PSVT???? Need

[fallingapart40]

I am 40, female and overweight. I have never had any prior heart issues, not diabetic, not sedentary. Had "episode" of faintness, shortness of breath, chest pain & pressure and pounding/racing heart. Lasted about 15 minutes then passed, returned three times before I could get to Dr. - He said I had probably pulled a muscle but would check other things - sent me for CT of lungs - clear. I got a little better so he sent me home and the next day I had another episode so I went back, said maybe shingles and gave me a shot. After I insisted, he did ekg - then sent me directly to cardiologist. Had 145 bpm when I arrived at office an hour later, did another ekg said abnormal T waves, put me on atenolol 25 mg daily. Next day they did blood work (cmp, thyroid and lipids - all good), nuclear stress showed no blockage but I only was allowed to get to 155 bmp (don't know why) 90 bpm when I started 132/82 bp - took 4 hours to back under tach level; did echo and so far no results other than a mention that mitral looked ok and my heart size was small (what does that mean??) I had/ have swelling in my left foot and ankle that varies from very mild to severe depending on my level of activity - no pain other than tight skin, no injury. Right side is normal. Swelling for 8-9 weeks - thought to be spider bite at onset due to extreme swelling - treated with antibiotics - went down and 2 weeks later the swelling returned but not as dramatically. A week after the "bite" I walked in 90 degree weather for 3-4 miles all over UGA's campus with my son - no symptoms except slight swelling in my foot. I walked for two days, all day (10 hours each) at the trade show for my job on concrete - no symptoms. I don't why it would be still be at tach rate for 12 days anytime I am off atenolol if I move for more than five minutes  or why I go tach WITH atenolol if I do lots of stairs, carry in groceries, etc things that used to not affect me at all. Can things just "show up"? Possible diagnosis? Thanks!

[kat4]

I don't think the doctors see follow up questions unless you use the post to a doctor feature.

If I were you, and I'm not a medical person, I would demand a 30 day monitor so the cardiologist can see what is actually happening when you have symptoms.   Then he or she will be able to tell you if medication is needed and what is going on.  I would take comfort from the fact that the echo and stress test are likely fine,  the cardiologist's office would, I suspect, have called you by now if they showed anything serious, although of course you should keep your upcoming appointment.

I looked on the web and the Mayo Clinic has a web page for foot swelling where you can check off symptoms and it will guess at a cause:
http://www.mayoclinic.com/health/symptom-checker/DS00671/SYMPTOM=43D62E5F-2A5D-9994-E50469A1BE051327&TAB=Foot%2520swelling%2520or%2520leg%2520swelling
Then I'd talk to your GP about it.  I am surprised he apparently didn't even take you pulse until you insisted on the ekg.  Maybe you need a doctor who pays more attention when you say something is wrong.

In the meantime, assuming exertion gets your heart rate higher, is there anyone who can help out when your son moves?  Maybe a friend or neighbor?  One of his high school classmates?

I have a non-harmful heart arrhythmia, but climbing stairs frequently or lifting heavy stuff will set it off, so I don't do much of that.  If I do it, it's in slow motion.

[kat4]

Boy, do I hear you about "a cardiologist that understands the importance of patient peace of mind."  I used to have a wonderful cardiologist like that, then I moved, and the new one, not so much.

It is normal for exertion to raise the heart rate somewhat, so that's one thing you could ask a cardiologist about if you have the monitor results.

My arrhythmia is atrial fibrillation ("afib").  Which is the upper chambers of the heart beat fast and chaotically.  With afib, if the heart rate is not kept more or less normal, i.e. not rapid, the heart can enlarge, but it takes months of rapid beating to do so, and the heart will go back to normal (slowly) if the heart rate is corrected, like with a beta blocker or calcium channel blocker.  The other problem with afib is that because the upper chambers are chaotic, blood can stagnate in places, and clots can form, so if episodes last a day or longer, people have to be on a blood thinner.  With both those things taken care of, life expectancy is the same as without afib.

All the more reason to find out what is going on and how long episodes last with the monitor.

p.s. 25 mg of Atenolol a day is not a lot, although the more you take the more lethargy it will cause, and maybe some shortness of breath.  I had none of that from a beta blocker until I was put on 25 mg twice a day.  It might be that you need more to control what's happening

[fallingapart40]

Thanks - I am beginning to think I need new doctors. A GP that will not assume because I have been healthy that nothing could be wrong and a cardiologist that understands the importance of patient peace of mind has a lot to do with well being!

Thank you for the link. I will try that...

The exertion does move my rate up now and that was why I wanted to know if it would be dangerous. I hate being concerned about doing something that I would have done a few weeks ago without a second thought.

Have you ever been told if your non-harmful could/would lead to more serious issues down the road? Does being careful not to raise the rate help that?

Thanks for your help!

[fallingapart40]

With all due respect, I was afraid you'd say that....

Even with the swelling of my foot (left only) and the fact that it has not gone away for 8-9 weeks with no injury? Seems vascular to me but I am no doctor and it may be of little concern.... The dull ache in my chest that has been there for 12 days - only left side from sternum through breast to ribs with sharp shooting pains intermittently. Worse if I get too hot or overexert myself.

I also don't understand why NOW after other much more stressful events in my life did not cause any symptoms at all. Having no major health issues all this time and now feeling like my symptoms are not being as seriously addressed because of it, along with the fact that my son is going to college is frustrating! I am not denying that it is stressful and sure I am going to miss him BUT he is only a two hour drive, he is great about keeping in touch - like he did when he went for 6 weeks to Gov.'s Honors (had no episodes then and he was 5 hours away and younger!), he got scholarships and this first round is paid for, he got into a prestigious program that fast tracks him into Vet school. He is a solid, responsible, great young man - he has his feet on the ground and he is ready and fully capable. I am very proud of him. Miss him for sure - worried not really.

I understand why everyone thinks that way but with all the other things that have happened in my life this is not a "heart stopping" issue. The doctors telling me my 4 week old baby needed a craniectomy - that was heart stopping! Getting a cancer diagnosis for my husband was heart stopping! Those things did not cause any symptoms or panic/anxiety attacks - why now?

I have seen my sister have full blown panic attacks - it wasn't like that. I had just gotten out of bed and was in the shower. I felt like I was having trouble breathing then chest pain and then the pounding heart - then I nearly passed out - I saw black dots . When I got into the bedroom where it was cooler I felt better and when I went to dry my hair it started again. I left the room, cooled off and felt better. Went back to finish dressing and got the third round. Overheating has set it off every time I've gotten too hot since it started 12 days ago.

I am not a panicky person. I deal with the facts and arm myself with knowledge, faith and honesty. I am, however, not confident about this. I have read many of your posts and I see many deal with stress and anxiety issues and it is logical to apply some value to my son's leaving for college BUT I think all things considered that my symptoms and concerns should be addressed as seriously as someone without that side note. I am trying to see this from your point of view and given your expertise I respect why you think it may be the cause. All I ask is that you consider why I don't.
Is it safe for me to move and lift the things next week as he moves in?

[Michael J. McWilliams, M.D.]

my heart size was small (what does that mean??)   Probably not much.  If the tech something that concerned them, they would say nothing.  They were probably must making a comment.  They sometimes don't realize that when people are worried, they sometimes hang on every word.

It sounds like this all started relatively recently.  You also mentioned that your son is going to college soon.  That alone is a lot of stress, whether you notice it or not.  It is hard to watch your kids get older, going to college is a pretty big step.  Organic heart disease should be ruled out as your doctors are doing.  If everything looks pretty normal, anxiety is going to be pretty high on their differential diagnosis.  This is pretty normal.  A 30 day event monitor, if they decide to do one, will increase the likely hood of you having your symptoms while you are wearing the monitor.  This is very important in making the diagnosis.  If it is a normal, fast rhythm, sometimes people don't respond as much as we would like from a beta blocker.  If the doctor tells you that your echo and stress test are negative, a heart monitor may help in the work up.

If it is stress, it is likely to get better after your son starts college.

If it is sinus tachycardia (normal tachycardia), beta blockers don't always help and the rates are typically elevated when you are awake and decrease with sleep.  I will see holter monitor that have night time rates of 50 and as soon the patient wakes up, the heart rate jumps to 110 or 120 and stays that way all day.

I hope this helps.

[fallingapart40]

FYI - I had a baby 3 years ago with no complications other than some swelling late - no surprise at 37, haha. Never problems with heart rate or bp  while pregnant and they watched me very closely because of my age and issues with 2nd child having craniosynostosis - (she is fine now - healthy, beautiful and 15) Had no "episodes" during VERY stressful times with her health, surgeries, etc. - Had no "episodes" through many other VERY stressful times - husband's cancer, etc.

I really don't think stress is causing this - aggravating it maybe - but not primary cause.

When the swelling is bad in my left foot, I get tingles and sometimes numbness in my toes but I assume this is from pressure of the swelling. Have always had cold feet and usually cold hands but since this started, my feet get hot - especially at night sometimes and then very cold.

Can't see cardiologist until 21st to get echo results but will be moving my son to college next week and I am concerned about lifting/carrying heavy items up the stairs... Hard for me since two weeks ago I would never have given it a second thought!