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Irregular Heart Beat?
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Irregular Heart Beat?

I'm a 31 year old male, a bit on the heavy side but not huge, I'm 5'7" 250 lbs. About a month ago I started feel an odd pressure on the left side of my chest right about where I'd think my heart would be. It wasn't painful or intense, just a dull ache. It went on for days, which I know is inconsistent with heart pain, but I still was concerned. Once after doing my evening jog I noticed that my heart was beating crazy fast and this sent me into a full blown panic attack. I went to the ER and they gave me an EKG, chest X-Ray, several blood tests, and left me on a heart monitor for about an hour. My bpm was 135+, which is Tachycardic, but not anything super crazy. The doctor said she couldn't find any causes for alarm, called it anxiety, gave me an atavan, and sent me home. I was encouraged initially thinking that they wouldn't send someone with a potentially dangerous condition home, but since then I've become increasingly anxious about my heart. I began using a heart monitor to keep an eye on my heart rate, and I realized that my rate is rather fast, around 85 at rest and 100-115 when active. I'm prone to anxiety, so this wasn't in itself surprising, but I also noticed that my heart seems to miss the occasional beat, once or twice a minute I can see the rate just drop and pick right back up again. The missing beats in particular worry me, even when manually checking my pulse I can feel my heart sit still for a second and then thump hard when it comes back. The initial tightness in my cheast has become intermittent and doesn't seem to be tied in anyway to the dropped beats, which happen regardless of my heart rate or position. I'm curious how the ER doc could have missed them, I can't see how it didn't happen in the hour they were monitoring me, but I'm thinking they were more concerned with the Tachycardia, and I didn't mention the skips because I wasn't aware of them at the time. Lately, it seems like the skips are more frequent and last longer when then happen. I don't have insurance until March and can't afford another $3000 ER visit, especially after being told I was ok, but I also don't want to ignore a potentially fatal issue! What should I do? Chalk it up to anxiety and hope it stops? Screw the money and get checked out again?
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Oh, and I do take 8mg of Subutex twice daily, and have done so for about five years without any perceivable negative effects. My heart activity doesn't seem to change whether I take it or not, with the exception of my pulse increasing slightly. I mentioned that I took this to the doctor and she didn't seem to think it all that relevant, buy who knows?
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1423357_tn?1373023915
I was once told by my cardiologist that 4 consecutive beats in a row without a "skip" is OK in his book.  Think about that.  That could potentially be 12 skips per minute or over 17,000 skips in a 24 hour period.  Something to chew on.

Your a guy, so I can be straight forward with you.... 5' 7" @ 250 is BIG!  Unless you're an athlete, I'm guessing you're probably wearing a 40" pants, and perhaps a shirt with a 20" neck?  Dude, there's half your problem.  You should be 150 to maybe 160 lbs. at the most.  You're body is lugging as it's carrying that extra weight.

How's your sleep?  If you have a sleep partner, do they report any snoring.  If you do, you could be suffering from obstructive sleep apnea or OSA as it's known.  OSA wrecks havoc on your body.  It's really a long slow journey to a stroke.

How about your blood glucose?  Have you had that checked?  Your body mass puts you right in Type 2 diabetic territory.

I'd wait until your insured before launching in on tests to see what's going on.  In the meantime you need to form a plan of attack on your BMI.  The best thing you can do is drop the carbs, avoid anything "white" or containing white. That's flour, sugar, rice, pasta, potatoes, anything with starches.  Get on proteins and fats.  If you don't cheat, the weight will melt off of you.

Buy yourself a WalMart blood glucose test meter and a box of strips;   they're cheap.  Start testing that blood and establish where your blood glucose is at,  Test first thing getting up, maybe just after getting home from work and before dinner, and at bed time.

Obstructive sleep apnea is easily correct by CPAP.  I've worn one when I sleep for years.  It no doubt saved me from a dreadful demise.

When you get on insurance, get these things checked out!  Best of luck!
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Thanks for the feedback, it's definitely comforting to know that skips aren't necessarily a fatal condition! I'm working on the weight, I was actually 280 a couple months ago. I hadn't thought of blood sugar, that actually might be worth looking into, though I assumed that was one of the things they checked me for in the ER. OSA is another thing I hadnt thought of, I need to look into that! Ideally, I'd wait for my insurance to kick in before getting checked, I just don't want to keel over before then!
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So my anxiety got the best of me and I decided to go in for a follow up after the first visit to the ER. This doctor was more effective at assuaging my fears, explaining the PVCs can be normal and that there's a number of benign enough conditions that cause them. I had blood tested for a full panel, chest x-rays, an EKG and was on a heart, lung, and oxygen monitor for two hours. They basically told me that as far as they could tell, I was fine. Right after the doctor left to tell me I was being released though, the heart monitor started reporting a PVC. When the nurse came back to release me, I explained that I had just seen a skip, she explained it away as a lose cable and when I insisted on having the doctor look it over, he again stated that PVCs can be normal. He told me that I could go the cardiologist to get a holter monitor to see if I had SVT, but that he seriously doubted I did based on what he was viewing. I was very relieved after this visit despite my misgivings that they never tested me under stress, only lying in a bed, and I never feel any weirdness in bed. I had resigned myself to focus on my diet and stop being so anxious about my heart. I uninstalled my pulse checking app and tried to get on with my life. I was feeling a lot better, until just tonight I was sitting at my computer when I felt a flipping feeling in my chest. I was suddenly light headed and my ears started ringing. I sprang up frightened to feel my heart suddenly slam into pounding. It was beating super fast and felt a little out of sync. I've read that for some people exercise restores normal heart rhythm so I grabbed my phone and power walked around my block for about 20 min. Now I'm sitting back at my computer and my heart feels mostly normal, but the peace I'd attained for a couple days is basically shattered. Is this SVT? I don't have insurance yet and these ER visits are getting costly, I'm unsure what to do!
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1423357_tn?1373023915
It's good to hear that you're working on shedding weight.  It will undoubtedly help your heart, and keep your pancreas from working overtime.

In your post above, you didn't state how fast your pulse was, so it's hard to say.  I can tell you that typical SVT rates are anywhere from 180 to 260.  SVT starts abruptly; within one beat it will go from normal to beating rapidly within one beat.  It ends the same way.  However quite often adrenaline from the fright at the episode will amp you up and your pulse could be in the low 100's for a period of time before dropping back to normal. Now on occasion, my SVT would start sort of jumbled.  I could feel the rapid pulse, but there were skips and stutters for 5 second or so before it would drop into a steady but extremely rapid rate.  Mine was up there around 240.  

I never heard of exercise to restore NSR.  For me quite often high respiration rate, ie. exercise was what started an event.  So if an event occurred, that first thing I'd do was to sit down, and let my respiration slow down before attempting to slow it with Valsalva.  This was my method.  Others claim that head stands slowed it, or putting just their face in a pan of ice water did it for them.  But for me Valsalva was successful for 50 years.  For me, my SVT was self sustaining.  Once it started, it would not drop out on its own.  I had to covert it.  I learned at 6 years of age to do this, and use that method all of my life.  I refined mt technique in the last 20 years, and developed my "perfect position" to sit in when I attempted to slow it.  Most of the time, one attempt was all that was needed.  But each one of the thousand events that I had over my lifetime was anxiety provoking.  To be at normal respiration rate, perhaps watching TV, and have your heart suddenly beating at 240 is a very disturbing feeling.

I hope I've given you enough symptoms to judge for yourself.  There are other conditions that may feel like SVT but could be something more serious.  When you can, I'd suggest not a Holter but rather a 30 day monitor that you wear 24/7.  You stand a much better chance of capturing these events that you do with one that you wear for only 24 hours.  A 30 day monitor is a simple 2 lead device which captures only one angle.  But it's often enough to see the basic mechanism of your problem. It's often how every SVT sufferer has their condition confirmed.  Best of luck!
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Thanks again for the response. I had uninstalled the pulse checker from my phone and I was little too excited last night to take a manual measurement, but I can honestly say that I doubt it was as high as even 140. Based on previous times I've had a high heart rate, I'd guess around 125-130. I guess that would pretty much rule out SVT? I've read that PVCs can happen for basically no reason at all, but this one felt BIG. Then again, I'm not even positive it was my heart. I've felt a similar sensation once before, and both times were accompanied by a sour taste in my mouth. Because of that, I've had people suggest that perhaps what I'm feeling isn't heart related at all, but gastrointestinal. I know a lot of the same sensations can be produced because all those parts are so close to one another. I suppose I will just have to wait for insurance and get a full work up, but I'm scared something life threatening will happen in the next 3 weeks before I get there. I can't, however, just keep going to the ER only to be told that it's nothing.
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