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heart pauses on holter monitor -- not during sleep
Hi everyone,

I have a brain stem under pressure, and I'm pretty sure that's whats causing my recent heart issues, but for the past ... six months or so I've had random tachycardia, heart pounding, sharp and dull chest pains that radiate down my arm and make me feel weak, and then, totally back to normal.  I get tired so easily since this all started.   I wore a 24 hour holter monitor back in April, and my heart rate was above 120 26% of the time, with no pauses.  I wore one July 25th for 48 hours and my heart rate was over 120 29% of the time and  it picked up 4 pauses, all during waking hours.  The longest being 3.7 seconds.  What does that mean?  I am going to see a cardiologist Tuesday, but any input would be nice.

As a side note, I'm a 26 year old female, totally mellow (no anxiety issues), 110 pounds at 5'2", relatively active but no major exercising for me ... I hike, and swim, though, less so in recent months.  No drugs, or caffeine even.  I only drink water or sprite (I'm an insanely picky eater / drinker)
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I should also mention that the pauses are after totally normal heart beats, not PACs or PVCs.  I posted a picture of one here:

http://www.medhelp.org/user_photos/show/286857?personal_page_id=1434044
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You say you have a 'brain stem under pressure.'  Since the brain stem is important to cardiac function, I have to ask what you mean.  Are you referring to this part of the body?

http://en.wikipedia.org/wiki/Brainstem

Do you have a tumor or hydrocephalus?  Do you have other signs of brain stem compression, such as strange difficulties with breathing or blood pressure? Are you seeing a neurologist--as you should be with any genuine brain stem problems?
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I have Chiari Malformation, some of my MRI pictures are here:

http://www.medhelp.org/photos/show/5780797?type=posts

I have a neurosurgeon who thinks it is totally feasible that my chiari is causing my heart issues, and I've known that surgery for this is in the near future, but he wants me to rule out my heart totally before seeing him again.  I really think my heart is okay, but the measly 4 pauses are worrying me a little.  
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This is such a specialized question, at the intersection between neurology and cardiology, that I think it probably belongs in the 'Expert Forum' here:

http://www.medhelp.org/forums/Heart-Disease/show/114

Certainly, you'd get a more complete answer than you'd likely get from us here, though we are a reasonably well-informed group of patients.

That said, I'll venture that description of yourself--apart from the Chiari malformation--indicates that you are in a low-risk group for heart disease, being young, female, normal-weight, and basically healthy.  However, your cardiologist will definitely ask about your family's heart history, which is often relevant.

It sounds as though you might be--very rarely--experiencing a very small number of sinus pauses interspersed with normal beats.  3 seconds is a bit 'out there,' and if you had more of them more often, you might even faint, but you don't mention experiencing that, and I'm sure you would have noticed it.  

Your cardiologist will probably be checking out your heart to see if you have any purely heart conditions, unrelated to your Chiari, that could be causing your pauses, like dysfunction of your SinoAtrial Node (the heart's pacemaker), or various types and degrees of heart block, or certain kinds of rare congenital heart disease, or even if you've ever had a heart attack that might have caused some damage.

If you're really worried, try posting your question in the Expert Forum.  But my advice to you would be, if you can, to just to write down your questions for the cardiologist before you see him, and otherwise not to fret too much.  Your best source of information will be the doctor who actually has your heart and your history in view.
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I got the holter monitor initially, in April, for extreme dizziness, and again in July because it has gotten worse, but I have not fainted.  I kind of "white/black out" for seconds but I have always been somewhere I can grab onto something until it passes.

But thank you for your response!  I will compile a list of questions, and see what the cardiologist says.
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Good luck to you.  Please let us know what you find out.
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187666 tn?1331176945
When I first read your msg I wondered if you had Chiari malformation and indeed you do. A friend of ours had that and had to have surgery to correct it. She's doing quite well now.

I went to another major web site (very reliable) and there's no mention of Chiari causing any heart arrhythmias. I'm a bit surprised by that but that's what it says. It's possible to have more than one thing wrong in the body so maybe you have a bit of arrhythmia due to an electrical issue in the heart. Many of us do. It would be a good question to ask the neurologist.
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My cardiologist visit went really well-- he thinks I'm young and healthy but prescribed a beta blocker for my tachycardia and I'll see him again at the end of the month. He also recommends an ep study, so I have a consult for an ep study next Tuesday.
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