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Re: MVP, Palpitations and Stress - help quickly please

Posted By Heiko on August 27, 1998 at 20:04:37:

In Reply to: Re: MVP, Palpitations and Stress - help quickly please posted by CCF CARDIO MD - DLB on August 27, 1998 at 15:16:21:






Im really looking for some insight here. Ive been chasing some problems
around for a couple years and fell stuck in a chicken and egg type
situation.
Here is some rather lengthy background:
Male age 32 about 6' tall about 160lbs.
2 years ago went to Doctor for skipped beats. They were occasional but
really worried me.  
Echocardiogram showed 'minor' MVP.  Dr said I didnt even need to take
antibiotics at dentist. But this could cause the skipped beats.
Started having non descript chest pains over next 6 months.  
Dr perscribed Inderal (20mg twice daily).  Seemed to help and also
had a general calming effect on me.  Which is good because Im pretty
high strung.
Had numberous EKGs and Holter monitor.  All returned normal over next
year or so.
Have also had number of dizzy spells and near fainting the last year
or so. (Been taking inderal about 13 months)
Had a glucose and thyroid test that came back fine.
Tilt table test revealed 'neuro cardiogenic syncope' after less than
20 minutes into the test.  
In the process of following up with a cardiologist on this.
Meanwhile doctor said that he believe I have an anxiety problem that
is adding the this mix of symptoms.  ( including a GIRD and hiatal hernia)
I have to agree with him on this one.
Additional information that may be superfluous:
Trouble sleeping ( staying asleep not falling asleep )
Markedly less tolerant of heat.  (I seem to get wiped out easily in hot weather even if Im not active)
Sensitive to light ( I now wear sunglasses even on overcast days and
leave the lights off in my office when I work on my computer which is
pretty much all the time)

---------end background
This whole thing has had me very worried over the last couple years.
Im even a bit afraid to excersize or overexert myself because sometimes that starts the palpitations up.  
The inderal (propranolol) keeps my heart rate down in the 55-65 range
often around 58 beats per minute.  Could this be contributing to my
near fainting spells and or a weak feeling??  
Is this 'bradycardia' induced by the propranolol??
This morning I was quite fatigued and my pulse was down to 52 according
to my blood pressure monitor. ( Blood pressure was 131/84)
Should I discuss changing the inderal dose?  
At one point a doctor had me try 20mg propranolol 3 times a day and
I found myself exhausted and noticed my pulse was occasionally <50.
Could the propranolo have any effect on my results from the tilt table
test or is this unrelated??

I also take prilosec daily for hiatal hernia.  And my doctor perscribed
diazepam on an as needed basis for anxiety and what I just recently found
out were possible panic attacks.
Could chronic stress and anxiety be the root of all these symptoms or
just an additive result of worring??  ( My job is quite stressful and
these first symptoms (skipped beats) started not long after our first
child was born and my father was diagnosed with cancer which only added
to the already high stress level).
I would appreciate any insight and possible areas for discussion with
the cardiologist to which Ive been refered. Im supposed to see him
for the first time tomorrow and Id really appreciate a reply ASAP if
possible.
Thanks In Advance
PCR

-------------------------------------------------------------------------------------------------------------
Dear Paul
I personally feel that mitral valve prolapse is overdiagnosed. Even if it is present, it is a rare cause of palpitations.
The inderal is probably causing your pulse to be in the 50's. A pulse in the 50's is unlikely to cause any symptoms, especially since you write that your blood pressure is normal with this low heart rate. Inderal can contribute to feeling fatigued.
If you are having dizzy spells and almost fainting, you need to mention these serious symptoms to your doctor.
I hope this is useful. Feel free to write back. I wish you the best of luck.
If you would like to set up an appointment with one of our cardiologists here at the Cleveland Clinic please feel free to call 1-800-CCF-CARE.
Information provided in the Heart Forum is intended for general medical informational purposes only. Actual diagnosis and treatment of any particular medical condition can only be made by your physician(s).
Paul:
Your profile sounds much like mine.
32 yrs, 190lbs, very sports oriented, had the same hernia as you when I was young(think it is coming back), and feel that I am anxious over some good news I received on the same day my heart beat pauses started happening. (I know this sounds weird being anxious over good news but I was under great stress over another medical condition that almost cost me my job; turned out positve and I am overwhelmed by the good news)
I monitored the heart palpitations over an 8 hr period and it happened 20 times; is his about the same for you. Seems worse when I think about it.  They feel somewhat like butterflies.  
Went to the doctor and the EKG was normal (of course no skips when they check!)  Now being refered to a cardiologist.
I run 5x/wk for 3 kms, bike 16 km 5x/wk and work-out 4x/wk for 40 mins.  After the work-out it usually takes about 1-2 hrs before I get a palpitation.  Maybe because I am relaxed.
Does this sound a litle like you? Let me know.  
Heiko


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