outcome was always PVCs and PACs and "inappropriate sinus tachycardia" but nothing life threatening. the worst ever documented was 3 pvcs in a row ,when it happened i felt weak.questions:
1. could small vessel disease in my brain indicate vessel disease in my heart? i have excellent blood lipids (175 overall, goodcholesteral 75, low trygyc,),no diabetes,low BP.
2. I have othostatic hypotension that can be very noticeable one day,not bad or not there the next. can that cause palpitations?
3.doc has suggested trying beta blockers.i'm concerned it will lower my blood pressue too much. can just a tiny amount help palps?
4.doc doesn't think an ep study is necessary but will go that route if i insist. do you agree that not having any blackouts in all this time and noone documenting any bad arrhythmias means i'm probably ok without one?
5. could the tooth problem increase the palps some way?
I guess i'm feeling concerned because of the chronic dizziness & today i had a brief burst of fast/irreg. beats lasting 10 secs or so & felt weak momentarily.it is so scary.i'm so tired of being scared..
1. could small vessel disease in my brain indicate vessel disease in my heart? i have excellent blood lipids (175 overall, goodcholesteral 75, low trygyc,),no diabetes,low BP.
2. I have othostatic hypotension that can be very noticeable one day,not bad or not there the next. can that cause palpitations?
3.doc has suggested trying beta blockers.i'm concerned it will lower my blood pressue too much. can just a tiny amount help palps?
4.doc doesn't think an ep study is necessary but will go that route if i insist. do you agree that not having any blackouts in all this time and noone documenting any bad arrhythmias means i'm probably ok without one?
5. could the tooth problem increase the palps some way?
I guess i'm feeling concerned because of the chronic dizziness & today i had a brief burst of fast/irreg. beats lasting 10 secs or so & felt weak momentarily.it is so scary.i'm so tired of being scared..
Doctor's Answer
by CCF-M.D.-KE, Jun 28, 2002 12:00AM
Palpitations:
I am sorry to hear your discomfort has been going on for so long.
If I am correct most of your symptoms are due to dizziness and palpitations. When confronted with the issue of PVCs one must ask whether or not there are symptoms associated with them and whether or not there is structural heart disease. In the presence of structural heart disease PVCs may represent some increase in risk and without structural heart disease are of very little risk. However, no treatment of PVCs has been shown to improve survival, just and improvement in symptoms.
To answer your first question, I would not extrapolate from "chronic small vessel ischemic disease" on an MRI report that there may be coronary artery disease. You don't sound as if you are experiencing sympotms to suggest heart disease. However to help answer this question a stress test would be reasonable.
Orthostatic hypotension may aggrevate the palpitations because during periods of hypotension the heart rate may tend to increase in response to the drop in blood pressure.
Beta blocker therapy would be an excellent choice to help control your PVCs. I think starting with a small dose is very reasonable.
Given that your heart is structurally normal, I don't think an EP study would add a lot of new information. You have not had significant arrythmias documented on your holter monitor and I think you are likely at low risk. Given your normal heart a trial beta blocker would be good option.
The problem with the tooth is likely unrelated to this issue of palpitations. I understand that you are scared, this not something you have experienced before and you don't feel well. From the information you have given me I have not found anything which points specifically to an ominous future. We are all at some risk. I think that being afraid is normal, but it may also heighten your awareness of symptoms and fuel your fears. I would recommend trying the beta blockers and seeing if your doctor will perform a stress test.
Thanks for your question,
CCF-MD-KE
I am sorry to hear your discomfort has been going on for so long.
If I am correct most of your symptoms are due to dizziness and palpitations. When confronted with the issue of PVCs one must ask whether or not there are symptoms associated with them and whether or not there is structural heart disease. In the presence of structural heart disease PVCs may represent some increase in risk and without structural heart disease are of very little risk. However, no treatment of PVCs has been shown to improve survival, just and improvement in symptoms.
To answer your first question, I would not extrapolate from "chronic small vessel ischemic disease" on an MRI report that there may be coronary artery disease. You don't sound as if you are experiencing sympotms to suggest heart disease. However to help answer this question a stress test would be reasonable.
Orthostatic hypotension may aggrevate the palpitations because during periods of hypotension the heart rate may tend to increase in response to the drop in blood pressure.
Beta blocker therapy would be an excellent choice to help control your PVCs. I think starting with a small dose is very reasonable.
Given that your heart is structurally normal, I don't think an EP study would add a lot of new information. You have not had significant arrythmias documented on your holter monitor and I think you are likely at low risk. Given your normal heart a trial beta blocker would be good option.
The problem with the tooth is likely unrelated to this issue of palpitations. I understand that you are scared, this not something you have experienced before and you don't feel well. From the information you have given me I have not found anything which points specifically to an ominous future. We are all at some risk. I think that being afraid is normal, but it may also heighten your awareness of symptoms and fuel your fears. I would recommend trying the beta blockers and seeing if your doctor will perform a stress test.
Thanks for your question,
CCF-MD-KE
Member Comments (3)
by LynnSB, Jun 28, 2002 12:00AM
PS. I had the "weak" palp episode while hanging some clothes up. I mention this because I can not tell you how many time lifting my arms or bending forward -- reaching up to get a coffee cup or bending forward to pick up the newspaper, for example -- is related to these palps.. sometimes turning my head quickly, too. I am no making this up. I've noted these relationships for so long. how can that have anything to do with palpitations? it's so strange... does it have to do with the autonomic nervous system somehow, I wonder?
by Tigger2, Jul 02, 2002 12:00AM
To: LynnSB
I am curious to know the answer to your PS. I too have many PVC's, along with pac's. I have often wondered, and asked why movements would seem to bring on or worsen palps. Never given an answer. I felt like I was reading about myself when I read your post on the different movements. Good luck!!
