My situation

[david2951]

Basic Question: Based on the information below, do you have any advice for me as to what I might want to look into and talk about with both my electrophyisologist and cardiologist during my upcoming appointments? Thanks.

Hi,
    Background:  I am going through the process of investigating the origin of some symptoms I have experienced infrequently throughout the course of my life. The symptoms include palpitations, lightheadedness, generalized fatigue. The only test results that have ever come back "abnormal" are my blood pressure (and that just runs in my family), and on EKGs I have always been told I have early repolarization. I recently had an echo done which demonstrated that any problems which are here are not structural in nature. I also had a Holter study completed. The Holter study showed 13 isolated PACs and 3 isolated PVCs. It also talked about an incomplete RBBB being present. At one point (during one of the PACs or PVCs) there was a QRS (T) contour abnormality. Given that I have ruled out structural problems and heart failure I have decided that whatever is causing my symptoms must be attributable to an electrical disorder. I have basically been trying to consider the probability of all of them, based on my symptoms as well as my test results. I have narrowed in on two of the more common syndromes; Long QT and Brugada Syndrome. I suspect the possibility of Brugada based on the fact that I have early repolarization and RBBB. Furthermore, on the EKG sheet with RBBB my QRS complex was elevated to 118ms (whereas it was normally at around 86ms on all the other EKG sheets). I know that if QRS is >110ms and incomplete RBBB is present along with elevated ST segments (over 2mm) then it is likely Brugada. However, a cardiologist has told me that my ST segments were not elevated at all, and therefore it probably isn't Brugada Syndrome. It was also pointed out that 85% of SCD cases in Brugada Syndrome come during sleep, and, although I do get some bradycardia related PACs and PVCs while in bed at night (probably just because I am an athlete) basically all but one significant run of fluttering tachycardia that I can ever remember experiencing during my life has been while running. While I know that sweat loss (I loose a ton of sweat) and increased body temp can induce Brugada symptoms, I have had multiple experiences of fluttering tachycardia (probably NSVT, although never documented) very early on in runs, and during runs when I was feeling quite cold, so that wouldn't seem to be consistent with Brugada. As far as Long QT is concerned I would tend to rule out LQT3 for many of the same reasons I think I might be able to rule out Brugada, and as for LQT2 I don't get palpiations when suddenly startled. That would leave LQT1, or the "mystery gene" LQT syndrome cases, but I'm not so sure that is it either, because aside from 1 EKG during an arrythmia in which my QTc interval was 453ms, they all are down at around 420ms or lower. And as far as some of the other syndromes like WPW or CPVT I just don't exhibit the symptoms at all. I have never passed out and I don't have any of the EKG characteristics of a pre-excitation syndrome like WPW. Basically, I am a little confused. I know it is not normal to have the symptoms I have. I have had runs of flutter tachycardia come and go with running throughout the years (maybe 5 to 10 episodes per year) and I have experienced infrequent PACs and PVCs at night and sometimes throughout the day. I have chronic fatigue and my heart rate gets far higher far easier when compared with others despite my status as an athlete. I used to get really lighheaded all the time and feel like I might pass out, but I never did, and get those episodes far less frequently now. I am kind of worried for a couple of reasons. I know that syndromes like Long QT and Brugada and the others in that sort of group tend to kill a lot of people, especially young, seemingly otherwise healthy males in their 20's and 30's. I also know that my cardiologist will soon want to be starting me on some beta blockers or ACE inhibitors for the high blood pressure and I know that sometimes those can be bad for these other arrhythmic syndromes. I feel like I am potentially very lucky because I feel the palpitation symptoms and many people never feel anything and just drop dead one day. I feel like I have been given an opportunity to research my symptoms and figure out what sort of treatment I might end up needing, but I want to make sure I get that treatment in time. I have an appointment in about a week with my cardiologist, and before that I plan to make an appointment with the elctrophysiologist that they have at his building. I am going to ask him if he thinks doing a drug study to try to induce Long QT and Brugada would be something we could do to try to further rule those out, or potentially find out that's what I have. If this pattern of no answers continues for a considerable amount of time, I may eventually decide to consider asking if we can do an EP study so we can maybe find the origin of the arrythmias I feel.   I am just a little confused, and any advice would be highly appreciated. Thanks for reading.

[petra04]

I have had severe trigeminy with bigeminy since my daughter was born nearly 4 years ago. I exercise, I watch what I eat and limit my use on coffee,alcohol etc. Was placed on veripimal( b blockers) and yes it eased however these symtoms usually do not go I was told by my cardiologist. I am only 39 years old and feel I want quality of life rather than having to constantly feel these horrible sensations. I was then refered to another cardiologist who does catheter oblations and after another ECG, she said she would be more than happy to do the procedure and I was a good candidate. I have done alot of research on catherter oblations and like anything there are risks, however the risks are very low and 90% success first time go and if that 10% it does not work than will have it done again.Maybe you should bring that up with you're cardiologist and see what they say.Remember quality of life is what is important.Hope this helps.

[is_something_wrong]

Hi,

I think you should read through your post again, and try to think what you really are doing. You've searched the textbook for 3 dangerous heart conditions (and one not that dangerous) and you are doing what you can to prove that you have one of those conditions.

Regarding your different "diagnoses": (I assume you've read so much about this that you understand a fairly technical language)

CPVT: Manifest with a massive amount of PVCs every time (since childhood) your heart rate increases above 110-120. As you push the heart rate higher, you'll go into polymorphic (bidirectional) ventricular tachycardia. 80% have an episode before age 20.

Brugada: RBBB + increased QRS above 110 msec (QRS will always be prolonged with RBBB!) and 2 mm ST-elevation is NOT diagnostic of Brugada! Almost all athletes have ST elevation, especially in the right/septal leads (V1-V3). Brugada is diagnosed by very specific changes, atypical RBBB + ST elevation + T wave inversion in V1-V3. And your cardiologist would have seen it. You have early repolarization, that will elevate the ST segment.

LQTS: As your QRS is prolonged, caused by RBBB, so will the QT time be, without being diagnostic of LQTS. In LQTS, there are often other changes in the T wave, it's not just prolonged. The QT time will change all the time, and a rapid heart rhythm may prolong the QTc (as the formula over-corrects QTc with a rapid heart rate).

WPW: This (usually fairly benign) condition shows a delta wave on EKG in most cases. Your cardiologist would easily see it.

You say that your "fluttering" is "most likely" NSVT. Based on what?! Why are you always thinking worst case? In a young healthy man, a short fluttering is almost always supraventricular. When having a PVC (or an early PAC), the QRS complex is changed. That's normal.

Infrequent PACs or PVCs are normal. We all have them.

What is slightly concerning is your blood pressure. A young athlete should not have high blood pressure. Is this diagnosis certain (verified by 24 hour measuring) or are you just afraid when measuring it?

You sum up your post fairly good by this statement:
"Given that I have ruled out structural problems and heart failure I have decided that whatever is causing my symptoms must be attributable to an electrical disorder."

Which of course I can't say if is right or wrong. But neither can you. You've done a lot of tests, and no doctor/cardiologist can find anything wrong with your heart. The diagnoses you have suggested MUST be given by a cardiologist, not yourself. And they are extremely uncommon and if you've been an athlete for a long time, they are extremely unlikely. There are a lot of more likely (and benign) causes for your palpitations.

See your cardiologist/EP, but if they say that your heart is fine, promise yourself that you trust them this time!

None of us are doctors and we can't diagnose you, but from your post, you're reading way too much about this, and you don't quite understand what you are reading. You are just scaring yourself.