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heart sound, bp and pulse pressure
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heart sound, bp and pulse pressure

Hi all,

Hopefully you don't just write me off as crazy after this.  I'm male, 23, 145 lbs, and exercise fairly regularly.

Last December I had a resting pulse well over my normal--usually I'm at 60-70 but at the time I was at 110-120.  I visited the hospital, where they did an echocardiogram and determined I had a pericardial effusion.  They sent me home with instructions to take ibuprofen, and that the problem would probably resolve on its own within a few months.

At first I would get tired climbing stairs, dizzy after a few flights.  I would feel like fainting after standing up.  The problem seemed to go away after about 5 months.  Then it slightly came back a couple of weeks later, and then it went away, and so forth for the last few months.  Each time it seems to be less pronounced.

Right now it's back, a little worse than last time.  I checked my blood pressure and pulse the last few days and my 21 measurements gave me an average of 118/60 with a pulse of 72.  My pulse pressure averaged 57, which is close to 60.  At my age it seems like it shouldn't be so high.

I also bought a stethoscope, and when I lay on my left side, my pulse races and there is a soft but audible sound starting immediately after the first heart sound, dying down right before the second heart sound.  It's like a "hmm" or "oosh".

I'm wondering whether it's possible that they didn't notice a heart valve problem last year when I had the echocardiogram, e.g. mvp or regurgitation causing the turbulent noise.  Do such things go unseen?  Is there anywhere on the net that I can compare the sound I'm hearing to sounds signaling valve problems?  My understanding is that this is not the sound a pericardial effusion makes, since there is no "scratch" sound.

I'll appreciate ANY advice, and especially good advice :)

thanks and regards,

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Hello :)

First, to your pericardial effusion. It can be severe, and is then called cardiac tamponade, if the pressure in pericard (the sack surrounding the heart) is so high that it puts pressure on the heart, preventing it to beat properly. This will cause signs of heart failure (though it isn't) like rapid heart rate, exercise intolerance, shortness of breath, etc. If you have signs of severe cardiac tamponade, doctors open the chest and drain the fluid. It wasn't the case with you, and I think you should conclude your pericard effusion wasn't severe. It still can cause symptoms to a certain degree, I think.

Your blood pressure is EXCELLENT! A heart rate of 72 is excellent too, and it can easily boost a little if you get aware of the heart rate and pay attention to it. My heart rate at rest can vary from 50 to 80, depending on my stress levels when I wake up.

An echocardiography is more accurate than a stethoscope, and probably a hundred times more accurate than you and me using stethoscopes :) That said, pericardial effusion can cause a murmur (a scratch sound, possibly, but I think a doctor must listen to it to be sure which sound you actually hear), and it's not necessarily a bad idea to ask for another echo, just to make sure the fluids around the heart are gone (well, not gone, some of it should be there, but normalized).

It will be of great help making you relax too, I think.

No, you're not crazy. It's perfectly normal to get the heart a little on your mind after you get symptoms from the heart. It's after all, our engine, and we don't want it to fail :)

Thanks for the reply!  You're absolutely right about getting an echo done (and about my use of the stethoscope :P).  I plan to get one done next summer when I can afford it.

I guess I didn't mention the signs that really trouble me.  I'm sure anyone else would think what I'm about to describe is related to my anxiety about having a heart problem.  But first of all, I no longer feel any special anxiety about it; and second, this happens without me noticing most of the time until it's been going on for a while.  

Every night the last two weeks, when I lay down my pulse gets pretty fast and its strength seems to reduce proportionately.  My chest gets tight and it is slightly harder to breathe.  Then my head swims, and there is a warm feeling in my ear canal as if there is fluid in it.  Just this morning, I woke up with a dull pain in my head and a quick, weak pulse.  Sitting at the kitchen table has more or less fixed this but I wonder how long I was asleep under the same conditions.

Regarding pulse strength, I'm not sure how you measure this, but most ways to measure this is highly unreliable. In addition, other factors are important (I will describe this later in the reply).

First, when you get anxious (if you do, aware or not aware of it), blood is drawn to your large muscles (that is the cause you get dizzy if you panic, the brain is not first priority either). In addition, the blood vessels contract to increase the blood pressure. Both factors can make the pulse, measured on your hand, feel weaker. You probably notice your hands and feet getting cold, due to lower blood flow. You probably know the expression "to get cold feet" when you are anxious / hesitating about something.

Your autonomic nervous system controls your heart rate and this system can underreact or overreact to certain settings. An example, the heart rate is supposed to increase to a certain degree while breathing, because blood is pushed from lungs to your heart as you inhale. If it doesn't, the heart beats while inhaling will feel stronger, because the heart is more filled up (autonomic under-reaction). In my case, I have a certain overreaction, making the heart speed up too much (a benign condition) but it can feel really weird. Before sleep, I can sense the heart beats when not breathing in my ear, but they go away when I inhale, because the heart speeds up more than necessary. That made me wonder if I had PVCs when I inhaled (skipped beats) but in fact, I didn't. My point is, certain "unnecessary" high heart rates can make the pulse feel weak. But as I said, measuring this yourself is not a good way to be certain, as many factors (such as blood vessel dilation or not, blood pressure, water intake, temperature, etc) can play us a trick.

The only way to be sure is measuring the ejection fraction with echocardiography. The pulse pressure (systolic minus diastolic blood pressure) can also give a hint, and if you have a blood pressure monitor (they cost from $50-100 I guess) you can try to measure your blood pressure when you have the symptoms, just to be sure everything is OK.

You can also ask your doctor for an EKG when you have the symptoms, or a Holter monitoring, but if you otherwise feel OK and you are cleared by a cardiologist, it's possibly waste of money and just something that builds up anxiety.

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