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Suggest Treatment For Chest Pain, Shortness Of Breath And Heart Palpitations
Question: Dealing with chest pain, shortness of breath, palpitations for about a year now. Seeing a cardiologist and have had echocardiogram, CTA, stress test and wore a holter monitor. Most test have returned normal although the monitor showed some times of tachycardia and a bradycardia of 38bpm when sleeping so he said any beta blockers would be counterindicated. Mentioned to him that while i'll experience my symptoms at any time, they sometimes will get worse when standing, especially increase in HR. My Cardiologist said possible POTS but didn't elaborate or proscribe further tests. Sometimes the HR change isn't too bad other times my HR doubles and I get pain and short of breath. What can I do? How can I further explore a possible dysautonomia? I'm not local to any known center (central NJ) so who would best diagnose and care for anything that would be wrong, a cardiologist or a neurologist?
Brief Answer:
Following answer to your queries.
Detailed Answer:
Hi and thank you for asking!
I read your query and understood your concerns.
Before reaching to a conclusion I want to check my self your test results especially Holter monitoring. Can you please upload those data for me?
POTS is an increase of HR 30 bpm or more while on standing. The HR increase shouldn't be associated with orthostatic hypotension.
Please keep in mind that POTS is suspected on Holter results but is confirmed with a tilt test. This is why if you were my patient I would have recommended to do a tilt test.
Only after checking the test results I would be able to give some treatment option. My opinion is that your symptoms should be treated by a cardiologist.
Wish you health!
Dr. Shehu
Following answer to your queries.
Detailed Answer:
Hi and thank you for asking!
I read your query and understood your concerns.
Before reaching to a conclusion I want to check my self your test results especially Holter monitoring. Can you please upload those data for me?
POTS is an increase of HR 30 bpm or more while on standing. The HR increase shouldn't be associated with orthostatic hypotension.
Please keep in mind that POTS is suspected on Holter results but is confirmed with a tilt test. This is why if you were my patient I would have recommended to do a tilt test.
Only after checking the test results I would be able to give some treatment option. My opinion is that your symptoms should be treated by a cardiologist.
Wish you health!
Dr. Shehu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ive attached the reports for my echo, cta, and stress test. I do not have the report for my CardioNet wEvent monitor. The doctor told me only that there were no PVC's, bradycardia as low as 38bpm while sleeping and twice when my HR was about 130bpm during times when i dont believe i was doing anything physical. The monitor is the type that self detects so i dont know if it would record an increase of say 30-40bpm just from standing. Also, When i was having my CTA done the nurse commented that sometimes my HR would jump up 15-20bpm for a little a little bit for no reason and then go back down but looked like a steady rhythm the whole time, just that it would get faster so they gave me Atenolol to slow it down and smooth it out. I noticed after the procedure for the rest of the day while the atenolol was still in my system my HR wouldn't go up as much with changing positions but like i said my cardio is reluctant to use a beta blocker because of my low HR while sleeping.
Brief Answer:
Following advice.
Detailed Answer:
Hi back,
After reviewing your data I would like to say that your examinations didn't found major cardiac problems. However on CAT cardiac scan was found an opacity on your right lung and the radiologist recommended a normal chest scan for further evaluation.
Can you upload the data of normal chest ct scan (if youhave done the requested test)?
Pulmonary problems (right lung opacity) may explain some of your problems.
You are reporting that your HR increase with 20 bpm, however this isn't enough to confirm the diagnosis of POST. This is why i strongly recommend that you should do tilt test to definitely confirm or exclude it.
Although your HR goes as low as 38bpm while on sleep (which is common during sleep) you may safely use a betablocker with ISA ( intrinsic sympathomimetic activity ). This betablockers are effective on controlling tachycardia but due to their ISA activity they never cause bradycardia.
Since this medications may have unwanted side effects i strongly recommend to discuss with your doctor about this treatment option.
Hope this was of help!
Wish you health!
Dr. Shehu
Following advice.
Detailed Answer:
Hi back,
After reviewing your data I would like to say that your examinations didn't found major cardiac problems. However on CAT cardiac scan was found an opacity on your right lung and the radiologist recommended a normal chest scan for further evaluation.
Can you upload the data of normal chest ct scan (if youhave done the requested test)?
Pulmonary problems (right lung opacity) may explain some of your problems.
You are reporting that your HR increase with 20 bpm, however this isn't enough to confirm the diagnosis of POST. This is why i strongly recommend that you should do tilt test to definitely confirm or exclude it.
Although your HR goes as low as 38bpm while on sleep (which is common during sleep) you may safely use a betablocker with ISA ( intrinsic sympathomimetic activity ). This betablockers are effective on controlling tachycardia but due to their ISA activity they never cause bradycardia.
Since this medications may have unwanted side effects i strongly recommend to discuss with your doctor about this treatment option.
Hope this was of help!
Wish you health!
Dr. Shehu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for all you help so far. I currently dont' have a copy for that one report but can easily get a copy during business hours tomorrow. I did have the normal chest CT done and saw a pulmonologist as well. He said that the nodule found looked benign and would not be causing my problems but to have another scan in a year to make sure it does not change (i guess in size or shape?. He also did a spirometry test which came back normal as well. What would be possible beta blockers that have the ISA activity that i may safely take to control the tachycardia? I would like a possiblilty or few to ask my cardiologist about. )
Brief Answer:
Following advice.
Detailed Answer:
Hi back,
It's a great thing that your preliminary pulmonary examinations didn't found anything wrong with your lungs.
If you were my patient I would recommend you to start with lower doses of Pindolol. It's effective on controlling tachycardia but it can cause less bradycardia due to it's ISA activity.
However since it's still a betablocker and it may cause severe side effects you should discuss with your doctor about starting any treatment.
Hope this was of help!
Wish you health!
Dr. Shehu
Following advice.
Detailed Answer:
Hi back,
It's a great thing that your preliminary pulmonary examinations didn't found anything wrong with your lungs.
If you were my patient I would recommend you to start with lower doses of Pindolol. It's effective on controlling tachycardia but it can cause less bradycardia due to it's ISA activity.
However since it's still a betablocker and it may cause severe side effects you should discuss with your doctor about starting any treatment.
Hope this was of help!
Wish you health!
Dr. Shehu
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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