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Suggest Treatment For Chest Pain And Shortness Of Breath
Question: I'm a 30 year old male, with no significant family history of heart disease and I passed a stress echo about 4 months earlier. Problem is I've been since having all these issues.
I've been in hospital multiple times for chest pain and a fast heart rate the ECGs have looked like a SVT but most think it was just a fast sinus rhythm as it was under 160 and self resolved. However recently I've been getting pain and every time I stand up afterwards my heart has been racing to speeds of 170-180 and skipping beats and settling back down on its on when resting. I've also began getting the pains more and more and even slight work now like walking down the stairs or walking to the front gate is causing pain and shortness of breath. The last time the pain was bad and the heart rate went up everytime with standing to 170 ish the ambulance came and had to help me go to the toilet and they noticed it go up quickly and then go back down when standing for a while or sitting. This time I went and had the usual tests in particular troponin I. This test has always been undetectable in me my levels under the detectable amount of 0.01 until this time when it was 0.014, they let me go as the 99th percentile is above 0.04 so mine was still too low to be any acute heat attack.
I know it's not acute but what I'm concerned about is that all of this could be from heart disease. My nanna had heart disease later in life but no sugnificant history other than thAt. The other strange things happening with me is I have had a massive elevated U wave show up everytime my heart is fast prolonging the QTC because of the u wave hospital has thought it was potassium too low but the blood tests came back perfect for all electrolytes. This is a pattern with me as is for some reason now newly inverted T waves is leads V1 and III both of these return to normal after chest pain resolves. Only pain relief that has worked is also GTN.
The other strange thing is I have had episodes where my heart is beating fast one second like 160 then drops back down to 45-50 then goes back up I can watch it do this and feel faint.
Because of the rhythm issues most doctors I've seen throw aside the chest pain and are thinking rhythm I've worn a event recorder for 2 weeks and all it picked up was several fast sinus rhythms and pauses of under 2 seconds with some PVCs one day 5 in a row like 1 beat between each.
There is no diagnosis and I'm still wearing the event recorder they are hoping to catch more but I don't believe they will. I'm concerned all of these symptoms could be warning signs of heart disease progressing also because I have been healthy until 8 weeks ago now everyday it's getting worse. I did have a pattern of exceedise induced chest pain though going back 5-6 years if I really think I know of several occasions in my job as an entertainer where I have exceeded my usual limits jumping around on stage or lifting to many things and have had the pain then until I stopped and sat down. As I said I'm concerned about heart disease and because I'm 30 they all say I'm too young and look into the arrhythmia side only, is it possible all of this could be from heart disease and what should I be asking they do to rule that out. Is a CT angiogram a good start to request.
Thanks so much in advance,
XXXXXXX
I have seen physiatrist before exploring every avenue and they seem to think something medical is causing it. I know there will be some anxiety attached to it for sure and recognise that but these pains and things have woken me up at night before. Being an entertainer I should elaborate I'm a guitarist singer but I've never been to the gym I'm not at all for in that respect, what I meant by more than usual is that I have had pains If I'm running around the stage a little more than usual. I have had a terrible diet the past 12 years of fast foods as its all that's open on the road. Also my blood pressure is usually 140/60. My biggest concern is that troponin they did a high sensitivity one also where over 14 ng is the cut off and mine was 6ng. Again higher than before on the normal troponin I where it's always been 0.01 and suddenly it's shown 0.014, (0.04 being cut off) can the slight leak be caused by anything else like anxiety maybe and doesn't that always mean there is some damage to the heart?
I've been in hospital multiple times for chest pain and a fast heart rate the ECGs have looked like a SVT but most think it was just a fast sinus rhythm as it was under 160 and self resolved. However recently I've been getting pain and every time I stand up afterwards my heart has been racing to speeds of 170-180 and skipping beats and settling back down on its on when resting. I've also began getting the pains more and more and even slight work now like walking down the stairs or walking to the front gate is causing pain and shortness of breath. The last time the pain was bad and the heart rate went up everytime with standing to 170 ish the ambulance came and had to help me go to the toilet and they noticed it go up quickly and then go back down when standing for a while or sitting. This time I went and had the usual tests in particular troponin I. This test has always been undetectable in me my levels under the detectable amount of 0.01 until this time when it was 0.014, they let me go as the 99th percentile is above 0.04 so mine was still too low to be any acute heat attack.
I know it's not acute but what I'm concerned about is that all of this could be from heart disease. My nanna had heart disease later in life but no sugnificant history other than thAt. The other strange things happening with me is I have had a massive elevated U wave show up everytime my heart is fast prolonging the QTC because of the u wave hospital has thought it was potassium too low but the blood tests came back perfect for all electrolytes. This is a pattern with me as is for some reason now newly inverted T waves is leads V1 and III both of these return to normal after chest pain resolves. Only pain relief that has worked is also GTN.
The other strange thing is I have had episodes where my heart is beating fast one second like 160 then drops back down to 45-50 then goes back up I can watch it do this and feel faint.
Because of the rhythm issues most doctors I've seen throw aside the chest pain and are thinking rhythm I've worn a event recorder for 2 weeks and all it picked up was several fast sinus rhythms and pauses of under 2 seconds with some PVCs one day 5 in a row like 1 beat between each.
There is no diagnosis and I'm still wearing the event recorder they are hoping to catch more but I don't believe they will. I'm concerned all of these symptoms could be warning signs of heart disease progressing also because I have been healthy until 8 weeks ago now everyday it's getting worse. I did have a pattern of exceedise induced chest pain though going back 5-6 years if I really think I know of several occasions in my job as an entertainer where I have exceeded my usual limits jumping around on stage or lifting to many things and have had the pain then until I stopped and sat down. As I said I'm concerned about heart disease and because I'm 30 they all say I'm too young and look into the arrhythmia side only, is it possible all of this could be from heart disease and what should I be asking they do to rule that out. Is a CT angiogram a good start to request.
Thanks so much in advance,
XXXXXXX
I have seen physiatrist before exploring every avenue and they seem to think something medical is causing it. I know there will be some anxiety attached to it for sure and recognise that but these pains and things have woken me up at night before. Being an entertainer I should elaborate I'm a guitarist singer but I've never been to the gym I'm not at all for in that respect, what I meant by more than usual is that I have had pains If I'm running around the stage a little more than usual. I have had a terrible diet the past 12 years of fast foods as its all that's open on the road. Also my blood pressure is usually 140/60. My biggest concern is that troponin they did a high sensitivity one also where over 14 ng is the cut off and mine was 6ng. Again higher than before on the normal troponin I where it's always been 0.01 and suddenly it's shown 0.014, (0.04 being cut off) can the slight leak be caused by anything else like anxiety maybe and doesn't that always mean there is some damage to the heart?
Brief Answer:
My answer is as follows
Detailed Answer:
Hi again and welcome back.
It is just that coronary artery disease is a very rare condition in your age. It is not always that you have to go to the gym for it to be revealed as a chest pain, also a fast walking episode like trying to catch a bus, or running, reveals it. If there would be a high probability of acute heart attack, chest pain should at least have been combined with dynamic changes in your EKG and, as I originally told you, troponin I should be elevated three to five fold. However, just to be completed, I would recommend you a cardiac stress test, not a stress echo, to evaluate your heart electrical system during physical stress. If it comes positive, it is only then when an angio computed tomography of the coronary arteries is recommended. In the matter of the other part, I stick to my opinion from the original answer.
I hope my follow-up is helpful.
Regards,
Dr. Meriton
My answer is as follows
Detailed Answer:
Hi again and welcome back.
It is just that coronary artery disease is a very rare condition in your age. It is not always that you have to go to the gym for it to be revealed as a chest pain, also a fast walking episode like trying to catch a bus, or running, reveals it. If there would be a high probability of acute heart attack, chest pain should at least have been combined with dynamic changes in your EKG and, as I originally told you, troponin I should be elevated three to five fold. However, just to be completed, I would recommend you a cardiac stress test, not a stress echo, to evaluate your heart electrical system during physical stress. If it comes positive, it is only then when an angio computed tomography of the coronary arteries is recommended. In the matter of the other part, I stick to my opinion from the original answer.
I hope my follow-up is helpful.
Regards,
Dr. Meriton
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
Answered by
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