Palpitations/Chest pains/Irritabilty?

[gnabgib]

Hello,
I am an active healthy 25 year old female.  I have no diagnosed medical conditions and am currently not taking any medication.  I have been experiencing a strange pattern of symptoms for the past 3 years.  The severity and duration varies, but the order of appearance of symptoms is conserved almost everytime.  On the first day, lets say this is Day 0, I experience symptoms that are typical of iron defiency; I feel tired, dizzy, slightly naseous, exercise intolerant, have heart palpitations (skipped beats) and chest pains (stabbing pain located beneath my left breast) and become very irratible.  That night of Day 1 I will experience oscillating heart rate and blood pressure when I go to bed.  After laying down, I will begin feeling very hot, my blood pressure and heart rate rise rapidly and I will sweat.  Then everything will return to normal.  I will go through multiple cycles of these changes until I fall asleep, the time in between the events os variable.  The next day, Day 1, I feel very tired to the point of barely being able to get out of bed.  If I do get up, my heart rate increases rapidly and stays elevated, but I feel like my blood pressure is very low.  I will be tired, exercise intolerent to the point of barely being able to walk more than a few steps, have difficulty concentrating and experince more severe chest pains.  In addition to the stabbing chest pains, the entire left side of my rib cage becomes tender, and I cannot lay on my side. Three years ago when these episodes started, Day 1 symptoms would continue for periods up to 3 weeks.  Now when it occurs they rarely last more than 48 hours.

After the first episode I saw my doctor, and she acknowledged the fact that my heart rhymth sounded starnge and sent me for a holter test, blood tests and an echocardiogram.  The echo showed nothing wrong, and my blood work was normal (cell counts, TSH, glucose, various ions, heamoglobin).  The holter test registered small runs that had the rythm of SVT, but didn't go over 120bpm.  My doctor said that the chest pains were most likely muscoloskeletal in nature and not related to my heart.  I am aware that these type of chest pains are common among women, and usually benign, but the only time I experience them is when I am also experiencing cardiac symptoms.  I also have my TSH levels checked as part of my yearly physical and have never had any abnormalities.
I have spent 3 years trying to discern any type of cause for these episodes, but have yet to find what the trigger is.  I do not drink alcohol, smoke cigarettes, or drink caffeine, and have no food allergies.  

Does anyone have any idea what can cause this pattern of fatigue, irritablity, chest pain and heart palpitations?  

[kayg33]

real quick, i also wore a 24 hour monitor that showed only benign pac's and a few pvc's. less than a month later is when my first 2 hour a-fib episode happened. multiple pac's are a warning sign that could be leading to a-fib. my cardiologist put me on a 30 day event monitor in may of 2009 and it picked up the short 3 to 6 beat stints of a-fib. maybe you should request an event monitor so you can record when you have the strange feelings. i think 24 hours is not long enough to be monitored when your dealing with rhythm issues because they have no certain pattern when they come and go.

[kayg33]

i had had palps in spurts that i was told were nothing to worry about. when i was diagnosed with a-fib in april of 2009 the episode lasted over 2 hours and i was able to get to the ER where they caught it on ekg. the sent me to have an ecg and my heart structures normal. after that i had a sleep study thinking maybe that could have caused it but it was normal also. i dont think that anything i could have said would have diagnosed me sooner. all blood work would come back normal so i had no deficiencies.  i always told my symptoms in detail but i think due to my age they wanted to brush it off as anxiety or something more common. just a quick note every month right before menstruation my a fib tends to act up a little more. i think hormones released during that time can trigger it to be more active.

[gnabgib]

Thank you for your story, this is what I'm concerned about, at the moment the symptoms are just an inconvenience, but I am afraid it will develop into something more serious.  I had a couple of questions if you don't mind.  How long did the episode of a fib last and were you able to have an ECG during the event, or did you go to a doctor afterwards?  Do you think there was anything that triggered any of these events (lack of sleep, change in diet or exercise)?  This might be a strange question, but did you ever notice any correlation with these events and changes in hormone levels?  I notice that most of my symptoms are more likely to occur at certain times of the month, and I don't have an iron deficiency.  And finally, in retrospect, do you think that there was anything that you could have told your doctor in order to get them to diagnose you sooner?

Thank you

[kayg33]

oh my gosh your post sounds just like me. my doc thought i was crazy when i would tell her about the sharp pains shooting through me. especially under my left breast above my ribs. i would get them down my sides also. sometimes i would just have a dull ache right in the center of my chest. palps would come and go through the day and night. my bp would always shoot up and i would get flushed. i had every kind of test and xray imaginable. nothing showed up. she would always suggest that maybe its anxiety. i knew it wasn't. i was only anxious and scared after i would feel the weird feeling in my chest not feel anxious and scared then have palps and pain. at my last visit to her 2 years ago i told her the ache in my ribs and the sharp pains in chest feel as if they go all the way to my spine. she left the room and came back with a printout on fibromyalgia! needless to say i stopped seeing her. it was all a big mystery until that fateful morning, april 2009, i woke up with the worst feeling in my chest. my heart was racing and felt very erratic. i could even find my own pulse. long story short, i was in full blown a-fib. most people don't know they have it unless it gets stuck in that abnormal rhythm long enough for a doctor to catch it on ekg or a monitor. i'm 33 and couldn't believe it when i was told that i have something usually associated with being elderly. living with this is hard and life changing. i'm scheduled for ablation in june with dr. mangrum at uva. i hope it works and he can give me my lively hood back. good luck to you

[jamiero80]

I have been diagnosed with inappropriate tachycardia and my symptoms are  very much like yours. I went out yesterday and bought a POLAR heart monitor watch, it uses a chest strap too. I find it awesome because when you are concerned you can see what your pulse is. I am on Pindolol which has slowed my heart rate but still get chest pain. When I experience this pain I checked my pulse and it was 116. My normal rate is around 85.Before my meds, I used to have it raise above 160 for long periods of time. But just wanted you to know even with meds my heart rate even raising a little bit causes symptoms so please exercise careful like the people above mentioned.

[is_something_wrong]

You are very welcome.

Regarding exercise intolerance: I totally agree, if I start to run or exercise hard without the half hour on my bike, when I have this condition, I don't wanna know what happens. I've tried a couple of times, just to end up with severe tachycardia, PAC trigeminy, and further on. Not sure about my BP. Not pleasant, but the key is to start VERY slowly, in a safe environment.

If your echo was normal, you can rule out cardiac causes for this problem (such as CHF and valve prolapse/leaks). Of course, it can still be caused by hormonal or pulmonal problems and maybe you should see an endocrinologist or at least another internist, though I personally believe this is caused by the autonomic nerve system.

There is a condition called neurocirculatoric asthenia (if my translation is right) that possibly may be considered. This is also a slight disturbance in the autonomic nerve system causing weird changes in blood pressure (high/low), exercise intolerance and fatigue, to mention some. It is a psychosomatic condition.

Remember though: Anxiety can be more subtle than just the panic attacks, and you don't even need to be aware of it. Periods with high sympatethic nervous activity (high pulse, etc) due to anxiety can be followed by "slow" periods where you feel fatigued.

Good luck :)

[gnabgib]

Thanks a lot for your input, it's always nice to find that there are people who can relate.  I was wondering if these symptoms happen whenever you are nervous or stressed, or if they happen at other times as well.  In my case I've actually found that there seems to be an inverse relationship with anxiety.  I'm a Grad student, so there are many times where I experience a lot of stress and don't get enough sleep, but these things do not precipitate symptoms.  I seem to get these symptoms when I am on vacation and not stressed out about anything.  Also, the irritability doesn't seem to be because I'm not feeling well, there are lots of days when I'm tired or sick, but can maintain very strong control over my emotions.  However, in this case I completely lose control and every little thing seems to make me angry (there is no correlation with time of the month).  When I become exercise intolerant, small amounts of exercise such as walking does seem to help, but any further exertion causes my heart rate and blood pressure to take off, and I get shortness of breath to the the point of not being able to breathe.

Anyways, again, thanks for your input.  So far the consensus has been that it is not life threatening, it would just be nice to be able to prevent it from happening in the first place.

[is_something_wrong]

Hi,

I've been writing answers on this forum today, and it's almost amazing how many of you guys that have the same symptoms as I.

I can resume this answer in a couple of words: Anxiety and possible a slight disturbance in your autonomic nerve system.

Myself, I've been suffering from "cardiac neurosis" (da Costas syndrome) for a year, with rapid heart rate (sinus tach), PACs and possibly occational PVCs, chest pain (due to tense muscles), SOB (due to hyperventilation), and further on. I notice that when I'm stressed or anxious, it can almost be a problem to climb up a stair or walk up a slight hill. I'm getting the feeling "I can't do this" or "I've got heart failure" or similar.

What I do, is to spend half an hour on a exercise bike in my living room (a safe environment where I can quit if I should feel exhausted), first with very low work load. Increase this slowly while you watch TV or something to get the attention away from yourself, your breathing, your heart rate, lightheadedness or whatever is making you anxious. After some minutes, the exercise intolerance is gone and your mind is more positive. After half an hour I can go out running if I want to.

Remember that tachycardia from anxiety stacks on top of tachycardia from exercise. I tried the experiment above while monitoring my HR (not that it's recommended for us somewhat cardiac neurotic people anyway). My HR actually decreased with higher intensity until a certain point, because the anxiety was reduced.

This is not dangerous. FYI, I sometimes get a panic attack while exercising, that can drive my HR up in the 200s, with several PACs in addition. Got this monitored on Holter, and my cardiologist laughed and said "you don't need to care as long as you're not fainting or getting serious problems"

Regarding your irritability, I myself get really pissed, scared and cranky if I've had a night with palpitations and/or tachycardia before sleep, waking up with anxiety and hyperventilation, or similar. The night really affects your mood the next day.

It seems that you just have some anxiety, and that your autonomic nerve system (the "gas pedal" and the "brake") overreacts sometimes. And it's almost unbelieveable which and how many "cardiac symptoms" this totally benign condition can cause.

Good luck, be encouraged and just call your doctor if somethings should get worse. He can give you medications, but it's always best to try to fix such things without them.