Extremely LONG heart pause

[jpcox]

Hi doctor,
I am a 29 year old female. I have been having an irregular heartbeat since the birth of my daughter 6 years ago. I have been seen by a cardiologist and have echos,ekgs,stress, and monitors. So far the only thing that has been seen is premature atrial tachycardia on stress test, and premature atrial contractions, and pvcs. I did not feel the PAT when it happened.   My doctor said these results were pretty normal. I am very symptomatic to the Pacs.

Two days ago I had the scare of my life. I was driving and all of a sudden it was like my heart paused for an extremely LONG time. My chest became very tight and it was like I was not breathing. I could still see because I continued driving, then it was like I felt my heart kick back in. After the episode my legs were very weak with weakness following the next day. I also had elevated blood pressure and pulse the next day. This is the 3rd time this has happened since August. I have reported this to my doctor and she seems unconcerned. This was not my average little pause after a pac.

I am scheduled to see my doctor on the  8th and I wanted to know if I should push for more testing? Also, I read that a long pause in a structural heart is of concern, why? Can you maybe help me understand what happened? What kind of specific questions should I ask my doctor? Does this sound like something serious? If I was your patient what kind of testing would you do? Also, is it normal to be very symptomatic to pacs? I have chest heaviness with this, and an overall poor feeling. Some days I feel like going to bed is the only thing that will help.

I was anemic back in December, but that has been corrected and I take 20mg of Zocor for high normal cholesterol.  I am so concerned and scared. Thank you

[Michael J. McWilliams, M.D.]

I appreciate that. The problem is you get much more information with the dynamic conversation and being able to review test.

[jpcox]

Thank you for replying. I really appreciate your service. This is the next best thing to being in your office.

[Michael J. McWilliams, M.D.]

I am scheduled to see my doctor on the  8th and I wanted to know if I should push for more testing?

Without seeing the studies I probably should not comment on whether it is safe for you specifically, I can say that withs a structurally normal heart, these are almost never concerning from a medical perspective -- although I do understand that the symptoms are significant.



Also, I read that a long pause in a structural heart is of concern, why?

In a structurally abnormal heart, heart rhythms can be more troubling.  It is important to know why it is pausing and what the rhythm is when the pause happens.

Can you maybe help me understand what happened?

It could be many things.  The only way to know is to see it on a monitor.  It was probably a premature beat with a pause afterwards but there are many other reasons for pauses.  A full evaluation and sometimes other tests like an echo, stress test, tilt table test, may be necessary to determine the cause.


What kind of specific questions should I ask my doctor?

The questions you are asking are appropriate.  is this dangerous, should I be worried, do you know what is causing it.


Does this sound like something serious?

It does not, but your doctor needs to decide this.

If I was your patient what kind of testing would you do?

it depends on the rest of the history and physical exam and EKG.  I would probably start with a 30 day event monitor to try and record one of these events.

Also, is it normal to be very symptomatic to pacs?

I commonly see people that are very symptomatic with their premature beats.  It is normal for you.

I hope this helps.