Shortness of breath

[Uhondo]

Hi all.I Have been plagued by palpitations (including abnormal beats) for a while now.I have had numerous tests done i.e. dozens of ekg, a couple of doppler echocardiograms, blood work, chest x-rays and stress tests that have apparently have all come out clean.I have been to the E.R. so many times in the middle of the night during these attacks but end up getting sent back home.I get shortness of breath and palpitations at night every so often.My cardiologist tells me he's not going to send me for an angiogram because the risk/reward possibility for my case is not worth it and that there needs to be more "evidence".I have been on metroprolol 50mg which has quietened things down for the most part.My question is could these tests have missed something significant? What more can i do so that i may get to find out what is bothering me?

This is the second cardiologist i am seeing for this problem

Thanks

[Jules209]

With all the tests that you've had done, they would have found it by now. My symptoms sound very similar to yours so my cardio wants to schedule me an ablation, where they go in through my groin and burn or freeze the extra pathways that are causing my heart to misfire(palpitate).I am a nervous wreck about having it done but I'm also tired of these symptoms. Good luck with your diagnosis.

[is_something_wrong]

No, LVIDd changes from minute to minute, depending on heart filling, rate, cardiac output, etc. So does EF and wall thickness during diastole, as well as EKG numbers. Nothing to worry about :)

[Uhondo]

Hi Dave2923, thanks for the response.

It took me a while to get those results but here's what i was able to see:

1)These were some of the numbers for the Echo and comments following:

IVSd 0.86cm
IVSs 1.20cm

LVIDd 5.1cm
LVIDs 2.75cm

PWd 0.92cm
PWs 1.6cm

FS 46%

LA 3.2cm

EF 75%

AO 2.93cm

-Normal cardiac wall and chamber dimensions
-Normal left ventricular wall motion
-Normal systolic Left Ventricular function
-Ejection fraction 75%
-Normal valve structure and function
-Intact atrial and ventricular septae
-Normal great vessels
-Normal pericardium

Conclusion:Normal Transthoracic Echocardiogram

I was unable to see the RV systolic/PASP or any other values

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2) For the EKGs in my possession, results are the following:

-None of the PR intervals is <120
-None of them mention ST elevation
-The 3ECGs in my possession have QTs less <450ms

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That's the much i am able to provide at this time.What has me concerned right now is that the LVIDd is changed from an earlier Echo and i am wondering if this is a sign of a developing problem..

Thank you for your input

[Dave2923]

   You most likely have nothing serious wrong with your heart. While palpitations can be the sign of structural or electrical heart defects, they are sometimes "benign/idiopathic." The theories are that there might be some microscopic defects that cause irritability and excitability in the atriums or ventricles and thus lead to ectopic beats and even short little runs of SVT or monomorphic VT. The two most common "irritable" sites are the RVOT and LVOT. It's an annoying and scary sensation to deal with, especially if it is frequently occurring, but in the absence of overt structural/electrical disease the prognosis is generally extremely benign.
        A few things you might want to double check on your tests which may or may not have been overlooked:
-Was the RV size and function normal on the echo? (ARVD check)
-Did they give you the RV systolic pressure or the PASP? (check for it being over 30mmHg as that could signal pulmonary hypertension, and thus your shortness of breath)
-Was the QTc interval <450ms? (LQT Syndrome check)
-Was there any unexplained ST elevation in leads V1-V3 (check for Brugada pattern)
-Do you have a short PR interval <120ms (potential WPW Syndrome)
-Was any valve regurgitation more than "trace" regurgitation mentioned on the echo report?
-Do you have high glucose, cholesterol, or blood pressure? (all may lead to palpitations)
    Generally though, you likely just have some benign PVC's.