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Dr. Andrew Rynne

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What causes heart palpitations and numbness of left arm with normal stress test?

Answered by
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Dr. Rahul Tawde

General & Family Physician

Practicing since :1980

Answered : 1 Question

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Posted on Thu, 28 Aug 2014 in Hypertension and Heart Disease
Question: I am a 39 yr old woman in good health..I have ongoing anemia, and a slight heart murmur.
About 2 weeks ago I had an episode ofsyncope, dizziness, numb left arm and palpitations.This went on for over 15 mins. so ambulance was called. i could not stand up on my own, was pale as a ghost, and developed significant nausea. The whole episode lasted a hour. The cardiac monitor in the ambulance showed an irregular heartbeat, but was never reproduced in the ER.The tech inthe ambulance suspected a fib based on the rythym strip. It took 45 mins. to get to the hospital as I was in the country.I have been very fatigued since, get short of breath super easily. I have been going to follow up test trying to see what this could be. I still get palpitations that feel like a hummingbird in my chest or something flopping around. It can happen many times in 1 day, and the nothing for a day or 2.

I had a stress test and no significant ST changes were noted, but i have a blunted response to exercise in regards to my blood pressure.baseline was 138/70.It dropped at peak exercise ton 130/70.My heart rate reproaching 170.My recovery heartrate was unchanged. There has been a lot of cardiac issues in my family, particularly the women..so i am a bit concerned.

I will be having a holter test as well, but was curious what this BP could be cause by. Should I be concerned?"
doctor
Answered by Dr. Rahul Tawde 2 hours later
Brief Answer:
Evaluation for arrhythmia needed

Detailed Answer:
Hi XXXXXXX thanks for posting your concern in the HCM.
As your stress tests came out with no significant ST changes, an ischaemic heart disease may be ruled out. However, you have palpitations and you have cardiac symptoms which are also compatible with arrhythmia.

Your doctor suggested the holter monitoring to rule out that arrhythmia.
This was a very rational decision taken by him. However, regarding the query whether you should be concerned, my opinion is you should avoid any form of stress at this point of time because stress can precipitate arrhythmia and cardiac symptoms.

Regarding the arrhythmia, I can say that they may be due to various reasons including primary cardiac cause or some other reasons.
Having anemia would cause hyperdynamic circulation and that would aggravate your arrhythmia.
Regarding the heart murmur, any structural cardiac or pulmonary problem should be ruled out.
For the time being, you should avoid any form of stress, have the holter done and I can assure you that most arrhythmias are benign and can be resolved spontaneously or treated with medications alone. If refractory, pacemaker implantation may be needed.

You may also need to check your fasting TSH level, fasting plasma glucose and HbA1c level, fasting lipid profile along with cardiac examinations.


Best wishes for your early recovery.
Hope you are satisfied with my answer. If you have any further query related to this, please write back.
In case you have any new query in future, you can directly ask me questions @ http://www.HealthcareMagic.com/doctors/dr-kaushik-sarkar/68460. I will try my level best to help you.
Regards,
Dr. Kaushik

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Rahul Tawde 38 minutes later
thank you. I have had bllod work and TSH, glucose, all normal.

What does the bloodpressure response during the stress test mean? It did not increase, it actually decreased slightly during maximul exercise level. Is this indicative of anything?
doctor
Answered by Dr. Rahul Tawde 43 minutes later
Brief Answer:
Vulvular abnormality should be excluded

Detailed Answer:
Hi XXXXXXX
welcome back and thanks for a prompt reply. You have raised a very important point.


Failure to increase in systolic blood pressure during stress test or a fall suggests exertional hypotension. This may occur due to several cardiac problems-
1. Mitral or aortic stenosis
2. Hypertensive vascular disease
3. Coarctation of Aorta
4. Vulvular regurgitation etc.
Among these researchers have found vulvular stenosis to be commoner. But, there are studies where researchers found this to have occurred in otherwise normal subjects.

An echocardiography should also be done rule out valvular or other structural problem of the heart, particularly because you had murmur and exertional hypotension.
It is good that your blood tests came out with good results.
So, let's look forward to your next test, i.e. holter monitoring.

Again I would tell you that you need not worry at all. Get adequate rest, avoid exertion and stress and let's hope for the best.

Best wishes for your health.
Hope you are satisfied with my answer. If you have any further query related to this, please write back.
In case you have any new query in future, you can directly ask me questions @ http://www.HealthcareMagic.com/doctors/dr-kaushik-sarkar/68460. I will try my level best to help you.
Regards,
Dr. Kaushik

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Rahul Tawde 24 hours later
Thank you very much for youe detailed answer.

My last question would be, can it be a normal thing to have this lack of response from blood pressure?
doctor
Answered by Dr. Rahul Tawde 1 hour later
Brief Answer:
rise of >40mm of Hg is considered normal

Detailed Answer:
Welcome back XXXXXXX
My understanding is, at least 10% rise in systolic BP or a rise of >40mm of Hg should be considered normal.
However, diastolic BP usually goes down or stays close to pretest value.
So, I am sorry that I cannot give you such assurance. But, one thing I can say is that, result of any test has some test retest variability. That may be due to instrument variation or observer variation or even variation in physical or mental status of the patient.
However, I should say that please don't worry. Let the report of holter come.
If you find any query then, please write back to me. I will try my level best to solve that confusion. Now, please don't speculate any bad outcome. Your speculation would do no good for you. Rather the stress would cause harm to your body. I think you are resilient enough to fight these silly things.
Regards,
Dr. Kaushik
Above answer was peer-reviewed by : Dr. Raju A.T
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