Bradycardia.. cause or a consequence

[dan_76]

It's a long story.. sorry about that. I felt I need to write it down as it has happened.

I am 34 year old male. A bit overweight BMI 33. I'd say i'm not in a good shape. But getting better since I have been excersizing past 3-4 months and lost 20lbs as a side. So one could say healthwise I am performing well, but in real I ain't. Past three months I have been suffering from some strange heart based symptoms. Before that I haven't had heart related issues at all.

It all started a day after a longhaul flight. I had been monitoring my BP at home for some weeks and noted that my heart rate is rather steady 72-75. On occasion bit under 70 in the morning. But that day it was 50 in the morning. On top of that I suffered from continuous missing-beat feelings for entire day. Resting heart rate remained on that low level of 50-55 and I didn't feel too well. I felt fatigued, lightheaded and some nausea was involved as well. I did some exersice at the hotel gym and my heart rate reacted normally. At that very moment I considered the to be related to jet lag.

It was as big disappointment that on the following day there was no change in my well being and heart rate except that the missing-beats were more or less gone. The situation remained stable entire week. After getting back home I went to see doctor and ECG and some blood test were done (including thyroid). Everything was normal. Around that time my heart rate started to pick up after staying constantly low for a week or so.

After that my resting heart rate has been fluctuating between 48 and 80.

What really disturbs my life is that I am suffering from a problem with my sleep. For one I cannot get sleep because of heart palpitations. My heart is not beating fast but it's beating strong so I can hear every move it makes. At worst even my eyelids are pumping in a rhythm. Secondly when I am about to fall asleep or have slept for some time I flinch awake and my heart is beating strong. After these events it is very difficult to calm down again.

Also, I feel chest pain. It's more of an occasional daggering feeling near where the heart is located and more continuous pressure type feeling which is not very strong. But strong enough not to go unnoticed. These have been ruled to be not heart related by all the doctors I have spoke to.

I can exersice myself up to 100% heart rate without any shortness of breath or other symptoms except the chest pain but that is in place regardless if I exersice or not. Only thing I have noted is that when I use treadmill on a same setting my heart rate my first be 150 for good 15-20 minutes after which it starts to slow down until 135 or so. All this without changing pace or angle.

I have been though Thorax X-ray, which was normal (expect that I am apparently missing the 1st rib on the left side), 3 ECG's, which were all clear. I have had the holter monitor for 24 hours, which was clear as well. Except the low heart rate of 49 day time and 44 night time. Not a single block or any other event was recorded. I did the stress test as well, which was good. I was able to cycle up to 100% heart rate before my legs failed on me. Then there has been numerous blood tests which all are more or less withing the normal ranges.

Typically my resting heart rate varies during a day following a rather same pattern:
- I wake up and while still in bed my heart rate is 60-70
- After I stand up and take shower it's usually 80-100
- Before lunch it usually remains between 60-70 when at work (my work is practically sitting and using computer)
- Usually the daily low is reached during the afternoon when my heart rate may plummit to 48
- After work when I do my workout it usually happens that my heart rate remains on a higher level for the evening at 60-70 range

In general I feel the symptoms like fatigue, dizziness, lightheadedness, nausea daily varying in strength. my subjective feeling is that these symptoms are more strong when my heart rate goes below 55.

My doctor has told me that all this is related to temporary sinus node dysfunction caused by probably some viral infection and that it should normalize over time.

o Does the diagnonsis sound feasible? I feel it is little bit too easy and it gives me hard time to digest it fully.
o Could the heart symptoms be secondary caused by some underlying disease? I have been considering something related to hormonal balance or lack or excess of some other substance.
o Do my symptoms point to any serious heart condition even rare? I have been researching actively in the internet but haven't really found any fully suitable culprit.
o Should I ask for echocardiogram as a next step? I really want to rule out all serious possibilities.
o How normal are this kind of symptoms in general? It would help to hear that I am not the only one suffering from similiar problems.

[tkip]

Dan, my situation is uncannily similar. But it's now Sep 2013. Are you still here on medhelp? If so, what's the status (recovered, I hope!)
tkip

[dan_76]

I thought I write an update since it is roughly half year anniversary of my heart issues.

Since my last post there hasn't been any major changes. I had an echo cardiogram done. Which resulted normal. Surprise.

I have also had a two weeks period of feeling really lousy with light headed feeling and nausea. I also had kind of pre-syncope episode to start that period. More blood works were taken and nothing was found.

I have noticed that when I have these ill-feelings my heart rate is not necessarily low (45-55). Even it usually is, but sometimes it can be on it's "normal" 70-80 level and I still feel surreal. I am not sure which way around it really is. I mean that are the symptoms at least partly due to slow heart rate or are these things fully disconnected. Or is the cause of my slow heart rate also causing the other symptoms.

I haven't got clear response to this from my doctors. My cardiologist said that there's nothing wrong with my heart which I believe and that my heart rate is normal as long as it is above 35. And that the heart rate cannot explain the symptoms. On the other hand my GP is thinking that all the possible tests have been taken and only "finding" is slowish heart rate. So we just need to wait and see if to goes away or I need  to live with the symptoms. But if the symptoms are not heart related where do they come from. I start to be little bit lost with all this.

Well, I am trying a medication for possible gastritis if it would help. I am a bit sceptical with this this since I haven't really had problems with my digestion.

All in all, it seems that I am not going to die for this and I have decided to put the symptoms aside and try to live my life as normally as I can. Unfortunately sometimes the symptoms like weakness and nausea are so overwhelming I cannot ignore them. If there only was a valid diagnosis I would be much happier bloke.

[dan_76]

Thanks for your reply. Sounds that our stories have a lot in common.

I am not a pilot for living, but sometimes it feels I am a passenger for living :) I travel more than half of my working days. I think this is what makes this very stressful for me. As the worst days come and go randomly. It's somehow more tolerable to have a sleepless night in your own bed knowing that if something more serious is to happen you have medical services available than have the same experience in some crappy hotel in a city in the country side of India.

You're right about exersice. I think knowing that I am able to do that, keeps me going. I think I had good luck that I started going to gym only a week or so before the onset of these symptoms. If I hadn't done that.. well.. I guess I would not have started due to feeling continuously sick.

I am going to see cardiologist in a week. I think I will get the echo after that. I'd guess that rules out most of the serious conditions..

And thanks a lot for the support. I hope I can feel like you in a few months. I cannot imagine what the relief will be, when these symptoms start to disappear. All the best for you and your family.

  

[itdood]

I went through something very similar starting back in jan 2009.  It's what originally brought me to this site.

Since then things have pretty much normalized but I still get some PVCs here and there.

The viral infection hypothesis is a good one, and one which I've settled in on for what happened to me.  It all started with a alot of GI distress for me.  So much GI distress that in addition to all my heart workups I got an upper endoscopy and a colonoscopy.  All of these were normal.

The palps at night were THE WORST PART.  Kept me up all night.  I averaged 2-3 hours of broken sleep every night for about 6 months straight.  When things started to improve it was very gradual.

I went through 2 different PCPs and 2 different Cardiologists.  I had 2 different stress tests, 1 nuke stress test, various EKGs, 1 24 hour holter monitor, 1 14 day event holter monitor, 2 echos, and 1 cardiac MRI.  All of this in about 6 months.  All turned out to be normal.

My resting heart rate used to always be on the average side.  Now I'm around 60 most of the time.  Every few weeks it cycles down to high 40s.  This still persists but I get no symptoms so I ignore it.

I remember one time, being in my recliner and over monitoring myself much like you are right now :-).  My HR was at 47.  I remember thinking how cool that was because I didn't feel any different.  I felt very relaxed.  All of the sudden I hear a huge thud upstairs and my daughter started screaming.  Next thing I know I'm upstairs with her.  She had fallen out of bed and was OK.  I don't think my feet touched the floor.  If my heart had a problem, there's no way I could have gotten up from a prone position and jumped 18 stairs in 3 leaps.  Same with you, your heart is responding appropriately to exertion.  This is a big indicator of proper health and function.

Your story is not uncommon.  I've heard quite a few of these since I've been helping out on this board, mine included.

It sounds like you are a pilot for a living?  I think it would be a good idea to get a complete cardiology workup.  I say this just so you document some tests. At a minimum you will get baselines that can be referred back to as you age.   I would get the echo and I would do a 14 day event monitor.  CardioNet makes a good one, though if you are out of the country might not be able to get it to phone home.  This way if something comes up in your annual cert physical you've got documentation to back up that you are cleared to fly.