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Hashimotos thyroiditis, breathless, tiredness, thickening on mitral valve, first degree heart block, bradycardia, took cardiac echo

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Cardiologist, Interventional
Practicing since : 1996
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i am a 34yr old female, approx 7st, bmi 18, with a 2yr history of hashimotos thyroiditis - this appears to have resolved itself and i am not on any medication now. i have been c/o feeling breathless, though not out of breath as if i am puffed out, just v aware of my breathing. i am also very tired. i have had a cardiac echo which showed heart valves structurally and functionally normal except for a slight thickening on the mitral valve - i am not sure what this means. 2yrs ago i had the same test and at that time they said i had a leaky mitral valve but it was nothing i needed to worry about. do these findings mean the same thing or does it show that there is a deterioration? i did the scary thing and googled mitral valve thickening/prolapse and it said that people with this have a 15-20% higher mortality rate and also mentioned sudden death. i am now very worried as i have two v young kids and am feeling scared as to what may happen. my 24tape showed a normal sinus rhythm with a first degree heart block, (slightly longer than average delay between the atria and ventricle). there was one episode of bradycardia lasting 4beats going down to 42bpm in the middle of the night. no dropped beats or pauses. there were very occasional ventricular ectopics. they say none of these findings need any specific treatment of further investigations. this tape was just a 24hr tape however i don't feel it captured my original concern of feeling my heart suddenly, for no obvious reason, start to beat very hard and when i feel the pulse in my neck it is very strong however, i seem to feel the 'echo' of this beat just as strong straight after in my chest, then i feel another pulse in my neck and straight after the same intensity in my's like i only feel one beat in my neck pulse and then the second in my chest before it repeats again...i do not know what this is. it is making me feel very concerned about what it happening. my gp is going to ask for another tape of tape where it only records my symptoms although i am not sure how long this will take to arrange.
thank you. mrs XXXXXXX
Posted Fri, 4 May 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 7 hours later
Thank you for your query.

The palpitations that you are feeling (the neck pulse and the chest beat) is due to occasional irregular heartbeats, most probably ventricular ectopics. The event recorder which your physician is planning will confirm whether this is so.

The heart is a muscular pump and the different chambers beat in co-ordination at a rate determined by electrical impulses which originate repetitively and regularly from the sinus node. This electrical impulse spreads throughout the heart using specialized conduction pathways and ensures the co-ordinated response from the heart muscle. However, sometimes, electrical impulses arise from other parts of the heart and these are called ectopic impulses.

Since these ectopics arise "out of turn" and conduct through the muscle in a different manner, these usually result in a less powerful, though earlier than usual muscular contraction. This change in rhythm may be felt in your chest. Following this, there is a very brief pause, as the original electrical pulse could not conduct properly and the heart muscle has to wait for the next electrical pulse. During this time, extra blood fills the heart and the next beat after the pause is extra-forceful. The strong pulse that this contraction generates is probably felt in your neck as a strong pulse as the blood is pushed more powerfully up the arteries.

You should understand that most types of ectopic beats are benign and do not result in any major harm. However, there are certain types of ectopic beats that can trigger another arrhythmia - either supra-ventricular or ventricular- which may be more serious.

It is therefore nice if these ectopic beats can be documented by ECG and correlated with your symptoms.

It may be difficult to pinpoint a cause for the ectopics. Since you had Hashimoto's thyroiditis, it is necessary for you to re-check your thyroid function tests and ensure that you have not become hypothyroid.

Certain other lung conditions like bronchitis and use of broncho-dilators can cause ectopics. Since you do complain of occasional breathlessness, it may be wise to check your lung function as well with a chest x-ray and pulmonary function tests.

Excess of tea or coffee, anxiety, sleeplessness are some of the other causes, which can be easily addressed.

Mitral valve prolapse has also been associated with arrhythmias. However, since your recent echo has shown a structurally normal heart, I dont think you need to worry too much on that count. Minimal thickening of the mitral valve can be found as normal variations, as also mild degrees of prolapse, especially if you are thin built and have a reduced antero-posterior chest diameter. There is really no increased risk for such patients.

Sensitive echocardiography machines do detect very trivial leaks which are not of functional importance. If the leak across the mitral valve is significant, then you may need some treatment.

I wonder if you have been put on some beta blocker drugs as treatment for mitral valve prolapse, since that could result in a "first degree AV block" as reported in your ECG.

For now, my suggestions would be
1) Get your event recorder done and upload the results
2) Get a thyroid profile done
3) Get a chest x-ray and pulmonary function tests done
4) Avoid stress, reduce tea/coffee, get a good night's sleep
5) Try to take a nutritious diet and walk for half an hour every day as exercise

Usually, simple ectopics do not need any drug treatment. However, if any high risk features are seen, there are effective drugs to treat them. Very rarely, they may need to be treated by Radio-frequency Ablation or other semi-invasive procedures.

I hope this answers your query. Feel free to contact me again for any further clarifications

With regards,
Dr RS Varma
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