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Stent placed in lad. What is causing pounding heartbeat?

DOCTOR OF THE MONTH - Jan 2013
Jan 2013
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Answered by

Internal Medicine Specialist
Practicing since : 2003
Answered : 1658 Questions
Question
I am taking 2.5 Ramapril, 2.5 Bisoprolol, 10 Prasagrel. I had a STEMI July 12, got emerg stent in LAD. Trop was .25 (it was .01 4 days later). T was inverted until ECG on 09/19/2012 then resolved to normal ECG. What causes sensation of pounding heartbeat on occassion? Is the the ACE and Beta blocker meds? It seems to get worse prior to taking daily dosage. I can internally sense beart beat all over body. Sometimes hot flush sensation as well feet to ears. Also taking Atovastatin (Lipitor)
Posted Mon, 22 Oct 2012 in Heart Attack
 
 
Answered by Dr. Mayank Bhargava 1 hour later
Hi XXXXXXX,
Thanks for posting your query.
What is your blood pressure before taking medicines and after taking medicines?
History of IHD with presence of palpitations indicates involvement of conduction system of heart with persistence of arrhythmias.
Do you have normal ECG or have some abnormality?
Although you are on safer side after application of stent in LAD but presence of arrhythmia is not good sign.
Ishcaemic heart disease (IHD) may involve heart muscles or may involve conductive system of heart by which impulse generated in SA node is conducted up to ventricular muscles.
ACE inhibitors and Beta blockers are best medicines and not associated with this side effects.
Arrhythmias may be APCs, VPCs, ventricular bigeminy/ trigeminy, AV blocks and the exact diagnosis can be made after ECG examination.
Palpitations are some time life threatening and may cause doom feeling in body.
You should consult with physician and should go for ECG, holter monitoring, electro-physiological studies of heart.
Atorvastatin is a better drug and it not only controls your lipid derangement but also stabilize the plaque.
Put your query if you have.
Best regards,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: Stent placed in lad. What is causing pounding heartbeat? 34 minutes later
My Sept 19 ECG said Sinus bradycardia (55bpm) Otherwise Normal ECG.

ECG in Aug said "T wave abnormality consistant with Antereolateral ischeamia"

I have no arrythmia, just a pounding heart beat occasionally.

Holter monitor in Aug was without comment or issues.
My BP historically was close to normal. with meds it typically shows 110/75 pulse approx 60
 
 
Answered by Dr. Mayank Bhargava 19 minutes later
Hi,
You may get sinus bradycardia due to Bisoprolol and you should consult with cardiologist regarding dose of Bisoprolol.
Although your ECG was showing T wave inversion but now it is normal.
Absence of arrhythmias with normal holter monitoring indicates that you may have panic attacks regarding your MI.
You should also consult with psychiatrist if you are perfect from cardiologist point of view.
You can take low dose SSRIs for relief of your symptoms.
Take care,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: Stent placed in lad. What is causing pounding heartbeat? 54 minutes later
Could the combination of bradycardia (Beta Blocker) and lowered blood pressure (ACE inhibitor) cause the sensation (and tingling) of a pounding heartbeat (without arrythmia).

I am assuming the ECG printout saying normal ECG is correct since the previous ones all indicated T wave abnormalities.
I am an engineer, so I spend a lot of time sitting down. The sensation of poundiing heart doesn't seem to happen when I am moving around. Seem to happen only when lying down or sitting. Is my circulation moving too slowly? Sitting up seems to make me feel better sometimes.
 
 
Answered by Dr. Mayank Bhargava 9 hours later
Hi,
Yes....presence of low blood pressure may cause your described symptoms but as you have mentioned previously "It seems to get worse prior to taking daily dosage", it indicates that you have all symptoms before taking medicines and your condition is improving after taking these medicines.
If you are in sitting/ lying position, then you are in relax conditions.
Cardiac conditions gets worse during exertion so your symptoms are not correlating with cardiac disease.
You should consult with psychiatrist.
Take care,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: Stent placed in lad. What is causing pounding heartbeat? 9 hours later
Dr. Bhargava

You have been very helpful. Getting these simple questions answered by my GP or cardiologist is impossible. They never have the time to explain what is happening. I trusted my heart for 50yrs lived healthy, was active and pretty fit. It let me down non the less. I had MI right after playing ice hockey.

Some of the meds i take suppress appetite and mask hypoglycaemia (according to my searches). I don't eat as much as before and have lost 17 lbs since my heart attack of 12 July (I used to be 207lbs now I am 190). Your thoughts?

XXXXXXX
 
 
Answered by Dr. Mayank Bhargava 1 hour later
Hi,
I think you lost your weight because of restricted diet after MI.
Kindly let me know to which drug, you think for the cause of anorexia.
You should take fat free high fibre diet and should live tension free life.
At the most, you have to ive a long life.
Thanks,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: Stent placed in lad. What is causing pounding heartbeat? 1 hour later
Dr

The drugs I have been taking daily 2.5mg Bisoprolol, 2.5mg Ramapril, 40mg Atorvastatin, 81mg ASA, 5mg Warfarin (INR of 2.5 measured weekly). 10mg Effient (prasagrel).

Maybe bisoprolol affecting appetite? There were no activities or dietary changes recommended after MI. My diet has always been reasonably healthy.

If I uploaded the 3 different 12 lead ECG's Taken July 26, Aug 22 and Sept 19 could you give me your opinion? I understand that ECG is only part of a prognosis and not a complete picture.
 
 
Answered by Dr. Mayank Bhargava 1 hour later
Hi,

So if you are thinking about Bisoprolol then you should consult with your treating doctor and should take another beta blockers.

Yes...kindly send your ECG details...its my pleasure..

Dr.Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: Stent placed in lad. What is causing pounding heartbeat? 17 minutes later
Thank You Dr

I have uploaded 3 ECG's. Dated July 27th, Aug 22 and Sept 19. I had my MI on July 12.

Your interpretation is most welcome....
XXXXXXX
 
 
Answered by Dr. Mayank Bhargava 18 hours later
Hi,
I have seen your ECG sequentially and they showed progressive conversion of inverted T waves to positive upright T waves.
Aug 2012 ECG showed both upright and inverted component while July ECG showed negative inverted component.
Sep 2012 ECG was fine with normal appearance except bradycardia.
Now your heart is working fine, yet you should consult with treating doctor for loss of appetite and bradycardia.
Take care,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: Stent placed in lad. What is causing pounding heartbeat? 26 minutes later
Dr Bhargava

That seems like good news to me. If my heart appears normal, in your opinion does that imply that the MI did not cause significant permanent damage (stunning vs significant necrosis)? Or that the any scarring that exists does not affect the electrical aspects of the heart. And may or may not affect the performance (Ejection Fraction).

The stent needs prasagrel for another year regardless and 81mg ASA and ATORVASTATIN helps and doesnt hurt, if I am not mistaken.

I hope the ACE and BETA blockers can end sooner rather than later. Maybe the bradycardia and anorexia goes away with these.
XXXXXXX

 
 
Answered by Dr. Mayank Bhargava 12 minutes later
Hi XXXXXXX
It appears that your MI was minor with lesser amount of damage or you can say "Better treatment at right time saved your heart".
Scarring can be detected by Thallium scan and Ejection fraction can be detected by 2 D echo.
Scarring is not involving your electrical aspects right now but there is as such no guarantee for future....so you should be aware and take precaution with proper medicines.
Prasugrel is essential for you.
Get well soon,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: Stent placed in lad. What is causing pounding heartbeat? 17 minutes later
Dr

I had the MI right after playing ice hockey (1AM in the morning), i was in the XXXXXXX lab in about 60 min (2AM). So i guess it was good timing. The stent went in the LAD just below the 1st perforator what ever that means (Dr called it a widow maker afterwards).

Thanks very much for your professional expertise. I am reassured that i might be somewhat ok.

Thanks from Toronto
XXXXXXX
 
 
Answered by Dr. Mayank Bhargava 3 minutes later
Hi XXXXXXX
Thanks for your positive feedback and taking participation.
Take care,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: Stent placed in lad. What is causing pounding heartbeat? 9 days later
Dr

How long do you think I should wait before starting any kind of cardio rehab. My cardiologist is uninterested in communicating with me any meaningful followup. So I am kind of on my own at this point. My MI was July 12/12.
XXXXXXX
 
 
Answered by Dr. Mayank Bhargava 7 hours later
Hi XXXXXXX

If you are not feeling pounding heartbeats & other heart related symptoms and your ECG is already normal (as previously mentioned), then you can perform daily routine activities.

Daily activities are required for maintaining normal heart activity.

Regaining routine activities (progressively) are also advised 24 hours heart attack.

Take care,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
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