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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for dizziness and fluttery sensation in chest area

Answered by
Dr.
Dr. Priyank Mody

Cardiologist

Practicing since :2009

Answered : 910 Questions

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Posted on Thu, 30 Jul 2015 in General Health
Question: Hello doctor,

I went to my primary care for being slighty dizzy.

Also I feel heart "flutters" when I bend over forward and with the increase in pressure on my chest it would feel like my heart is skipping. (This has been like this for the more than a decade and seems to be tied to how much lbs I carry. Is that possible? My cardiologist did not say anything when I asked about that. In 2012 I was 190lbs and I am 5 foot 10 and did not have issue and was very active). Due to personal problems I gained weight slowly up to 230 lbs since then with physical activity on and off.

Last year I complained about the heart skips and an ecg was done as part of a checkup and was fine.

This time for being dizzy again an ecg was done as part of the checkup and it indicated the following:



"Slight inferior repolarization disturbance, consider ischemia, LV overload or aspecific change small negative T in aVF with negative T in III. Borderline ECG"



P/PR: 94/142 ms

QRS: 88 ms

P/QRS/T Axis: 45/38/6 deg

Heart beat 67 pbm



Chest Xray done for cardiac size indicated normal.



I am being sent for Echo, Carotid and heart holter.

All blood work was normal except for cholesterol total and LDL

Total 206 (range 125 - 200)

HDL = 55 (range > 40)

LDL = 130 (range < 130)

Ratio = 3.7 (range < 5.5)

Vit D was low = 16 ( range 30 - 100)



I have not had high cholesterol before this time. I have been eating incorrect and limited physical activity for the past 8 months+.



My followup is scheduled for end of Aug and I am not sure if it is just anxiety or a real problems. I never get heartburn but now is seems to come and go everyday for the past few weeks. Excessive sweating but limited to my head with activity and feeling dizzy when working.

My feet hurt quite noticiable when waking up in the morning, this has been like that for a few months and gets better as I start to walk.



I do keep biking and feel fine doing it. Sometime I feel what might be heart beat skip, but not sure. I wear a heart rate monitor and racing up hill I get to about 165 and it drops back quick. I keep it at 140 and does not reach it to easy. I do around 15 miles 3 to 4 times a week in mountain bike trails

I will drop back to around 100 within ~3 min of completing.



I was sent for an echo in 2008 and it came back fine. ( the doctor indicated that he did head something, this was routine checkup.)



My question is would the Echo be enough? Do I need to push to expedite the followup or could be anxiety. I do have a habbit of working myself up.

Any feedback would be appreciated.



Thank you
doctor
Answered by Dr. Priyank Mody 32 minutes later
Brief Answer:
Be reassured, get the scheduled test. Some modifications as recommended

Detailed Answer:
Hi, I went through the history in detail.
I would brief while I address your concern.
1) there may be 2 possible reasons for your symptoms.
1) some transient ectopic beats. As your ecg has always been normal, the nxt teat to be done is 24 hour holter which will monitor the ecg for 24 hours and we will be able to document if nay arrhythmia. If identified it will be easy to treat the same.
2) because it's increased when you weigh more and increases on bending strongly consider reflux gastritis (GERD- gastroesophageal reflux gastritis where stomach acid comes in the food pipe causing heart burn like sensation.
Here try losing weight.
Avoid spicy and preserved food, no coffee chocolate, smoking..
If a drug is needed a proton pump inhibitor like pantoprazole 40mg in morning 15 mins before breakfast.

3)the ecg interpretation is of machine which in most times of no significance. I will be able to comment if you can upload the same here . But reassured nothing to worry in that context.
4) the heart rate Response is normal of all activities you mentioned and you don't need to worry for the same.
5) lipid profile seems normal too, however cutting on carbs and red meat will help.
6)anxiety will increase the perception of normal heart beats, so try staying calm during such episode

Do get the test of echo, holter as prescribed and let us evaluate the result.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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