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CT Angiogram
I started having heart palpitations/rapid rate about 5 months ago. My regular Dr had me wear a Holter monitor on May 10-11 and then referred me to a heart specialist. I have very low cholesterol/triglicerides, am a dailly walker and work out with weights 2-3 times a week. I am 5'4" and weigh 120. I had an echo cardiogram and it was good, but I took an echo stress test and they took me off the treadmill after 3 minutes because my heart rate was at 200. Before the stress test the heart Dr. put me on 12.5 Metropolol (a beta blocker) and 4 mg of Coumadin each night. By the way my normal blood pressure is 110/60. I am worried about the beta blocker lowering my blood pressure -- also, I don't like the idea of going in for a blood test all the time. The heart DR wants me to have a CT angiogram to rule out heart disease and them might put me on a heart regulating medicine so I can go off the coumadin. Any ideas with all my other "stats" why my heart is acting up?
Thank you! The Drs assistant said she/the Dr will be in touch with further treatment/medicine recommendations and I will ask about it.
Well, I had an abnormal nuclear medicine test, which is why they wanted to order the angiogram to begin with. A nuclear medicine test involves being hooked up to an EKG, then doing a treadmill until your heart rate excels to a certain level, at which time they inject some dye and have you go lay down and they take pictures of your heart. Some will have you rest for so many hours and take pictures of your heart the same day. Or they might wait and see if the exercise part of the nuclear medicine test comes out normal, and if it does, skip taking any pictures of the heart at rest.
It does sound like maybe your problem is somthing other than related plaque in your heart's blood vessels, given your excellent cholesterol and triglyceride numbers.
It does sound like maybe your problem is somthing other than related plaque in your heart's blood vessels, given your excellent cholesterol and triglyceride numbers.
I don't know what a nuclear medicine test is, but I will look it up! I don't think I want the invasive type of angiogram. To tell you the truth, with my low cholesterol, low blood pressure, general good health and perfect blood tests I don't think I have heart disease (I don't think afib is considered "heart disease." When the nurse gave me the echocardiogram she said I had a "beautiful heart" ; but the Dr said that to ABSOLUTELY rule out ANY other heart problem he could do the CT angiogram for the sole purpose of feeling comfortable putting me on a stronger heart regulating medicine (instead of the beta blocker) and by do so enabling me to go OFF the blood thinner. It may be the perfect echo that prevented the approval. I just found out from a voice mail yesterday, so I will find out more about the reason. Thank you so much!
Hi it sounds like you know what you are talking about so I have a question I have sinus tachycardia but I don't have it like others I have reading my heart is always around 120 at rest and any where from 150 to 200 while doing anything and this is all the time, my ep doctor i seen today done no testing he went off of old test and he did not know what my cardiopulmonary stress test results meant so he put me on this medicine called florinef so that my kidneys will not rid my salt from my body and a beta blocker called atenolol. I am worried about this medicine due to the fact my doctor didn't seem to know why my heart is always fast
I remember I wanted a virtual angiogram myself and my insurance at the time didn't cover it either, so I wound up having the invasive type, which was covered. Would they at least cover a nuclear medicine test? That same insurance covered one of those for me!
I just found out today that my insurance company will not authorize a CT angiogram. Sooo, I will talk to my Dr about alternative medication WITHOUT a CT angiogram. I will keep you posted as to future treatment. Again, thank you!!
Thank you, bigkev14. By the way, Surgimenopause, I did leave a long response (the extra "opause" was just a typo!), but I criticized my Dr and I think the post was removed! :)
I do appreciate all your feedback.
bigkev14, is your wife on a blood thinner? I am not too concerned a about the afib (my 92 year old mother has it and has been on Warfarin for years) -- I would just like to be on something that would totally regulate the heart rate (pacemaker?) so I could go off the blood thinner. I will let you all know what happens after the CT angiogram. Thanks again.
I do appreciate all your feedback.
bigkev14, is your wife on a blood thinner? I am not too concerned a about the afib (my 92 year old mother has it and has been on Warfarin for years) -- I would just like to be on something that would totally regulate the heart rate (pacemaker?) so I could go off the blood thinner. I will let you all know what happens after the CT angiogram. Thanks again.
I have episodes of SVT where my heart rate suddenly goes up to about 200 beats per minute without warning and I feel horrible. You feel a bump inthe chest, sudden dizzyness and feel your heart racing.These episodes have been 'caught' when I went to the ER and they gave me an ECG. These are not harmful they say, just distressing (you can say that again!) and just 'revert' back to a normal rhythm suddenly . Sometimes after a few minutes and usually last about 30 - 45 minutes with me. Once they went on for over 2 hours and I went to the ER and they gave me an injection which 'bumped' it back to normal. Chemical reversion it's called. That stops your heart for a couple of beats and they told me to expect a sudden feeling of terror when it happened. And I did, but only for a few seconds. After it takes hours to slow right back to normal and you feel real tired and have to rest. The Tenormin seems to be controlling this pretty well, and I only have an episode every couple of months now. For me this is preferable to having an ablation which is invasive and doesn't always work. At my age, over 60 they aren't keen anyway.
My wife does have Atrial Fibrillation which is different to the SVT's and her heartbeat is continuosly irregular. It's been going on for about 4 years and the cardiologist said it sometimes reverts spontaneously, but that's usually within the first couple of months of the onset. Hers is permenant and the only thing they apparently do sometimes is to 'shock' it (ie de-fibrullate) back to normal but the risk at her age (60s) isn't something the doctors want to take and say that her medication is keeping her heart rate down (but irregular) and her blood pressure is fine. She doesn't notice it at all most of the time. I read that George Bush senior had AF for many years and he lived on OK. Sorry to waffle on, and everybody please excuse my bad spelling. Good luck, keep us posted.
My wife does have Atrial Fibrillation which is different to the SVT's and her heartbeat is continuosly irregular. It's been going on for about 4 years and the cardiologist said it sometimes reverts spontaneously, but that's usually within the first couple of months of the onset. Hers is permenant and the only thing they apparently do sometimes is to 'shock' it (ie de-fibrullate) back to normal but the risk at her age (60s) isn't something the doctors want to take and say that her medication is keeping her heart rate down (but irregular) and her blood pressure is fine. She doesn't notice it at all most of the time. I read that George Bush senior had AF for many years and he lived on OK. Sorry to waffle on, and everybody please excuse my bad spelling. Good luck, keep us posted.
Thank you so much for the info. I think I need to write down my questions before I see the Dr because I forget to ask! I may see another cardiologist as this one, although I'm sure he is quite good, doesn't seem to want to spend much time with me. It's been a week since he suggested the CT Angiogram and I will call him tomorrow to see what's happening. I'm wondering, since this all is an "electrical" problem if it is ever "reversed" or can be controlled naturally in any case. You stated the triggers for afib in you and your wife -- I don't know why mine started. Is it always permanent? Thank you all for your responses!
Did they say why your heartrate went to 200 on the treadmill? It sounds like you had what is called an SVT (supraventricular tachycardia) episode. The cardiologist knows what it was so you should ask your doctor to explain it fully. The reason you doctor put you on the beta blocker was to regulate your heartrate by calming the electrical impulses that make our hearts behave the way they do when there is a problem; kind of like like a short circuit. (I'm an electrical engineer and understand the principles, much to the irritation of my cardiologist)
Usually the beta blocker alone doesn't have a great affect on blood pressure, and the dose can be adjusted depending on how you get on with it.
Coumadin was prescribed as a precaution to lessen the possibility of a clot forming due to the irregular hearbeats in case the chambers didn't empty properly. 4mg is a low dose, and depending on what your further tests show they might prescribe a daily low dose aspirin instead, and you won't need to go for INR tests. (blood clotting measurement that is).
As far as ablation is concerned, it is an absolute last resort and medication is the way to do if possible. There are a number of different beta blockers so if one doesn't work well the doctor can try another. It takes patience and the more questions you ask the more you will learn, and the better you will cope with things. I must sound like a real knowall but I've been through all this for over 15 years, and have learnt all these things because I have SVT's Beta blockers (Tenormin) has worked wonders. My wife has permanent Atrial Fibrillation and has to take Warfarin. Hers was triggered with a dentist's injection of adrenaline would you believe! My SVT's started when I took Sudafed for sinusitis!
lest all know how your tests go.
Usually the beta blocker alone doesn't have a great affect on blood pressure, and the dose can be adjusted depending on how you get on with it.
Coumadin was prescribed as a precaution to lessen the possibility of a clot forming due to the irregular hearbeats in case the chambers didn't empty properly. 4mg is a low dose, and depending on what your further tests show they might prescribe a daily low dose aspirin instead, and you won't need to go for INR tests. (blood clotting measurement that is).
As far as ablation is concerned, it is an absolute last resort and medication is the way to do if possible. There are a number of different beta blockers so if one doesn't work well the doctor can try another. It takes patience and the more questions you ask the more you will learn, and the better you will cope with things. I must sound like a real knowall but I've been through all this for over 15 years, and have learnt all these things because I have SVT's Beta blockers (Tenormin) has worked wonders. My wife has permanent Atrial Fibrillation and has to take Warfarin. Hers was triggered with a dentist's injection of adrenaline would you believe! My SVT's started when I took Sudafed for sinusitis!
lest all know how your tests go.
Was that a joke on my nickname with the "nopause" part at the end? :0)
A person's CBC can be normal and ferritin still be low- have you had this checked? Even with POTS, I found my tachycardia to be worse with low iron and a normal CBC.
And a problem can develop with the thyroid- like a "toxic" nodule forming on it, even when the thyroid was fine in the past, I believe- so have you had testing recently since the rapid heart rate started for thyroid function that came back okay?
Why did the doctor think there was a possibility of blood clots? Was it based on your prothrombin (clotting) time test? Or perhaps a high vitamin K level in your blood? You say your cholesterol and triglycerides are very low, so it would seem clot formation from a plaque build up would be unlikely, right? Curious as to his/her reasoning.
No difference with position- so what sort of tachycardia did the doctor say you had? If you have SVT (supraventricular tachycardia), they treat that w/BP medications at times and advice not to eat/drink things with caffeine and such. If conservative methods don't work, they might suggest you consider ablation by an electrophysiologist to try to get your heart rhythm back to normal. On the other hand, if they say you have "IST" or inappropriate sinus tachycardia, you might want to look more into dysautonomia.
A person's CBC can be normal and ferritin still be low- have you had this checked? Even with POTS, I found my tachycardia to be worse with low iron and a normal CBC.
And a problem can develop with the thyroid- like a "toxic" nodule forming on it, even when the thyroid was fine in the past, I believe- so have you had testing recently since the rapid heart rate started for thyroid function that came back okay?
Why did the doctor think there was a possibility of blood clots? Was it based on your prothrombin (clotting) time test? Or perhaps a high vitamin K level in your blood? You say your cholesterol and triglycerides are very low, so it would seem clot formation from a plaque build up would be unlikely, right? Curious as to his/her reasoning.
No difference with position- so what sort of tachycardia did the doctor say you had? If you have SVT (supraventricular tachycardia), they treat that w/BP medications at times and advice not to eat/drink things with caffeine and such. If conservative methods don't work, they might suggest you consider ablation by an electrophysiologist to try to get your heart rhythm back to normal. On the other hand, if they say you have "IST" or inappropriate sinus tachycardia, you might want to look more into dysautonomia.
Thank you for your detailed response. You are obviously well versed in all the possibilities.
My CBC was perfect in April. My regular Dr is very thorough and I've never had a thyroid problem and only slight anemia when I was younger. I know the heart Dr immediately put me on the Coumadin (before all the testing) because of the reading from the Holter monitor and the possibility of blood clots. Same reason for the beta blocker. It is the stronger medication to stabilize my heart rate to a degree that the blood clots are no longer a threat and I can get off both the beta blocker and coumadin that the CT angiogram is for. I'm not sure I'm being clear. I will look into and ask about "dysautonomia" as sitting, lying down or standing doesn't seem to be any different.
My CBC was perfect in April. My regular Dr is very thorough and I've never had a thyroid problem and only slight anemia when I was younger. I know the heart Dr immediately put me on the Coumadin (before all the testing) because of the reading from the Holter monitor and the possibility of blood clots. Same reason for the beta blocker. It is the stronger medication to stabilize my heart rate to a degree that the blood clots are no longer a threat and I can get off both the beta blocker and coumadin that the CT angiogram is for. I'm not sure I'm being clear. I will look into and ask about "dysautonomia" as sitting, lying down or standing doesn't seem to be any different.
I don't understand a doctor who would not make the test happen ASAP to rule out heart disease BEFORE putting you at risk of side effects from an anti-coagulant medication he/she doesn't even know is warranted! Were you having chest pains with the tachycardia?
I had a doctor tell me an anecdotal story about a man in the hospital who was given blood pressure medication, which normally lowers it, but in this man's case, it actually raised his blood pressure, because the medication was helping his heart to beat more effectively. I'd recommend you get a home BP monitor (Omron is a recommended brand) and make sure your BP is not dropping too low- you should be monitoring your blood pressure regularly when you are taking BP medication.
As to your rapid heart rate- I would recommend you make sure with thyroid function testing you don't have hyperthyroidism. I would recommend you get your ferritin (iron stores) level checked as well as a CBC, to be sure you aren't iron deficient and don't have anemia. Also, make sure you aren't dehydrated and don't have an electrolyte imbalance.
And if they did not tell you you have supraventricular tachycardia, but told you your type of rapid heart rate is sinus tachycardia, I would suggest you might want to learn with lying down and standing blood pressure and pulse readings if you have an orthostatic intolerance problem. Or if your heart rate is rapid regardless of position, you may want to research something known as IST or inappropriate sinus tachycardia, considered a form of dysautonomia.
If you do have an intolerance to being in a standing position, and your heart rate increases by at least 30 beats per minute compared to when you are lying down for awhile (if I may suggest-be lying down at least 10 minutes before taking your pulse and standing at least two to three minutes before taking your pulse again), you may want to pursue getting a test from a cardiologist (more specifically an electrophysiologist) called a tilt table test, to see if you have an orthostatic form of dysautonomia.
A tilt table test is where they take your pulse and blood pressures while lying on a table you are strapped to and then they tilt you up and take blood pressure and pulse rates several times in an upright position. They might give you something like nitroglycerine under your tongue while lying down again (they did me) and then tilt you up again, monitoring your blood pressure and pulse. If at any time you become unresponsive, because you passed out (as happened to me after the nitro part of the test), they quickly tilt the table back down so you are laying down again. This test can assist with diagnosis. They diagnosed me after one of those kind of tests with a condition called postural orthostatic tachycardia syndrome (POTS).
I had a doctor tell me an anecdotal story about a man in the hospital who was given blood pressure medication, which normally lowers it, but in this man's case, it actually raised his blood pressure, because the medication was helping his heart to beat more effectively. I'd recommend you get a home BP monitor (Omron is a recommended brand) and make sure your BP is not dropping too low- you should be monitoring your blood pressure regularly when you are taking BP medication.
As to your rapid heart rate- I would recommend you make sure with thyroid function testing you don't have hyperthyroidism. I would recommend you get your ferritin (iron stores) level checked as well as a CBC, to be sure you aren't iron deficient and don't have anemia. Also, make sure you aren't dehydrated and don't have an electrolyte imbalance.
And if they did not tell you you have supraventricular tachycardia, but told you your type of rapid heart rate is sinus tachycardia, I would suggest you might want to learn with lying down and standing blood pressure and pulse readings if you have an orthostatic intolerance problem. Or if your heart rate is rapid regardless of position, you may want to research something known as IST or inappropriate sinus tachycardia, considered a form of dysautonomia.
If you do have an intolerance to being in a standing position, and your heart rate increases by at least 30 beats per minute compared to when you are lying down for awhile (if I may suggest-be lying down at least 10 minutes before taking your pulse and standing at least two to three minutes before taking your pulse again), you may want to pursue getting a test from a cardiologist (more specifically an electrophysiologist) called a tilt table test, to see if you have an orthostatic form of dysautonomia.
A tilt table test is where they take your pulse and blood pressures while lying on a table you are strapped to and then they tilt you up and take blood pressure and pulse rates several times in an upright position. They might give you something like nitroglycerine under your tongue while lying down again (they did me) and then tilt you up again, monitoring your blood pressure and pulse. If at any time you become unresponsive, because you passed out (as happened to me after the nitro part of the test), they quickly tilt the table back down so you are laying down again. This test can assist with diagnosis. They diagnosed me after one of those kind of tests with a condition called postural orthostatic tachycardia syndrome (POTS).
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