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Dr. Andrew Rynne

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Chest pain, back pain and feeling dizzy with increased heart rate. Should I consult electrophysiologist?

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Dr. Prabhakar C Koregol

Cardiologist, Interventional

Practicing since :1998

Answered : 424 Questions

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Posted on Wed, 23 Jan 2013 in Hypertension and Heart Disease
Question: Hi,

I have question around my fast heart beat.
Today I had a heartbeat of 115-138 when I was just sitting or laying down and had chest pain, upper left back-shoulder pain and I feel dizzy. I feel dizzy most of the time and feel like can faint any moment.
I see many of the symptoms described here wish is ventricular tachycardia:
WWW.WWWW.WW

My background:
Im 32 years old from Belgium and I have a Asymmetrical chest, my left chest is smaller and my right chest bone is bigger. I eat very healthy, fish, vegetables, nutrition and exercise every day.

I exercise 3 times a week for 1 hour intensive weightlifting interval training, all the other days of the week I swim 1km every day.

My average heart rates:
When I exercise my heartbeat is between 120-165…
When I sleep 60-75/ when I lay down 78-95/
when I sit down 95-115 and when I stand without moving around allot 98-125
When I feel stress 128-139
Im concerned about the fast heartbeat, my whole family has a very low heartbeat everybody in my family.

Sometimes I have very slight chest pain and un comfort, like a stinging feeling on my left chest and a bit pressure and pain on my chest and my left upper back shoulder. Every once in 2 weeks I get a nerve cramp in my chest…

1-2 months ago I had severe chest pain and high heart rate,
I went to do full checkup at 3 different specialist center and did all following test:
- full blood test (all perfect, can send you copy to check)
- stress test (very good, achieve level 7)
- x-ray (all good)
- Echocardiogram (all good, I can send you copy to double check)
- bloodpressure (all good)
- ECG ( all good, can send you copy to check)

All the 3 specialist told me everything is good can not find anything…
Then I have done a spine adjustment for a few times at Chiropractor see if that helped but very little change average it went down 5-10 beats…so it helped very slightly…

But still my heart rate is fast 95-110 when I sit down average over the week,

But today it was 115-138 and chest, back uncomfort stays…my partner helped me to massage my back where it hurts and my heart rate dropped to 95, 30 min afther massage back to 130

One of the specialist told me I can best visit a ELECTRO-PHYSIOLOGIST

What can you advice me? Will this be something you can help me with?
What can I do to reduce my heart rate? Will this bring me any complications or danger if I keep walking with this fast heart rate?

Can I still exercise? Is this to do with my spine, nerve system or has it to do with my slightly different chest? Or any other reasons?

Thank you!!
doctor
Answered by Dr. Prabhakar C Koregol 7 hours later
Thanks for the query.

I understand your concerns. At the outset, you look like a case of inappropriate sinus tachycardia. Does not look like ventricular tachycardia. However considering the variability in your heart rate, we need to make sure that its not atrial fibrillation.

To confirm or rule it out you should under go holter recording. If it is abnormal, you need to undergo treatment. If not, it is normal. You can still be put on low dose beta blockers to help you with symptoms. Apart from these, some yoga and specific exercise training can help you to reduce your heart rate.

Considering your exercise tolerance, there is unlikely to be any underlying serious cardiac ailment.
As long as you don't feel unusually uncomfortable or fatigued, there is nothing wrong in continuing your exercise. But if it increases your symptoms, then you should better reduce the intensity of exercise.

Hope I had been able to clear your concerns. Please ask if you have any further queries.

Regards
Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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Follow up: Dr. Prabhakar C Koregol 9 hours later
Dear Dr. XXXXXXX

Thank you so much for taking your time to find the cause of this Im really grateful for that. After seing many doctors I belief you are the first one knowing the reason inappropriate sinus tachycardia.

5 years ago I already went for full checkup and I had the high Heartbeat, but it seems the fainting feeling, chest pain get worse. After reading about inappropriate sinus tachycardia its exactly what I have. Im very happy already if its not Aortic dissection. Can it be Aortic dissection?
As I also have the pain in my top left back shoulder.

Just to make sure I have uploaded all my documents. You can find all my results of bloodtest, stress test and ECG here:
WWW.WWWW.WW
Next week on tuesday I will go for 24 hours monitoring in Cardiology Medical Center and they will do the holter monitering, urine test and other test to find out source of high heartbeat.
Anything you would advice me to ask them to look or test for?
How to see if its atrial fibrillation?

Any successful treatment for inappropriate sinus tachycardia?

Doing a test with      SOMATOM Definition Flash CT scanner will this be good to do for me?

Im a health and exercise freak ;-)
Lately my heartbeat stays very high after my excercise, 130-140 for hours...and I feel very dizzy the first 30 min after.
I do not have this when I swim or do yoga etc...so I will do more of that for the moment..
Does that mean I can not do any high intensity exercise for my life?

I really appreciate all you do and I can see you really taking your time to look in to this, thank you, thank you, thank you
XXXXXXX
doctor
Answered by Dr. Prabhakar C Koregol 1 hour later
Thanks for detailed reply.
First lets wait for your Holter Report before embarking on treatment discussion.
It can not be aortic dissection from what you describe.
Next coming to how to diagnose AF its very easy on the ECG and cardiologist reading it will be able to give you that information.
You just have tell them your symptoms and nothing else. They would know what to look for.
Yes there is treatment for inappropriate sinus tachycardia which depends on your holter findings.
Please get back to me details and shall advice you
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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