Question: Hi, I am 35 yr old male weigh 65 kilos, height 5’5”, waist 34”, unexpanded chest 38”, unmarried, veg except egg and milk, no butter and fats , rarely oily food, never processed food, no caffeine for last three years. Was little bit of smoker and rare drinker for few years, but before 2008, never after that. Like to be fit used to do light weights but out of that for last almost one year. Used to have acid or gas for almost 15 years taking ranitidine only when required and it relieves, but no such issue for last over two years. For more than last 10 years I occasionally felt some pinch on left center chest, sometimes it felt on muscle going to left arm sometimes I was totally confused but as I used to do exercise so it never bothered. Few times felt dizzy when sit up or get up from bed. Few times on bed felt like I am on water. Sometimes, blood vessels anywhere on my head felt fluttering in rhythm with heart beat, some strain or pain also. Use to occasional muscle pull or strain. But I was never bothered as these feelings rarely occurs and are only for a day and I am living with these for many years and are common to many peoples and can be related to sleep, environment or food.

10 days back while on bed I felt sudden strain on left backside of neck thought due to watching TV in wrong posture so went to sleep, next early morning 3:30 am I woke up, Oh my God, my heart pounding hard and I am feeling it, counted heart beat it was 70 bpm, tried to sleep but not able to. And also my neck strain was totally gone. During the day normal routine, job I felt nothing weird and forget what happened in the morning. Next night, after few minutes of falling asleep, I woke up again with same pounding. I arranged bp monitor measured my bp heart rate all fine, after trying hard I felt asleep again but woke after few minutes with same feeling. This happened four times that night every time I checked my stats below 120/80 mm 80 bpm. Obviously next day I was nervous for it, I felt it whole day.

In the evening while driving home I felt like decreased sense of surrounding. I reached home checked my bp it showed 167/101mm, I went to physician he checked my BP 150/100mm. He said its anxiety or something you have eaten. He gave me tablets containing Amlodipine, Atenolol and Alprazolam. I have taken one dose of it that night and had really good night sleep no issue. Next morning bp normal, so skipped the dose. In evening went to the cardiologist, he checked my bp 170/100 mm (I must tell you that I was nervous at that time thinking of the outcome). He did ECG, 2D Echo and Troponin T, all perfect. He prescribed me tablet composition :- {Telmisartan(40 mg),Amlodipine(5 mg),Hydrochlorothiazide(12.5 mg)} and alprazolam. And schedule a TMT (stress ECG) after five days if my BP comes to normal. I took the medicines and on fifth day went for TMT. On that day my BP was 130/80mm so they did TMT whose outcome is as:-

“Mr. ------- exercised for 06 min and 33 sec on XXXXXXX Protocol. The resting heart rate was 106 beats/min and resting BP was 130/80 mmHg. Baseline ECG did not show any significant ST–T changes. He achieved a maximum heart rate of 202 beats/min, which was 109% of age predicted maximum heart rate. The blood pressure response was normal (Maximum BP achieved 160/90 mmHg). He achieved a workload of 7.63 Mets. The reason for termination of test was achieved THR and Breathlessness. There was no angina. No significant ST-T change was noted during exercise or recovery period. No significant arrhythmia was seen.

FINAL IMPRESSION

1- Treadmill test is negative for inducible ischemia at moderate workload.

2- Normal BP response

3- Fair exercise tolerance”

After seeing this cardiologist said young man go enjoy your life and continued me with same medicines excluding alprazolam.



Now my concerns are:

i) As my family doesn’t have hypertension history, why it happened to me at this early age.

ii) My eating habits are healthy, I am quite active, nothing happened to trigger anxiety.

iii) After this incident pounding feeling is almost continuous

iv) My HR during day is always above 110 bpm in night while lying on bed it is around 80 to 90 bpm, but my BP is under control taking medicines.

v) I feel pain in my left back, tingling in left arm, pain in neck. Sometimes pain beneath lower left ribs, jaws.

vi) Lying on one side creates stress on other side.

vii) Strain here and there.

viii) Feeling of like air bubbles release in my blood vessels here and there.

ix) Pain in left leg and left knee.

x) While driving jerks are now felt in my left chest.

Any Suggestions?

Do I need to anything more?

Thanks Doctor for the reply.
Well I never suspected any cardiac cause. And anxiety never had such thing. But since all this started with heart that’s why I am here. Going to investigate what you have suggested. Can you guide me further with respect to my following concerns:
I forgot to mention that my younger brother had undergone Bentall Procedure two years back due to aorta dilation, almost on death bed, he is alright now. But please note that he is having something called Marfan’s Syndrome, he looks totally different, at 6’3” and 48 kgs he is way taller and thinner than our family average of 5’4” and 60 kgs. Other than him no one in my blood relatives of over 40 members is having this syndrome or early age hypertension. My mom, dad, sister and I all have healthy BMI, and had healthy phase so far. Even after this incident I never felt weak, maybe dizzy two three times.
After three days of seeing cardiologist I have tried to check myself by exercising little hard and checked my BP. On the first day my BP XXXXXXX alarmingly to 201/130 mmHg, but after that I didn’t noticed such high reading and even had a TMT (all these while on medication TELMA AMH 40mg). Infact while exercising all my symptoms go away and I feel quite fine. Is this concerning?
Last night I woke up again with these pounding feelings but this time strong numbness in left arm clearly felt blood supply to left arm was blocked, and started flowing when woke up. Checked my BP 115/75 mmHg 80 bpm. Took half tablet of alprazolam 0.25 mg and slept well.
You have mentioned some spinal test so please know that two months back I suddenly have sharp pain for few seconds like electric shock on left back on two consecutive days while changing body posture but not after that, does this mean anything?
Why many time BP monitor reports abnormal heart beat, mostly in mornings?
Why sometimes pinch and heaviness is felt on left chest?
All my symptoms that I mentioned in the last section of previous post actually appeared after this incident. So is there any chance that these are side effects of medicine I am taking?
Thanks & Regards
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