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Heart & Cardiology/ECG changes and symptoms

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Question
Please help me if you can.I am feeling very confused and scared at the moment. I would really appreciate any advice.
I have always had the odd palpitation since I was a teenager. I wasnt really that bothered by them until I had a horrible life changing experience when I almost died from a torn spleen in a gynae related op 18 months ago.

Since then I have had moments of extreme panic. In fact, I would say it's daily moments of panic. I at times live in complete terror thinking I am going to die. I was diagnosed with PTSD and have been getting therapy for it. I also take citalopram.

My 'flutters' and big 'thuds' really were upsetting me, and I was feeling light headed more and more, so I got an echo done aswell as a 24hr ecg. These are the basic results:

ECHO:
'Left Ventricle on the upper limits of normal. Good systolic function. Right Ventricle normal. All normal widths and walls.
24 HR ECG:
'Sinus rhythm with fairly frequent periods of sinus tachycardia, 1 was prolonged. Unifocal ventricular ectopic beats were detected.They occured frequently at times including 414 episodes of trigeminy,the longest being 604 cycles at 23.37hrs. There was a marked increase in frequency during the nocturnal period.Aberrant total: 5000. Premature aberrants: 928.'
'No arrhythmia documented. Frequent unifocal ectopic beats. No treatment required but an echo is useful to rule out structural heart disease'.

That was back in January. Now I am experiencing chest pains which feel sharp in nature, and a lot of dizziness.... for example last night I was reading my daughter a story lying down in her bed when I felt a wave of severe lightheadedness like I was about to pass out. I bolted upright in a panic as I didn't want my daughter to see me black out. I lay back down, and the same thing happened again. I then felt pins and needles in my whole face and couldn't stop violently shaking.

This severe lightheaded spell happened last week also, but this time I was in a public play area with my daughter. At that time, I felt very lightheaded all of a sudden, and a wave of warmth came over me and I thought I was going to collapse. My heart rate was incredibly fast and took a long time to calm down again.

Every time I have seen a Dr about this they say that they don't know what's going on. The only thing that has changed is I keep showing T wave inversions on Lead III for the past 4 weeks and at times on leads avR and V1 I think.

I have just had a 72 hr holter monitor and am waiting for the results now.

Should I have another echo? My last one was in Jan.

I am very, very scared about this. My resting heart rate is always tachycardic and can often shoot up to 130bpm with minimal exertion.

Why am I feeling so tight chested? Why am I getting Short of breath (sometimes I have to gulp for a breath)? Why have t wave inversions appeared in my ECGS all of a sudden?

The GP wants me to try a beta blocker, but propranolol caused me breathing problems and a heaviness that I am scared to try another.

As I type this I feel fatigued, light headed and tight chested.

Please, any advice would be so much appreciated.

Charlotte
(Im 29 year old female. 14lbs overweight, mother, other than laparotomy to repair spleen and ITU admission- good health, PTSD and anxiety since Sept 2011 ).

Answer
ello Charlotte,

As you know, premature beats 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 cardiac catastrophe.

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.

Lightheadedness can be caused by overbreathing.  Pay attention to your breathing and breathe slowly and shalowly and see if that helps.  Overbreathing commonly causes pins and needles in fac.

T inversion in III, R and V1 is usually normal and can come and go with breathing.

Please write back if this note 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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