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PFO symptoms in 18 year old

Hi! I am an 18 year old female who plays college soccer. I recently posted a question about an ablation I had for reentrant tachycardia. The doctor was certain that he completely corrected the problem with the ablation, but I have not experienced any relief three months after the ablation. He then did a bubble study, and it was found that I have a small PFO. I also had a junctional rhythm one minute after exercise stopped. While my doctor is not concerned with the results and considers these findings entirely normal, I feel like this could very well be what is causing my tachycardia. My heart rate increases from 80 to 150 with just walking up a flight of stairs, and it goes even faster while trying to play soccer! I get extremely fatigued and short of breath with minimal exertion, and I get horrible headaches upon standing (I haven't gotten my blood pressure checked yet, but I suspect it might be hypotension related to this heart condition). My question is: has anyone with a pfo ever experienced these symptoms? Searching for pfo symptoms online results in repeated statements that most pfo's are asymptomatic, or that they cause numbness and strokes. I have never had a stroke, and I have a little numbness on my thighs (I don't know if that's relevant at all!), but nowhere else (especially not in my jaw or face). Some websites tend to imply that fatigue and shortness of breath can be symptoms of a pfo, but non have really elaborated. Also, I can only find evidence that these symptoms usually appear at an older age. Has anyone had experience with this? I greatly appreciate your time and help, this is a great forum!
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Avatar universal
Hmm, so they say you have junctional rhythm after exercize? Maybe I have the same (that's when the AV node sets the pace as a backup to an 'out of order' SA node).
I don't feel any different than when I was little. I've always been paradoxically very lazy and sleepy and, begrudgingly, a very hard worker and in good enough shape to run circles around a D1 soccer team. As you'll find out over the next decade, getting older starts very early and you'll start to see your body change. You'll get more tired, feel that extra pound of fat accumulate quicker and take more than just a good long run to burn off. So it could be totally unrelated to the heart thing.
Am seeing the EP next monday and am hoping to set up another EP study.
Keep me updated and good luck.
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Avatar universal
I am almost positive that my ejection fraction was normal, but I'm not sure about the junctionally paced thing. What is that? Are you referring to the junctional rhythm? I only had that for a minute after exercise. Mine doesn't really pause like yours, but it actually kind of just increases ridiculously quickly, and goes down very quickly as soon as the exertion is slowed. I did have an EP study and an ablation that got rid of an accessory pathway, but I have experienced no relief whatsoever.
I have absolutely no idea if this is relevant, but when I was little, I used to be so energetic. I suddenly began to feel tired much more easily, and I just always wanted to take a nap. I've felt like that ever since, and I fee like I'm getting worse every year. It could possibly be related I guess, but probably not. I hope so though! Did you ever feel like this when you were little? I have an appointment with my new doctor the 19th of June, and he specializes in holes I guess, so I have to wait until then to really get any more answers.
I'm so jealous of your roommate!!!! We'll get there someday :)!!!!! Talk to you later! ~Erin
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Avatar universal
Hmmm. Very interesting. I'll ask my EP about the possibility. Was your stress test ejection fraction low? And are you always junctionally paced? I don't get the fatigue or shortness of breat, thankfully but do have similar fast/paus/regular/fast/pause/regular kind of irregularly irregular rhythm.
DId you already have an EP study?
Roomate is running the NYC half marathon today...am jelous!
Be in touch,
Adam
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Avatar universal
Sorry this has taken me so long! So, the doctor said that I don't necessarily have a PFO, but I certainly have an atrial septal defect in some form. He also said that the junctional rhythm should not be disregarded entirely, as normal hearts don't usually have these, but that he believes it is all related to the hole in my heart. I have an appointment scheduled with a specialist in these holes in the middle of June, so I just have to wait and see, I guess. Have you had a bubble study? Because our symptoms are so similar, I would definitely ask your doctor to maybe order one of these tests for you. The symptoms of these are very much what I have been experiencing in terms of shortness of breath, fatigue, and palpitations. And, these symptoms only start to appear in teenage years! I don't know, it seems like it could possibly be what's causing all of these problems. And getting the hole repaired is typically pretty easy. If it's not repaired, the symptoms only get worse, so if you think you could have it, try to find out more from your doctor! I am getting some more information from my regular cardiologist Monday. She is veryyyyyyy knowledgable, so I think she will be able to say more definitively if she believes this is the problem I am having. I'll update you Monday!
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Avatar universal
Sorry I didn't get back to you yesterday. The doctor was out of town and will be back tomorrow, so I should have answers for you then! Sorry about the holdup haha! So, your tachycardia was not all of the time? It's so frustrating that the stress test won't initiate our crazy rhythms. I don't know about how your doctors respond to you when this happens, but this makes me look crazy to the doctor and he thinks it's all in my head. He doesn't even want me to wear a monitor because he's so sure there's nothing wrong with me! I'll definitely ask about the squat test... it seems like that's something that could induce my funky beats, too. Again, I'm sorry about the delay, but I should know by tomorrow!
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Avatar universal
Hmm. Not sure about the PR interval thing. My PR interval gets longer and longer until it flips over on itself (Wenchebach block). Perhaps you want to inquire about what is causing the long PR and if it is a block of some sort.
I've had the same frustration with my doctors about how to capture my events. When I ramp up into exercize, I almost never have symptoms. My symptoms are exactly the same as before so no changes there. I wore a 24 hr holter about a month ago for extra beats I was feeling and I think I captured them. I haven't heard back so I'm assuming there was no big issue there. The doc didn't really know how to try to get my episodes on record but only got me in for a stress echo. They gave me a portible recorder that looks like a pager for 30 days. I was supposed to (before my ablation 9 months ago) try to bring the episodes on but was too freaked out. I found a different protocol you might want to check into: it's called the squat test protocol. You go from rest into 50 squats and then to complete rest. I know that would do it for me so I'm going to try to get them to do it soon. I guess the other option is to try to get the 30 day moitor (looks like a pager) and try to induce it.
Let me know how it goes tomorrow.
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Avatar universal
Oh sorry about that, I could have sworn it was 30 seconds! I'm glad it's not that long, but 3 seconds still must be horrible! I really don't know how if they recreated the situation in the stress test. In my last stress test, the PR interval was funky like I said in the other post, and I asked the LPN if it was the same in this, but she never got back to me. I still have quite a few questions about that test, so I'll try to get it all settled tomorrow when they are back in the office. The thing is, if I gradually increase my exercise, as is the case in a stress test, my heart doesn't go up abnormally. It's only if I climb the stairs or start jogging or sprinting. I know how ridiculous that might sound, but this was the case in the stress test I had before the ablation, too. Every person involved with the test I told this to kind of shrugged it off, but that is why I am pleading them to compare the two tests, which they have yet to do. I really don't know much about the results of the test, now that I am thinking about it, but I will tomorrow! As far as blood work, I have had every test under the sun I think haha! My thyroid, crit, blood sugars, and everything else has been checked multiple times, and they always come back normal. It just seems odd to me that the abnormal incease in heart rate is so consistent and so predictable. I know with yours, you said it varies a little bit, and sometimes it doesn't inncrease as much as other times. Before your ablation, was it more consistent, like mine? Or was it a little more varied? Have you worn a monitor after the ablation? How long has it been since your ablation? Thanks again!
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Avatar universal
Hi Erin,
One area of clarity: my heart stops for only about 3 seconds, not 30, thankfully. I say 'stops' because it seems longer than a skipped beat. Perhaps it is 3 skipped beats.
I suppose the doc may have missed the pathway but I suspect there is another issue, maybe it regrew somehow. I'm going to try to get another EP study done this summer.
I don't really know enough about it but will hazard a guess that the atrial hole is not so big that it will cause a problem but maybe that in conjunction with the main problem exacerbates the problem. Did they do blood labs on you? Were they able to recreate your condition in the stress test? If they can, it's just a matter of time until they narrow everything down. Make sure to press your doctor for all the right tests (and it sounds like he's been very obliging in getting you worked up).
Keep me posted.
=A
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Avatar universal
Hi! I've talked to you before! I just got the results of my bubble study, and it did show a small hole. They were able to see that I have a small pfo on the echo.
I am very lucky in that I know exactly what triggers my heart to increase so fast. With any exertion whatsoever, my heart ramps up to 150. It doesn't increase gradually whatsoever, and this is what first led my EP to determine to do the ablation. He saw this on my monitor. You said your heart will stop for like 30 seconds and then beat outrageously out of control for a while after that, right? Mine starts beating crazily as soon as I start moving, and stops soon after I stop. He did find reentrant tachy, but that's now gone I guess and I have no relief!
The thing about my heart is that it is indeed so predictable, which makes me think that it may not be an electrical problem after all. To me (and my knowledge is veryyyyyyyyyyy limited), electrical problems seem to be more spontaneous than what I am experiencing. I know, however, that these problems are all very varied and much is still unknown about them. However, with this discovery of this hole, I am just curious if maybe my heart is having to work so hard when I start exercising that it causes these horrible palpitations and shortness of breath? With your tachy, did you have these same symptoms? Do you think this could still be some electrical problem?
I haven't even talked to my doctor yet. The LPN was actually the one who relayed the information to me, and so I don't really understand why my doctor is not concerned with the junctional rhythm yet. I will tell you as soon as I talk to him. I think by saying he's not concerned, he means that it's not life-threatening. And like I said before, I'm very grateful this is not life-threatening, but it's very difficult to live with! I promise to get back to you as soon as I get answers from him about this.
I can't quite remember; you said that you had an ablation but you still have symptoms, right? Did you have repeat ablations? Is it possible that your EP missed some of your reentrant tachy during the EP study? Again, thanks for all of your help! I'm so glad I found someone who is experiencing something similar to me!
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Avatar universal
Hi Erin,
I hadn't heard of PFO before so I looked into it. It seems that 20% of adults have it in some form and that yours is probably very slight because they didn't pick it up in your echo. I doubt that is what is causing your symptoms.
Sorry to hear you are still suffering from this. When you say that your heart rate goes up to 150, do you mean that when you walk up stairs your pulse ramps up 80, 90, 100, 110, 120, 130, 140 150 over about 10 seconds or does it just start double time on a dime? With my reentry tachy, it would just jump into double time and back into single time after 30 seconds or so. But now, on some days, I walk up the stairs and my heart rate ramps up to 150 as if I were out of shape. I'm certainly not as fit as when playing college sports but am not an old man either. Some days my heart only gets up to about 100 or so when walking up stairs. I can't pinpoint the difference. Do you have any hypotheses on what the triggers for you are?
Does your EP say why he is not concerned with events in the recovery period? I have the same thing and my doc showed similar unconcern. I trust him but I have to understand why it's not dangerous. Why would they always self correct? Any ideas?

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