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Smoker. Getting temporary loss of sensation in arm and leg. Getting variable heart rate. Concerned

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Practicing since : 1981
Answered : 922 Questions

I'm a 35 yo female, smoker, non - drinker, familial high cholesterol who has recently become intolerant to exercise. My Doc has had a neurolgist rule out Multiple Sclerosis (MRI showed a few lesions that was chalked up to migraines) as I have had several bouts of left sided pins/needles and temporary loss of sensation in my arm, leg etc. MRI incidently discovered chronic paranasal sinus disease. I have cervical lymph node enlarged for 3 years but appears benign (reactive) on ultrasound. I am asthmatic. This is my medical history ... Pretty boring, really.

I signed up for the gym and had a fitness test done by a personal trainer who sugested I follow up heart health with my Doctor because of an excessively high heart rate during warm up (198 bpm). The Doc took my pulse and blood pressure and said they were normal. This was a year ago. During that year I have had normal chest x-rays for shortness of breath. Now my Doc thinks I might have Chronic Fatigue Syndrome because he cannot find a cause for my 'puzzling' symptoms and I am currently unable to walk the dog, clean the house, without taking a break because I am breathless.

I bought a Polar heart monitor ( strap on around chest) just so that I could try to do normal activities without getting my heart rate into the 200 bpm zone and was shocked! Sitting on the couch my heart rate jumps between 95 - 145 bpm. Walking the dog on flat roads, slowly, 185 bpm. I slept with it on to get a true resting heart rate upon waking and it was 111bpm with an overnight average of 95 bpm.

The sleep study I had suggested mild hypopnea (NOT apnea) and sometimes I faint. Admitedly, I am unfit but this is ridiculous!

My husband wants me to ask my Doc to do a stress test - but I'm worried that he is tired of my complaining about a raft of symptoms.

Should I be concerned or should I just keep going, ditch the heart monitor, and rest when I feel light headed or puffed out?

Current meds:

Diane-35 ED (Bith control/ Acne)
Ventolin (Symbicort preventative but hate using it so often miss doses)
Rarely Paracetemol

Posted Sun, 4 Nov 2012 in Smoking and Alcohol Addiction
Answered by Dr. Anil Grover 1 hour later
Hi there,
Thanks for writing in.
I am a qualified and certified cardiologist.
As normal person on activity maximum heart rate you can achieve is 185 (220-Age). Provided the rate is sinus (beats are like normal beats) there is no problem.
There I would agree with you to ditch the monitor you are using.
Drugs for asthma can increase heart rate without exercise.
I am not sure of diagnosis of chronic fatigue syndrome, however, that is all I can say without doing thorough clinical work up in person.
You want to join gym then I would go with your husband's suggestion of stress test test it can be pharmacological stress radionuclide study or stress echo and a HOLTER examination (that will clear all the doubts about your having arrhythmia of heart) where you will not have to exercise and your fitness will be known. Vegetarian diet is good and can include eggs but avoid yolk part of it.
Good Luck, if you have any followup query I will be happy to answer it.
With best wishes.
Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by
Follow-up: Smoker. Getting temporary loss of sensation in arm and leg. Getting variable heart rate. Concerned 3 hours later
I understand that a normal maximim heart rate is 185 (220 minus age of 35) but my problem is that I exceed that often without making any effort. If I were to exercise then my heart rate would be well into the 200 range and I would not have to try very hard.

Just walking I can reach maximum heart rate range. 3 minutes on a stationary bike without exertion and my heart rate is too high! I feel dizzy and wobbly after 5 minutes.

Which stress test is best and what happens after I fail it?

Thanks for answering, sorry to bother you with this.

Answered by Dr. Anil Grover 1 hour later
Thanks for writing back. I am baffled by your saying 'sorry' for MY failing to make my point understand. That is my job and I did not do well in that.
I had added with exercise and normal beats in my first reply. As you are getting this rate rather frequently and inappropriately (that is without stimulus of exertion and assuming these are normal beats that is why suggestion was Holter examination) your provisional diagnosis is Inappropriate Sinus Tachycardia. First and foremost cause is hyperthyroidism, an easily treatable condition, I hope that has been excluded.

To your question, which stress test is best, I would say for you Holter examination should precede stress test. That will confirm the rhythm diagnosis of inappropriate sinus tachycardia. Thereafter, let your cardiologist decide. In my personal opinion combination of treatmill and radionuclide is best. If you are afraid of exercise then pharmacological radionuclide stress test is best.

You do not fail or pass test. Idea is to achieve a rate pressure product (your blood pressure -systolic the upper one multiplied by heart rate) of more than 22,000 if that achieved your heart does not show any signs of ischemia (mismatch of demand of a part of heart for blood and supply it receives at peak stress) you are not likely to have coronary artery disease is the conclusion. That is expected in you despite your having few risk factors like high cholesterol. That will leave no puzzling doubt in physical trainer or doctor's mind to decide your suitability of joining and working in gym. It looks unlikely but if the reports suggest otherwise (like all tests there are false positives) a cardiologist will take a decision based to all the factors a) whether to allow you joining the gym but limiting exercise or giving drugs to regulate rate b) or to go for further tests like CT coronary angio which I think is very remote possibility in you. (for the simple reason when your heart rate is around 200 you had already achieved rate pressure product of more than 0000 and there is no chest pain or shortness of breath occuring simultaneously based on what you have written about). Then there are absence of risk factors like obesity, being a lady above 45. Only point which concerns me is your being smoker. So, please fix an appointment with a cardiologist and get rid of this stress of being labelled "unfit". Good Luck. If there is any more question, I will be only too happy to answer.

Dr Anil Grover
Above answer was peer-reviewed by
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