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Heart & Cardiology/Miriad of heart symptoms

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Question
Hello,

22yr old male / 5'11" / 195 lbs / normal to elevated blood pressure.

I have had many cardiovascular symptoms that doctors don't seem too concerned about.  would like you expertise on my symptoms listed below:

1) Bradycardia - Low 50's, high 40's. (not particularly active)
2) heart palpitations - skipped beats, PVC's etc. Usually at night before bed.
3) Pulse is very visible in carotid arteries in neck.
4) Head seems to be bobbing with my pulse.
5) When I get up from a lying down position, my heart rate is still slow, but it bets very hard. It does not seem to speed up until Im up for about 15 seconds. This is when my pulse is REALLY visible in my neck.
6) sometimes chest pain around heart, it seems more like musculoskeletal pain, but not sure.
7) just seems like my heart is always beating HARD, not fast, just hard.

Testing: I had an echo back in January of 2012 when the chest pain popped up. It showed slight left ventricle enlargement, but otherwise my heart was "fine." Stress test normal, holter normal, and event monitor normal. These other symptoms have popped up since that last echo.

I am worried about something like aortic regurgitation (because of head bobbing), and the fact that my pulse is quite visible in my carotid arteries also has me concerned. Could the enlargement of the left ventricle be an early warning sign for something like heart failure? Am I at greater risk for developing cardiac arrest? I've had a whole bunch of weird sensations and heart problems. What else should I have tested? I'm quite concerned. Thank You.

Answer
Hello Evan,

1.Lower limit of normal for  heart rate is 45 awake, 35 asleep.  The slower the heart the longer the life.
2.  Skipped beats and PVCs are normal heart activity, easy to understand as normal from knowledge of the heart's electrical system and occurring in about half of us.  They don't mean you have heart disease or will in the future develop heart disease or any catastrophe.
3. See 5 below.
4. Your Head bobs because slow pulse means each beat is extra big so as to keep the volume of blood pumped per minute adequate.  
5. Visible puse in neck is from same reason.  Big volume of blood pumped with each beat.
6. Chest pain in a young person is usually cramping of muscles in the chest wall.  If pushing on the painful area modifies the pain (makes it better or worse), or if the pain is relieved by bending the body away from the painful area, that proves the pain is from chest  wall.  Even if these maneuvers donít affect the pain, itís still probably chest wall.  Pain caused by narrowing of the coronary arteries that supply blood to the heart is extremely rare below age 40. Chest wall pain is no threat to life or health, just a big nuisance.  Safest management is just to ignore the pain, though Tylenol, aspirin or ibuprofren usually help.
7.  Yep, it is beating HARD because of your slow rate.

Echo would have shown aortic regurgitation.  The slight enlargement of the left ventricle is also the result of your slow rate.  The left ventricle fills with lots of blood during the long pause between beats.  You are at less-than-average risk of heart attack or cardiac arrest.  In my opinion you need not be concerned.  No further testing is needed.

Please write back if this doesnít answer all your questions.

David Richardson

Heart & Cardiology

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David Richardson

Expertise

Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.

Experience

Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Organizations
Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Publications
Circulation, American Heart Journal, Hypertension.

Education/Credentials
M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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