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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for chest pain and fast heart rate

Answered by
Dr. Sagar Makode


Practicing since :2013

Answered : 1774 Questions

Posted on Thu, 2 Mar 2017 in Hypertension and Heart Disease
Question: My mom is 72, she went to the hospital last night for cheat pain and fast heart rate. The problem is they live in the mountains and the hospital there cant even do a stint if needed. They want to keep her and make her wait until Monday to see a cardiologist, no idea why one isnt on call.

The closest hospital with a good heart team is 4 hours away.

She was taking meds to try and stabilize everything but when she just had water her pulse went from 50 to 140.

I asked what else was going on and she said this "All- feels like heart RACING & jumping in my chest- then like someone sitting on it- some pain- shortness breath- fast breathing- then headache ! Comes on weird times!"

What should we do???
Answered by Dr. Sagar Makode 48 minutes later
Brief Answer:
See the description

Detailed Answer:
If possible, try to upload ecg and other reports available. Also, let me know the troponin report which is a kit test.
Here, the primary problem looks like a palpitations and high heart rate which can secondarily lead to chest pain or heaviness etc. Also, heart attack can also cause chest pain, heaviness and palpitations, but jumping of heart rate is less common. I guess she is having symptoms intermittently and she is fine in between.
Here, the priority is to rule in or rule out heart attack. If it's a heart attack then she should be shifted to other hospital on priority. So we need two things here, one is ecg and other is troponin. If troponin test is positive then it suggest she has heart attack. So please get back with ecg and report. Or at least discuss with doctors over there, are there any changes like heart attack in ecg and about troponin.
If it's not a heart attack then the possibility is of arrhythmia mostly atrial fibrillation, which is not life threatening and certainly can wait three to four days. Ecg will clear the diagnosis. Also, if she is cardiac monitor attached, try to take picture of the rhythm on the monitor especially during high rate. It's a possiblity that she is having intermittent atrial fibrillation, during which heart rate races intermittently and become normal in between. So it's important to have ecg during that high heart rate period.
Considering, she is having intermittent symptoms like palpitations and also heaviness in chest is also intermittent associated with racing, arrhythmia possibility is more. In this case, she should be started on medicine called as beta blockers like metoprolol which will control her racing and other symptoms. Still I would like to review the reports. Get back if you have further doubts.
Above answer was peer-reviewed by : Dr. Yogesh D
Follow up: Dr. Sagar Makode 5 hours later
I've uploaded the report for you showing the information you wanted from the hospital. Please take a look and let me know what you suggest.

Answered by Dr. Sagar Makode 23 minutes later
Brief Answer:
It's a atrial fibrillation, not a heart attack

Detailed Answer:
This is a paroxysmal atrial fibrillation, in which heart rate suddenly goes up. Blood pressure falls during these episodes and one has dizziness, chest pain, shortness of breath, fainting, blackouts, sometimes syncope. Usually, not a life threatening condition and very well treated with drugs.
Her CKMB and trop levels are within normal limits ruling out heart attack. Cause for this here is probably age related, other causes includes like valve problem, heart blockages, hypertension, thyroid problems.
She ll need echocardiography and thyroid test to evaluate for the cause as early as possible, but not a dire emergency.
The problem associated is increased heart rate and chances of formation of blood clots in heart. So she should on drugs for this, and also on blood thinners to prevent clot formation. I guess she must have been started on this as heart rate in next is low.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
Follow up: Dr. Sagar Makode 22 minutes later
They said the heart doctor won't be in until Tuesday, that's ok to wait?

She just messaged me and said she went to pee and her pulse went to 148, when she got back in bed it went down.

158/77 is her current blood pressure, pulse went to 55 in bed.

Answered by Dr. Sagar Makode 18 minutes later
Brief Answer:
Yes she can wait provided she is receiving blood thinners (anticoagulant)

Detailed Answer:
yes, she can wait.
This increase in heart rate is not life threatening, although may cause symptoms.
But it's important that she is started on anticoagulant like xalreto or dabigatran etc. in order to prevent blood clot formation. This condition can be managed well by good MD as well. Echo can be done on Tuesday.
Above answer was peer-reviewed by : Dr. Vaishalee Punj

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