Palpitations... Scared of echo results.

[devm95]

I apologize in advance for the lengthiness of the post but I’m hoping someone can give me some opinions or some peace of mind. I just turned 20 years old and I have never had any health problems. Even though I almost never EXERCISE I am at an average weight, but I don’t eat as healthy as I would like. Not sure if that plays a role in my problems. I had been having these strange chest pains. It’s hard to explain what they feel like. They are always on the left side of my chest at the top of my breast and it’s off and on, not continuous pain. It is not exactly painful, but more bothersome and makes me worry. Sometimes I find that moving to a different position will help relieve it. After having these strange pains for a few months I decided to go to the nurse last semester at college, who then advised that I should go to the ER immediately because of my racing heart RATE. After x-rays, an EKG, and blood work, the DOCTOR informed me that everything was normal and that reason for the chest pain did not seem to be coming from my heart, but maybe just stress. Before he came in to talk to me, my BP and HR were fine, but as soon as he walked in, the monitor started beeping like crazy as my HR shot up. He said my HR increased as it should when you exercise, and that it wasn’t abnormal, but it’s strange that it would rise for no reason. He thought of Costochondritis but that was ruled out as it doesn’t really hurt when you press on that area of my chest, just a little discomfort. He referred me to see a cardiologist to follow up to get more answers and maybe wear a holter monitor for a day. After a few more months, my chest pain continued off and on as it had been, and my palpitations as well. I was diagnosed with an unspecified anxiety disorder around this time so I blamed the palpitations on the anxiety. I was put on 10 mg of Lexapro, which even a couple months later I haven’t noticed a difference in my symptoms. While playing volleyball at a family party I noticed my heart beat speed up and pound through my chest even though I was barely moving around, and thought, “my heart shouldn’t be doing this.” I kept ignoring the palpitations and thinking nothing of them until I finally felt the need to make an appt. with the cardiologist a few days later. At the cardiologist appointment, I told the doctor about the palpitations and occasional chest pain. He ruled out the chest pain to be just musculoskeletal, but my palpitations concerned him. He told me if your heart rate stays up there for a long time it could cause heart damage, but mine isn’t like that, it starts racing then slowly comes down.. After placing his hand on my chest he said my heart beat was rather strong... I knew my nerves were making my heart pound. I told him an example of how when I sit in class and I know I’m about to be called on by the teacher, my heart starts racing. Sometimes DIZZINESS is involved, but not enough that I would faint. I believe the anxiety plays a big role. The more I think about it, the more my heart races. After listening to my heart, he told me I have a murmur, but it isn’t much to be concerned about,because they are usually benign. I was never told this by any doctor my whole life. I’ve never had problems with my heart in 20 years. I went for blood work because he wants to check my thyroid levels and to see if I’m anemic. My T4 levels have been elevated in the past but I was never placed on medication for it, and my triglycerides are slightly high. My BP was also elevated at this appointment. I have to wait 2 weeks to go back for an ultrasound (echocardiogram) to evaluate the murmur and to just see the overall anatomy of my heart. He says if everything comes back normal he will diagnose me with Inappropriate SINUS Tachycardia (IST) and discuss putting me on a beta blocker. He decided wearing a holter monitor would not provide any answers. These next 2 weeks of waiting are going to be brutal. I find myself checking my pulse a million times daily and I can’t stop thinking about it. I’m not sure if I would be better off on a benzodiazepine like xanax, klonopin, ativan, etc.. for the anxiety. But I need to see if there’s any problem with my heart first, and find out if it really is all anxiety/nerves and stress, or not. I’m noticing that even if I get up from a chair to walk up the stairs my heart instantly starts racing which makes me believe it’s not anxiety at all. I viewed the lab results online a few days after the appointment, and it looks like everything is normal, but I’m not entirely sure as I’m not a doctor and don’t really know what the levels mean... I didn’t receive a phone call or any urgent messages. In the meantime, I would like to know what to expect after this echo of my heart... and any thoughts on my problems and what could be wrong if anyone has any ideas... I shouldn't ask this but what's the worst case scenario? I’m so anxious and so scared.

[tacolino]

Hi there. You got the Echo result. It went very well for you thank god. There were no real serious issues. Stick with what the doctor is telling you. I just feel that having read your posts, that maybe the anxiety is creeping in and taking over a bit. It happens so easily. Go back and re read your posts, it seems that the minute you got an ok result on the echo, a new small problem became a big monster problem that troubles you. It becomes gigantic when its a minor issue. Then you feel that its a crisis problem! Its easy for me to say this, but its only fair i say what i see when i read your  posts. Anyway look at all the positivity you have. No major issues, no major treatment, no pile of drugs to take every day. God wow thats a good place to be. Hope you get on ok, keep us posted.

[devm95]

So I had the echocardiogram done and when I went for the results, the doctor informed me that he saw a little effusion (fluid surrounding my heart) which was interesting. He said I probably had pericarditis (inflammation of the pericardium) and it most likely has resolved. The pericarditis most likely was causing the chest pain, and I am no longer having this chest pain, so it makes sense that it may have resolved already. And he said pericarditis is very positional, which also makes sense because the chest pain would be relieved if I changed position. I am still having palpitations daily throughout the day. I find that it bothers me more when I wake up in the morning... He said treatment for pericarditis would be some kind of anti-inflammatory medication like ibuprofen.. But he doesn't think I need treatment. Other than that, he said my heart looked fine, and said nothing regarding the murmur. He ordered me a blood test to check some markers of inflammation and to wear a 30 day event monitor to see more about the palpitations, which I am now wearing.  I got blood work for sedimentation rate, rheumatoid factor, ANA, anti neutrophil cytoplasmic antibody, and C-Reactive protein. I looked at the results online and everything looks fine except for the C-Reactive protein. It says the standard range is 0.00-10.00 mg/L and my value is 5.55. It says high cardiac risk is > 3.0 mg/L. This has me very worried. The doctor hasn't sent me any messages or called me.. So I'm not sure if I should be concerned. I did some research and I read that your CRP level may be high if you have inflammation throughout your body. I'm not sure why it would be high... Maybe because of inflammation of the pericardium? I'm scared. I don't have another appointment until I'm done with the monitor, a month from now... Opinions?

[Ger57]

Hi devm,

A lot of murmurs are quite harmless. The murmur sound often comes from heart valves that show some leakage. A lot of people have these valve leakages and as long as they are not substantial, it is normally no problem and can remain stable throughout life.
If your cardiologist by listening to your heart says that it is minimal, do not expect that the echo will reveal substantial leakage. It will probably be trace or mild leakage.

It seems to me that you should try to get the anxiety under control. Except fort the murmur, everything you describe really sounds to me as results from anxiety.

There is for the moment no reason to talk or think about worst case scenarios.

take care and let us know the result from the echo, please.

[is_something_wrong]

I would try to trust the cardiologist if I were you.

I had the exact same symptoms back in 2010. My heart rate at rest were normal. My heart was structurally normal. But in response to adrenaline, the heart rate would climb to almost ridiculously high numbers. I remember when I was at the ER and the doctor measured my blood pressure. My heart rate went up to almost 210 and the blood pressure was 170/75. Exactly the same happened during exercise (probably because I developed a fear of exercising). Just walking up some stairs increased heart rate to 160 and walking up a hill sent my heart rate up to 230. I had wild variations in the heart rate (like, I could feel the heart racing just when kicking a football and it slowed down just seconds later) At that time, I started taking a small dose of beta blockers (propranolol). The change was like night and day. The problem was gone, and I started to exercise to strengthen my heart.

I was absolutely convinced that some horrible disease (myocarditis, heart failure, etc.) was the cause. I even asked my doctor to measure heart enzymes like Troponin to rule it out. Everything was, of course, completely normal.

Inappropriate sinus tachycardia is not a structural heart disease. It's only caused by oversensitivity in the sinus node towards stimuli like adrenaline. Even if the heart rate is rapid, it very rarely causes damage to the heart. Your heart rate slows down at night and during rest as it's supposed to and your heart gets the necessary "rest" so it doesn't dilate. It would be worse if you, for example, had persistant atrial fibrillation with rapid ventricular response.