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Worried about abdominal aortic aneurysm due to stomach pulse. Heart palpitations, back pain, no abdominal or chest pain

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Practicing since : 1993
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Hi there -
40yo, male. 6 feet, 190lbs. Former competitive athlete (more than 10 years ago). No previous health issues and no family history of anything serious. Been under a lot of chronic stress. Have a current diagnosis of anxiety disorder and high blood pressure. Went to ER fearing a heart issue, turned out to be an especially bad panic attack. BP measured as high as 170s/110s in white coat situations (ER that day), but also as low as 140s over 90s the same day. Saw a GP, was given a selective, slow release beta blocker, just 25mg/day. In one week, my BP is down to 122/85, pretty consistenly in 120s over 80s, resting heart rate 60. Can walk 8 miles briskly w/ heart at 120, no issues. Recovery factor (the # by which heart rate goes down in 60 seconds after exertion) is between 30-40. Manual exam w/ stethoscope does not show any murmur, gallop, etc. ECG 100% normal, so they don't even think the left wall of my heart has thickened, as it happens to athletes. Or if it had, it isn't that way now. Chest x-ray normal. Blood and urine all ok. Overall cholesterol under 200. No anemia, etc. Liver, kidneys ok. Only some vitamin D and magnesium deficiency, which I'm now supplementing. So I was ready to consider this my "medical clearance" to go deal w/ the anxiety and accept that all the physical symptoms result from somatizing anxiety. However, in this same period (last few weeks), I've had trouble laying on my stomach (which is how I normally sleep) and on either side. This has cased significant sleep disturbance. It causes heart palpitations. No racing (only goes from 60s to 70s, low 80s max) but heart seems to beat "harder" and there's also a stomach pulse. I can mechanically reproduce this regardless of my mental state, any time of day. I should mention that I've been losing weight very slowly and successfully after I turned vegan 6 months ago after a lifetime of standard American diet. Never go hungry, but all those XXXXXXX vegetables and fiber have been causing me to lose weight, as it happens to a lot of people who go vegetarian. I quit all animal products and supplement vitamin B12 in addition to magnesium and vitamin D now.

So now I'm really worried about AAA (abdominal aortic aneurysm) due to the stomach pulse (which is occasional and only happens during the heart palpitating/beating harder sensation) and some lower back pain, though the back pain has very good alternative explanations, does not radiate, and I have no other risk factors (never smoked, etc.) other than the higher BP which is now under control. No abdominal or chest pain of any kind. But I can't even press on the abdomen (or lean forward while eating fast, or tighten the belt) w/o getting these symptoms. So far, my GP has not even advanced a theory about this abdominal and thoracic sensitivity other than saying "anxiety" and something related to the vagus nerve. I know the vagus nerve extends up when you lie on your stomach and may be understimulated and thus cause the heart to beat harder. I know that when you lose a bunch of weight, you may get a stomach pulse. I know that when your heart rate / BP go down, the receptors in your carotid can speed up your heart artificially. But why is this happening now and why won't it go away in weeks despite the now normal BP? If I lie on my stomach at any time, my heart starts going hard within seconds. Shouldn't the stethoscope and manual exam (pressing/feeling) of the abdomen have revealed something if there's an aneurysm? Could the stomach pulse be due to anything less ominous? Do I need to get an ultrasound? What is the likelihood that I have AAA? Thanks in advance.

Posted Sun, 29 Apr 2012 in Hypertension and Heart Disease
 
 
Answered by Dr. Shainaz Arif Kaware 2 hours later
Hi;
Thanks for your query.
The overall history what you have posted looks like anxiety.
The only abnormal thing was probably your high BP which has now settled with help of medicines(betablocker).
I am glad that all your blood reports and urine are normal.
Even the cholesterol is under control and since you have shifted to a vegeterian diet you also lost some weight which is good.
The harder heart beats you feel is due to palpitation.
With a stethoscope examination it is not possible to diagnose an Aortic aneurysm as the abdominal aorta is quite XXXXXXX
The stomach pulsations may just be a exaggerated pulsations felt due to anxiety and nothing serious.
As far as getting an ultrasound done;well if it is possible for you please get it done.
The reason is that once you find that there is no Abdominal Aortic aneurysm you will feel relaxed and as a result your anxiety will reduce.
As for the likelihood of having an Abdominal Aortic Aneurysm I guess the possibility is not there(as seen from your history).
So please relax.
Hope I have answered your queries.
Please accept this answer in case you don't have any further queries.
Take care.
Regards
Above answer was peer-reviewed by
 
Follow-up: Worried about abdominal aortic aneurysm due to stomach pulse. Heart palpitations, back pain, no abdominal or chest pain 3 hours later
Thank you for your answer. I will get the ultrasound done but b/c of doctor's schedules, it's going to be another 2 weeks. I don't want to live w/ this fear for 2 weeks if someone can reassure me sooner. It's become very disruptive. Cannot sleep at night, partially b/c of anxiety, partially b/c I can no longer lie on my stomach which makes it hard to fall asleep, and partially b/c in my sleep, I roll over to the side or on stomach and the palpitations start and wake me up.

I realize you don't have a crystal ball and don't even get to examine me physically, but I'd just like to understand scientifically why you say "the possibility is not there" based on my history. Is AAA rare in general or at 40? I did have high BP, probably for a few years. No other risk factor according to my reading. Also, I read that the stethoscope would hear a "swooshing" sound if there's aneurysm which it did not. There's no bulge I can feel but that doesn't mean anything. If not AAA, what's your best explanation for the stomach pulse and the occasional stomach "twitching". Even if that's all somatizing anxiety, how do you explain the lying on stomach / vasoconstriction thing? Again, I can mechanically reproduce palpitations at will at any time and every time by lying on stomach, in seconds, while BP is normal. Even while on Ativan. How do you explain that? And how do I sleep at night again? I need to eventually be able to lie in a position other than on my back. Many thanks again!
 
 
Answered by Dr. Shainaz Arif Kaware 5 hours later
Thank you for your answer. I will get the ultrasound done but b/c of doctor's schedules, it's going to be another 2 weeks. I don't want to live w/ this fear for 2 weeks if someone can reassure me sooner. It's become very disruptive. Cannot sleep at night, partially b/c of anxiety, partially b/c I can no longer lie on my stomach which makes it hard to fall asleep, and partially b/c in my sleep, I roll over to the side or on stomach and the palpitations start and wake me up.

I realize you don't have a crystal ball and don't even get to examine me physically, but I'd just like to understand scientifically why you say "the possibility is not there" based on my history. Is AAA rare in general or at 40? I did have high BP, probably for a few years. No other risk factor according to my reading. Also, I read that the stethoscope would hear a "swooshing" sound if there's aneurysm which it did not. There's no bulge I can feel but that doesn't mean anything. If not AAA, what's your best explanation for the stomach pulse and the occasional stomach "twitching". Even if that's all somatizing anxiety, how do you explain the lying on stomach / vasoconstriction thing? Again, I can mechanically reproduce palpitations at will at any time and every time by lying on stomach, in seconds, while BP is normal. Even while on Ativan. How do you explain that? And how do I sleep at night again? I need to eventually be able to lie in a position other than on my back. Many thanks again!
Replied by Boston06 , 6 hours ago
Doctor's reply to question above...
Hello;
Thanks for reverting back.
I would like to reassure you that abdominal aortic aneurysm is a rare condition as such and is even rarer at the age of 40 years. Further, AAA does not commonly present with the symptoms that you are describing. Abdominal aneurysm is seen in the age group of 60-75 yrs. The causes are smoking, atherosclerosis, connective tissue disorders and trauma, so even you don't have that history. These are the reasons why I said there are less chances or no possibility for you to get Abdominal aortic aneurysm at present.
As such, the abdominal aorta is a large blood vessel and runs upto the middle part of abdomen.
During periods of stress or excitement, you will notice an increase in heart rate so if the heart beats faster, the arteries will also pulsate. Being a bigger artery you feel the pulsations more.
Secondly pulsating of abdominal aorta is more noticeable in lean people, and since you have been an athlete, I guess you are fit and not obese.
This can be the possible explanation for the pulsations in your abdomen.
Like you said, you can produce the palpitations mechanically, let me tell you that anxiety and panic attacks can mimic and even produce such symptoms.
Rest assured that you do not have any major problem like an aneurysm and the symptoms are all suggestive of anxiety. Some XXXXXXX breathing, relaxation exercises and yoga will help relieve your symptoms.
The reason you can't lay on your stomach may be that you get anxious due to pulsations when you lie on abdomen.
Please consult your treating doctor and discuss your problem, if needed he may add or change some medicines and you should do fine.
Hope this answer is helpful to you.
Please accept this answer if you don't have any further queries.
Wishing you good health.
Regards
Above answer was peer-reviewed by
 
Follow-up: Worried about abdominal aortic aneurysm due to stomach pulse. Heart palpitations, back pain, no abdominal or chest pain 10 hours later
Hi there -

Thanks again. This should be the last question.

I do realize that anxiety/panic can mimic all these symptoms. What I don't understand is that how I can _mechanically_ reproduce them, regardless of whether I'm anxious or not. I lie down on my stomach, within 20 seconds, my heart is palpitating. Are you saying that b/c I'm worried about this happening, I have subconscious anxiety so each time I lay down on my stomach, I fear the palpitations (though I'm not having that thought consciously), so they start up? If that were the case, then why does it happen when I roll over on my stomach in my sleep? Obviously, I'm unconscious in sleep, so I don't even know that I'm rolling over. Yet the palpitation starts and wakes me up.

As mentioned, I have lost a bunch of weight since turning vegan some months ago. So I'm lean elsewhere but still have kind of a distended abdomen b/c (a) belly fat is the last to go in men, (b) I haven't done the type of interval/resistance exercise that tends to burn off long-term stored fat in belly, (c) I'm sure I have high cortisol due to chronic stress, which usually also causes stubborn subcutaneous fat in the abdominal region. It has been suggested that I may be feeling the apic impulse of the heart when the chest or abdomen is pressed against, b/c I've lost weight but still carry some fat in the abdomen, or that the apic impulse has shifted locations due to the weight loss. What do you think about that? Bottom line, I will be much relieved if I find out that I don't have AAA, but I still need to find a solution to this palpitation issue. Having slept on my stomach all my life, it's causing a major sleep disturbance. What do you suggest as a remedy? Are you really saying it should just go away when I reduce BP and stress? B/c I have reduced BP to 120s/80s and have taken up the pranayama breathing and vipassana meditation that I used to do, and feel less stressed (except for this major medical anxiety due to ongoing tests and the fear of AAA), but there's been no change in this particular set of symptoms.
 
 
Answered by Dr. Shainaz Arif Kaware 1 hour later
Hi,

Thanks for writing back.

You can reproduce the symptoms because the symptoms of anxiety will come on once you start thinking about them.

If you never let the symptoms go away they will never go and this anxiety will work to reproduce the symptoms you want to.

Laying on the stomach causes pulsations you know and may be due to anxiety in subconscious mind you get up from sleep as you fear to get palpitations once you lie on stomach.

And another reason for a stronger heart beat when laying prone is due to an increased venous return to the heart. Change of position does cause the heart to beat faster and stronger.

When the blood returning to the heart increases, the heart beats with extra force to push out the extra blood, and this extra force can be felt very well by even well built people.

So I do not find your symptoms to be alarming. Relax and forget about this.

Just to clear your doubts once and for all you can get an abdominal ultrasound scan done or a CT scan of the abdomen. This will relieve you of your anxiety pertaining to the aneurysm.

Another thing I would advise you is to get a medicine prescribed from your treating doctor for sleep.

If a medicine is able to induce good sleep hopefully you will not get up due to the palpitations.

Please consult your doctor and he will either change the dose of ativan or prescribe some other medicine.

Please accept this answer in case you don't have any other queries.

Wishing you good health.

Regards
Above answer was peer-reviewed by
 
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