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What Do My Lab Test Reports Indicate?
Question: Dear Dr Iliri,
This is OCD crazy XXXX. Today, I received news that my medical clearance was denied for Class 1 travel to Cambodia (no restrictions for 2 years, travel to anywhere in the world) but I was told I can still qualify for a Class 2 (conditional, with each trip requiring separate approval) but because of the severity of my heart problem, I would need to submit to quarterly exams with checks of my heart function and heart valves along with complete medical check. They said while I appear to be completely healthy, in general, history of heart failure is almost always a disqualifying condition.
They have asked me to submit to a nuclear stress test with a cardiologist they recommend. I called my cardio who strongly urged me to say that a nuclear stress test is unnecessary and is dangerous because of the radiation involved and I had one last year with good results. I am going to ask if an echo by my own cardio will be sufficient, as it was last time. I am scheduled for an echo for next Tuesday IF the state department will accept that instead of the nuclear stress test.
Now I am very stressed and worried and am considering simply giving up on the medical clearance. Perhaps it is true that I am just too risky for travel to a place like Cambodia where there is insufficient medical care and no cardiologists if I should get sick. I would put my company's project in jeopardy if I needed to be evacuated because I get sick. In their letter they state that cardiomyopathy is considered permanent and incurable and simply well compensated if not symptomatic.
My heart rate has recently been so steady, seemingly always in the 50-60 range at rest and almost never feeling PVCs. In the last few days as I've waited for my clearance decision, I've felt PVCs occasionally, and while at night at rest, heart is okay, I've felt moments of 80-90 heart rate even while just doing something simple like walking a little. I'm so scared something is wrong now.
If I have to have nuclear stress or even echo from my own cardio, I am so scared there will be changes from my echo of 11 weeks ago. Could my heart suddenly having a few PVCs and more variable heart rate indicate that there are some negative changes? While I am always anxious about my heart, all of this discussion about my heart, and having to look at all my old records and hearing opinions that I am not actually cured have made me feel just terrible and so scared.
Do you think my echo or nuclear stress will still be normal? Without a true disease process, will my heart stay normal? Are a few PVCs benign, even in someone like me whose heart failed from PVCs? My worst holter since ablation showed 900 PVCs, although the rest were all under 100. I am so scared it's all coming back.
I have submitted my last few echo reports again, to ask if you see any signs of relapse. Also a tracing from something called "heart rate monitor", an app for the iPhone which tracks your heartrate from the camera phone shining on your pulse in your fingertip. I know it is nothing like a true EKG, but does this weird beat in this tracing look like a PVC? I see these fairly frequently when I do this heart rate app.
I know I am just so anxious from everything going on right now. Must calm down but hearing that I will always be considered sick and "a risk" has made me feel terrible.
Thank you Dr Iliri. I will be feeling quite scared until Tuesday (if I do indeed get echo) and your words are always so helpful
thank you so very much,
XXXXX
This is OCD crazy XXXX. Today, I received news that my medical clearance was denied for Class 1 travel to Cambodia (no restrictions for 2 years, travel to anywhere in the world) but I was told I can still qualify for a Class 2 (conditional, with each trip requiring separate approval) but because of the severity of my heart problem, I would need to submit to quarterly exams with checks of my heart function and heart valves along with complete medical check. They said while I appear to be completely healthy, in general, history of heart failure is almost always a disqualifying condition.
They have asked me to submit to a nuclear stress test with a cardiologist they recommend. I called my cardio who strongly urged me to say that a nuclear stress test is unnecessary and is dangerous because of the radiation involved and I had one last year with good results. I am going to ask if an echo by my own cardio will be sufficient, as it was last time. I am scheduled for an echo for next Tuesday IF the state department will accept that instead of the nuclear stress test.
Now I am very stressed and worried and am considering simply giving up on the medical clearance. Perhaps it is true that I am just too risky for travel to a place like Cambodia where there is insufficient medical care and no cardiologists if I should get sick. I would put my company's project in jeopardy if I needed to be evacuated because I get sick. In their letter they state that cardiomyopathy is considered permanent and incurable and simply well compensated if not symptomatic.
My heart rate has recently been so steady, seemingly always in the 50-60 range at rest and almost never feeling PVCs. In the last few days as I've waited for my clearance decision, I've felt PVCs occasionally, and while at night at rest, heart is okay, I've felt moments of 80-90 heart rate even while just doing something simple like walking a little. I'm so scared something is wrong now.
If I have to have nuclear stress or even echo from my own cardio, I am so scared there will be changes from my echo of 11 weeks ago. Could my heart suddenly having a few PVCs and more variable heart rate indicate that there are some negative changes? While I am always anxious about my heart, all of this discussion about my heart, and having to look at all my old records and hearing opinions that I am not actually cured have made me feel just terrible and so scared.
Do you think my echo or nuclear stress will still be normal? Without a true disease process, will my heart stay normal? Are a few PVCs benign, even in someone like me whose heart failed from PVCs? My worst holter since ablation showed 900 PVCs, although the rest were all under 100. I am so scared it's all coming back.
I have submitted my last few echo reports again, to ask if you see any signs of relapse. Also a tracing from something called "heart rate monitor", an app for the iPhone which tracks your heartrate from the camera phone shining on your pulse in your fingertip. I know it is nothing like a true EKG, but does this weird beat in this tracing look like a PVC? I see these fairly frequently when I do this heart rate app.
I know I am just so anxious from everything going on right now. Must calm down but hearing that I will always be considered sick and "a risk" has made me feel terrible.
Thank you Dr Iliri. I will be feeling quite scared until Tuesday (if I do indeed get echo) and your words are always so helpful
thank you so very much,
XXXXX
Brief Answer:
I would explain as follows:
Detailed Answer:
Dear XXXXX,
I am glad to hear from you again on HCM!
I am sorry for your medical clearance. This shows just that the persons responsible for these documents are not real professionals of this field.
I carefully reviewed all your uploaded tests and would explain that they are perfectly normal.
There is no single element in your tests indicating any possible relapse or aggravation of your situation.
You should know that your case is different from the others.
Differently from other types of cardiopathies, tachycardiomyopathy is properly curable and if this arrhythmia substrate is effectively removed, a cardiomyopathy relapse is quite impossible.
I would like to assure you that in your actual clinical status that there is no risk of cardiomyopathy relapse.
Regarding your heart rate variability, I would like to explain that it is quite normal in healthy adults. It is a sign of the healthy status of your cardiac conductance system.
Referring to your premature ectopic beats, they are quite scared and clinically irrelevant. They cannot harm you, as they are quite benign.
It is true that you may feel a little more ectopic beats as you are more anxious because the department results, but this is the way that every normal and healthy individual would react.
There is no need to perform a nuclear stress test. I agree with your attending cardiologist on this point. We are professionals of the field and we know that we cannot expose our patients to unjustified increased risks without yielding any extra available clinical information from a certain test (compared to your already provided medical evidence from the previously performed medical tests).
So, I would not recommend performing this test.
You should just try to calm down and manage your anxiety.
Everything is going to be OK. It is your right to have the medical clearance as you are perfectly normal and nothing bad is going to happen to you.
I can assure you that even if you repeat those tests, they will result normal. And you will have your medical clearance Class I.
So just relax!
I am always here is you need to discuss with me at any time!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Dear XXXXX,
I am glad to hear from you again on HCM!
I am sorry for your medical clearance. This shows just that the persons responsible for these documents are not real professionals of this field.
I carefully reviewed all your uploaded tests and would explain that they are perfectly normal.
There is no single element in your tests indicating any possible relapse or aggravation of your situation.
You should know that your case is different from the others.
Differently from other types of cardiopathies, tachycardiomyopathy is properly curable and if this arrhythmia substrate is effectively removed, a cardiomyopathy relapse is quite impossible.
I would like to assure you that in your actual clinical status that there is no risk of cardiomyopathy relapse.
Regarding your heart rate variability, I would like to explain that it is quite normal in healthy adults. It is a sign of the healthy status of your cardiac conductance system.
Referring to your premature ectopic beats, they are quite scared and clinically irrelevant. They cannot harm you, as they are quite benign.
It is true that you may feel a little more ectopic beats as you are more anxious because the department results, but this is the way that every normal and healthy individual would react.
There is no need to perform a nuclear stress test. I agree with your attending cardiologist on this point. We are professionals of the field and we know that we cannot expose our patients to unjustified increased risks without yielding any extra available clinical information from a certain test (compared to your already provided medical evidence from the previously performed medical tests).
So, I would not recommend performing this test.
You should just try to calm down and manage your anxiety.
Everything is going to be OK. It is your right to have the medical clearance as you are perfectly normal and nothing bad is going to happen to you.
I can assure you that even if you repeat those tests, they will result normal. And you will have your medical clearance Class I.
So just relax!
I am always here is you need to discuss with me at any time!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
This morning I have heard that echo will suffice and I will not need to have a nuclear stress test. My own cardio will do the test on Tuesday. I am very nervous as I have spent so many days having to go over my medical history and having people tell me that I will always be considered a heart patient. It has been a difficult week.
Are you quite sure my echo will still be normal? I have sometimes felt worried that Echoes of July 2015 and February 2016 showed EF 65-70 but then April and XXXXXXX 2016 were 64 and then 60-65. First two were at one office and second two at his other location. I guess you would say all have said 65.
I am disturbed that I dont feel pvcs without actually feeling my pulse. In the past I could always feel them. Surely if I were having many thousands I would know? Does that tracing from heartrate app look like it shows a pvc?
I am trying to stay calm and hopeful. It has only been not quite 3 months since last echo. Hopefully i am
Ok.
Thank you so much, as always.
XXXXX
This morning I have heard that echo will suffice and I will not need to have a nuclear stress test. My own cardio will do the test on Tuesday. I am very nervous as I have spent so many days having to go over my medical history and having people tell me that I will always be considered a heart patient. It has been a difficult week.
Are you quite sure my echo will still be normal? I have sometimes felt worried that Echoes of July 2015 and February 2016 showed EF 65-70 but then April and XXXXXXX 2016 were 64 and then 60-65. First two were at one office and second two at his other location. I guess you would say all have said 65.
I am disturbed that I dont feel pvcs without actually feeling my pulse. In the past I could always feel them. Surely if I were having many thousands I would know? Does that tracing from heartrate app look like it shows a pvc?
I am trying to stay calm and hopeful. It has only been not quite 3 months since last echo. Hopefully i am
Ok.
Thank you so much, as always.
XXXXX
Brief Answer:
Your next cardiac ultrasound will result normal again.
Detailed Answer:
Dear XXXX,
I am really glad that you are not going to perform a nuclear stress test as it was really unnecessary in your case.
I can assure you that your next ultrasound will be great. You have not even one element or sign of any cardiac disorders.
Regarding all these variations in the past ultrasounds, they are just inter-observer variability (as I already explained to you before).
So, just relax and do not worry about it!
Everything is going to be OK!
The only thing you should do is try to stay calm and think about beautiful things.
Let me know about everything.
Best wishes,
Dr.Iliri
Your next cardiac ultrasound will result normal again.
Detailed Answer:
Dear XXXX,
I am really glad that you are not going to perform a nuclear stress test as it was really unnecessary in your case.
I can assure you that your next ultrasound will be great. You have not even one element or sign of any cardiac disorders.
Regarding all these variations in the past ultrasounds, they are just inter-observer variability (as I already explained to you before).
So, just relax and do not worry about it!
Everything is going to be OK!
The only thing you should do is try to stay calm and think about beautiful things.
Let me know about everything.
Best wishes,
Dr.Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you so much for everything. I am feeling very scared and vulnerable right now because of my medical review. It reminds me of how sick I was, how bad my prognosis was. I have a lot of confusion about the time I was ill because I was labeled "asymptomatic" and "well-compensated" and yet I was also labelled as having "severe heart failure, transplant candidate". As you have helped me remember, I did have symptoms such as orthopnea and tight shins, but I never felt unable to keep up my busy work and caregiving. I actually wish I had felt sicker at that time because I would feel more reassured now that I am ok.
Are you quite sure my echo will be normal? If I had even mildly impaired heart function- like 50-55- would I have symptoms? I know I am not in severe heart failure but I fear a downward turn. Just as my first post ablation echo showed EF 55 and then seemed to show greater improvement to 65-70 late, I am afraid of going backwards back to 55 or lower. Would that not happen without a heart attack or disease process or without noticing symptoms?
As for symptoms, I don't feel Pvcs internally but I have felt a few while taking pulse. I use an app called heartrate monitor which measures heartrate with iphone camera on tip of finger. It also takes a wave tracing of heart. I have noticed these weird tracings at times and attached photos. While I know it's not an EKG, do those look like pvcs to you?
At what level do you believe pvcs can affect heart function? My EP said only at 20% and I had been at 50% but I have read that even 5000 pvcs or less can be dangerous.
I know I need to just be calm and wait for Tuesday but I am very very nervous.
Thank you so much,
XXXX
Thank you so much for everything. I am feeling very scared and vulnerable right now because of my medical review. It reminds me of how sick I was, how bad my prognosis was. I have a lot of confusion about the time I was ill because I was labeled "asymptomatic" and "well-compensated" and yet I was also labelled as having "severe heart failure, transplant candidate". As you have helped me remember, I did have symptoms such as orthopnea and tight shins, but I never felt unable to keep up my busy work and caregiving. I actually wish I had felt sicker at that time because I would feel more reassured now that I am ok.
Are you quite sure my echo will be normal? If I had even mildly impaired heart function- like 50-55- would I have symptoms? I know I am not in severe heart failure but I fear a downward turn. Just as my first post ablation echo showed EF 55 and then seemed to show greater improvement to 65-70 late, I am afraid of going backwards back to 55 or lower. Would that not happen without a heart attack or disease process or without noticing symptoms?
As for symptoms, I don't feel Pvcs internally but I have felt a few while taking pulse. I use an app called heartrate monitor which measures heartrate with iphone camera on tip of finger. It also takes a wave tracing of heart. I have noticed these weird tracings at times and attached photos. While I know it's not an EKG, do those look like pvcs to you?
At what level do you believe pvcs can affect heart function? My EP said only at 20% and I had been at 50% but I have read that even 5000 pvcs or less can be dangerous.
I know I need to just be calm and wait for Tuesday but I am very very nervous.
Thank you so much,
XXXX
Brief Answer:
My opinion:
Detailed Answer:
Dear XXXX,
I would like to assure you that everything you fear about, doesn’t seem to have a scientific explanation for being actually a possible alternative to you.
Let’s make some points of reference.
- When you mention your clinical conditions before the successful cardiac ablation you forget the fact you had symptoms and signs of overt heart failure, though they may have been moderate (as young individuals have excellent myocardial reserve).
- Also, there has not been a permanent substrate for your cardiomyopathy.
The only one has been successfully eradicated by the already performed cardiac ablation.
So, keeping these two key points in mind, I would conclude with certainty, that there is neither a clinical basis, nor a structural substrate inside your heart to justify your actual fears.
A relapse of cardiomyopathy cannot turn out from nothing.
It is true that your LV ejection fraction may have been 50% or even lower during the time your cardiac arrhythmia was present, or was a fresh and cool record (just after cardiac ablation). Our heart has been shocked by a very frequent arrhythmia, leading to depletion of its energy supply and an adverse remodeling.
So, it has been inevitable for those EF values to happen shortly after cardiac ablation.
Everything in nature needs its sufficient time to heal and reverse the pathological changes.
The same is for your heart. After a prolonged healing, it has returned to its original status; no matter what EF (60% - 65%-75%) will be precisely accurate an echo technician to yield.
Some measurement inaccuracies will always be present.
Now returning to your heart rhythm, I could add that, in conditions of increased psychological stress just as you are getting through; it is hardly to find a person without any premature heart beat.
So, I am not surprised, you may have some extrasystoles. It is difficult to distinguish from that iphone application, whether it is a ventricular or supraventricular premature impulse.
It is necessary to perform a ECG, and if enough time will pass from the last one, to check a prolonged heart rhythm trend by an ambulatory ECG (Holter). But, this latter doesn’t seem to be necessary for the moment.
If you had so many premature heart beats (20% or greater), I assure you that you would have so many unpleasant feelings
The only thing I would suggest to you is to relax and enjoy your weekend.
As I know your history quite well, I am sure you are going to be OK by every cardiac test they may suggest.
Wishing you are heaving a pleasant weekend,
Kind regards,
Dr. Iliri
My opinion:
Detailed Answer:
Dear XXXX,
I would like to assure you that everything you fear about, doesn’t seem to have a scientific explanation for being actually a possible alternative to you.
Let’s make some points of reference.
- When you mention your clinical conditions before the successful cardiac ablation you forget the fact you had symptoms and signs of overt heart failure, though they may have been moderate (as young individuals have excellent myocardial reserve).
- Also, there has not been a permanent substrate for your cardiomyopathy.
The only one has been successfully eradicated by the already performed cardiac ablation.
So, keeping these two key points in mind, I would conclude with certainty, that there is neither a clinical basis, nor a structural substrate inside your heart to justify your actual fears.
A relapse of cardiomyopathy cannot turn out from nothing.
It is true that your LV ejection fraction may have been 50% or even lower during the time your cardiac arrhythmia was present, or was a fresh and cool record (just after cardiac ablation). Our heart has been shocked by a very frequent arrhythmia, leading to depletion of its energy supply and an adverse remodeling.
So, it has been inevitable for those EF values to happen shortly after cardiac ablation.
Everything in nature needs its sufficient time to heal and reverse the pathological changes.
The same is for your heart. After a prolonged healing, it has returned to its original status; no matter what EF (60% - 65%-75%) will be precisely accurate an echo technician to yield.
Some measurement inaccuracies will always be present.
Now returning to your heart rhythm, I could add that, in conditions of increased psychological stress just as you are getting through; it is hardly to find a person without any premature heart beat.
So, I am not surprised, you may have some extrasystoles. It is difficult to distinguish from that iphone application, whether it is a ventricular or supraventricular premature impulse.
It is necessary to perform a ECG, and if enough time will pass from the last one, to check a prolonged heart rhythm trend by an ambulatory ECG (Holter). But, this latter doesn’t seem to be necessary for the moment.
If you had so many premature heart beats (20% or greater), I assure you that you would have so many unpleasant feelings
The only thing I would suggest to you is to relax and enjoy your weekend.
As I know your history quite well, I am sure you are going to be OK by every cardiac test they may suggest.
Wishing you are heaving a pleasant weekend,
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
I will have ECG on Tuesday too. I have found those "weird" beats occasionally when using that app but usually they are fine and normal. It seems I can have these occasionally for a few minutes but usually it's ok. I am attaching some tracings from a few minutes ago during a gentle cycling workout of several miles. I know during a treadmill test I have had things that look like PVCS but my EP said they looked like motion artifacts and not PVCs. It looks like if this is at all accurate, I am having extrasystoles and weird rhythm. I am worried- I was hoping those weird tracings were not extra beats. I am not always having them but they worry me so much.
At height of my PVCs, I was having 65,000 a day, more than 50% burden. I could feel them in my chest all day long. I am very scared that they are coming back. Before a few days ago, I almost never felt a PVC even while taking my pulse. My EF at diagnosis was very low, 25. My cardio was shocked at how quickly I recovered after ablation, just 3 1/2 weeks and EF was nornal.
I am trying to stop using that horrible app. It is making me crazy.
Thank you so much for all your help.
Mi
Do these tracings look ominous like something is going on? I see cardio on Tuesday for echo and EKG. I know a camera phone wont be truly diagnostic like a true EKG but it does give some indication, doesnt it?
Dear Dr Iliri,
Does this wave tracing from
The app with heart rate of 73 show a PVC? As a non doc, I can just tell that that beat is wider and looks different but doesn't have the distinct points on the bottom of some of the other weird beats. I was hoping that these were not PVCs.
I don't know why I no longer feel PVCs in my chest. Even after ablation I could feel them but now I need to check pulse to feel one. Normally I don't have them but it is worrisome that I can see them on this app while not feeling them otherwise. What if they are coming back? Until a few days ago, I almost never felt a PVC.
I will get an EKG on Tuesday with my echo. Hopefully all will be well and I will calm down.
Many many thanks,
XXXX
I will have ECG on Tuesday too. I have found those "weird" beats occasionally when using that app but usually they are fine and normal. It seems I can have these occasionally for a few minutes but usually it's ok. I am attaching some tracings from a few minutes ago during a gentle cycling workout of several miles. I know during a treadmill test I have had things that look like PVCS but my EP said they looked like motion artifacts and not PVCs. It looks like if this is at all accurate, I am having extrasystoles and weird rhythm. I am worried- I was hoping those weird tracings were not extra beats. I am not always having them but they worry me so much.
At height of my PVCs, I was having 65,000 a day, more than 50% burden. I could feel them in my chest all day long. I am very scared that they are coming back. Before a few days ago, I almost never felt a PVC even while taking my pulse. My EF at diagnosis was very low, 25. My cardio was shocked at how quickly I recovered after ablation, just 3 1/2 weeks and EF was nornal.
I am trying to stop using that horrible app. It is making me crazy.
Thank you so much for all your help.
Mi
Do these tracings look ominous like something is going on? I see cardio on Tuesday for echo and EKG. I know a camera phone wont be truly diagnostic like a true EKG but it does give some indication, doesnt it?
Dear Dr Iliri,
Does this wave tracing from
The app with heart rate of 73 show a PVC? As a non doc, I can just tell that that beat is wider and looks different but doesn't have the distinct points on the bottom of some of the other weird beats. I was hoping that these were not PVCs.
I don't know why I no longer feel PVCs in my chest. Even after ablation I could feel them but now I need to check pulse to feel one. Normally I don't have them but it is worrisome that I can see them on this app while not feeling them otherwise. What if they are coming back? Until a few days ago, I almost never felt a PVC.
I will get an EKG on Tuesday with my echo. Hopefully all will be well and I will calm down.
Many many thanks,
XXXX
Brief Answer:
I would explain:
Detailed Answer:
Dear XXXX,
I carefully reviewed all the pulse recorders that you have uploaded for me and would say that most of them do not have a pulse wave form pattern of normal and even premature heart beats.
Probably only the first recording that you send me before, together with the echo reports may resemble a premature heart beat pattern.
Regarding the other strips, I am more convinced they are just artifacts.
I don't think they are premature beats (extrasystoles).
Nevertheless, as I have explained you before, we can not judge correctly about a possibility of any rhythm disturbances based only on that Iphone application.
I would not be correct and professional. The best strategy is to study the resting ECGs and if necessary Holter recordings.
On my personal opinion, your actual premature heart beats are quite rare and without any clinical significance.
I hope you will finally calm down and relax after having the tests results on Tuesday.
Best regards,
Dr. Iliri
I would explain:
Detailed Answer:
Dear XXXX,
I carefully reviewed all the pulse recorders that you have uploaded for me and would say that most of them do not have a pulse wave form pattern of normal and even premature heart beats.
Probably only the first recording that you send me before, together with the echo reports may resemble a premature heart beat pattern.
Regarding the other strips, I am more convinced they are just artifacts.
I don't think they are premature beats (extrasystoles).
Nevertheless, as I have explained you before, we can not judge correctly about a possibility of any rhythm disturbances based only on that Iphone application.
I would not be correct and professional. The best strategy is to study the resting ECGs and if necessary Holter recordings.
On my personal opinion, your actual premature heart beats are quite rare and without any clinical significance.
I hope you will finally calm down and relax after having the tests results on Tuesday.
Best regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you for your help. I am obviously very troubled by all this medical history being reviewed and my clearance being denied.
I typically have low heart rate of 50-60 and it is still so late at night but as I told you, I am having bouts of 80s, 90s the last few days, probably from anxiety. I was reading heart rate and EF are definitely correlated- if my heart is going just a bit faster than normal, could EF read lower? I imagine during most echoes my heart rate is a little higher than normal, at least at the start.
I have had tremendous stress, with my mother in hospice, my father in kidney failure and today my husband (soon to be ex husband) nearly had his arm severed at elbow in an accident and he had surgery and is now also in my care. And I have a small child and demanding job! Can stress cause heart failure?
At time of my diagnosis, my EF was just 25 but my symptoms, as we have discussed were still very tolerable and I was fully functional although now I realize there were definite signs. If I were sliding backward now- from 70-65-60- then lower, would I notice symptoms? I have excellent exercise tolerance, no swelling, and no fatigue. But I worry all the time because presumably I had normal EF and I slowly went down in heart function and didnt notice until it was very severe. It has left me with such strong PTSD, I hope I can recover.
I pray my echo and ECG will be normal tomorrow. I know I always worry but right before a test is so so scary to me.
Thank you so much,
XXXX
Thank you for your help. I am obviously very troubled by all this medical history being reviewed and my clearance being denied.
I typically have low heart rate of 50-60 and it is still so late at night but as I told you, I am having bouts of 80s, 90s the last few days, probably from anxiety. I was reading heart rate and EF are definitely correlated- if my heart is going just a bit faster than normal, could EF read lower? I imagine during most echoes my heart rate is a little higher than normal, at least at the start.
I have had tremendous stress, with my mother in hospice, my father in kidney failure and today my husband (soon to be ex husband) nearly had his arm severed at elbow in an accident and he had surgery and is now also in my care. And I have a small child and demanding job! Can stress cause heart failure?
At time of my diagnosis, my EF was just 25 but my symptoms, as we have discussed were still very tolerable and I was fully functional although now I realize there were definite signs. If I were sliding backward now- from 70-65-60- then lower, would I notice symptoms? I have excellent exercise tolerance, no swelling, and no fatigue. But I worry all the time because presumably I had normal EF and I slowly went down in heart function and didnt notice until it was very severe. It has left me with such strong PTSD, I hope I can recover.
I pray my echo and ECG will be normal tomorrow. I know I always worry but right before a test is so so scary to me.
Thank you so much,
XXXX
Brief Answer:
I would explain as follows:
Detailed Answer:
Dear XXXX!
I am sorry about the difficult situation which you are going through lately!
It is true that life can be hard sometimes, but I hope everything will be OK soon for you!
Regarding EF and increased heart rate, I would explain that heart rate does not influence on EF.
So, you should not think about it.
I am sure that your next ECG and cardiac ultrasound will be OK.
You should just try to manage your anxiety.
I recommend taking alprazolam 0.25mg three times daily during these days. It will help manage your anxiety and prevent tachycardia from panic attack.
You are not going to have heart failure again! I have explained to you that there is no chance of relapse in your case.
So, just take it easy!
Let me know about everything!
Best wishes,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Dear XXXX!
I am sorry about the difficult situation which you are going through lately!
It is true that life can be hard sometimes, but I hope everything will be OK soon for you!
Regarding EF and increased heart rate, I would explain that heart rate does not influence on EF.
So, you should not think about it.
I am sure that your next ECG and cardiac ultrasound will be OK.
You should just try to manage your anxiety.
I recommend taking alprazolam 0.25mg three times daily during these days. It will help manage your anxiety and prevent tachycardia from panic attack.
You are not going to have heart failure again! I have explained to you that there is no chance of relapse in your case.
So, just take it easy!
Let me know about everything!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you so much for your help. Ive had a stressful time lately and have been taking some xanax to relax. I hope I can relax now that I have had my echo today.
Everything appears normal except that it says mitral valve is mildly thickened and leaflets mildly calcified. I have never seen that on my reports before. What could that mean? Is that very bad? Regurg is just trace.
Also LV wall size seems to be at very high end of normal. Is this anything to be concerned about?
Thank you so much for all your help through a very stressful period of life.
Many many thanks,
XXXX
Thank you so much for your help. Ive had a stressful time lately and have been taking some xanax to relax. I hope I can relax now that I have had my echo today.
Everything appears normal except that it says mitral valve is mildly thickened and leaflets mildly calcified. I have never seen that on my reports before. What could that mean? Is that very bad? Regurg is just trace.
Also LV wall size seems to be at very high end of normal. Is this anything to be concerned about?
Thank you so much for all your help through a very stressful period of life.
Many many thanks,
XXXX
Brief Answer:
I would explain as follows:
Detailed Answer:
Dear XXXX,
I carefully reviewed your cardiac ultrasound and I am glad to confirm that it shows a normal heart structure and function.
Your LV wall dimensions are within the normal ranges.
Also the mildly thickened mitral valve and mildly calcified leaflets has no clinical significance as it does not compromise the mitral valve function.
So everything seems to be OK and I don't think that you will have any more troubles with your medical clearance.
So I would advise you to go out tonight and have dinner with a friend or your son, try to think about beautiful things and forget about this stressful situation for some moments.
Wishing a nice evening,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Dear XXXX,
I carefully reviewed your cardiac ultrasound and I am glad to confirm that it shows a normal heart structure and function.
Your LV wall dimensions are within the normal ranges.
Also the mildly thickened mitral valve and mildly calcified leaflets has no clinical significance as it does not compromise the mitral valve function.
So everything seems to be OK and I don't think that you will have any more troubles with your medical clearance.
So I would advise you to go out tonight and have dinner with a friend or your son, try to think about beautiful things and forget about this stressful situation for some moments.
Wishing a nice evening,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much Dr Iliri!
I was indeed very happy when I got my results but one thing troubled me- they had not scheduled me for EKG as requested. I may need to get it later, if medical board asks. My cardio didnt see pvcs on echo telemetry and and didnt hear any when He was examining me. Do you think that means I couldnt be having too many PVCs?
I thought yesterday would calm me completely and it did to some degree but I am anxious about possible PVCs. I am not due for another holter until next April. Last holter showed 101 PVCs. I suppose if one felt their pulse all day and was having roughly 100, you would feel them now and again. My EP said under 20,000 is a non-issue. I am trying to delete that horrible app and I know I must. It is hard not to be so frightened of a PVC when they previously weakened my heart greatly and almost killed me. But yesterday's echo was good so I know I should relax.
Thank you so much, for all your help.
XXXX
Should I insist on ECG or holter? When I submitted my test results for echo, I was not asked for EKG report. I certainly am not having 20,000 PVCs but is the difference between say 10 and 900 significant?
I was indeed very happy when I got my results but one thing troubled me- they had not scheduled me for EKG as requested. I may need to get it later, if medical board asks. My cardio didnt see pvcs on echo telemetry and and didnt hear any when He was examining me. Do you think that means I couldnt be having too many PVCs?
I thought yesterday would calm me completely and it did to some degree but I am anxious about possible PVCs. I am not due for another holter until next April. Last holter showed 101 PVCs. I suppose if one felt their pulse all day and was having roughly 100, you would feel them now and again. My EP said under 20,000 is a non-issue. I am trying to delete that horrible app and I know I must. It is hard not to be so frightened of a PVC when they previously weakened my heart greatly and almost killed me. But yesterday's echo was good so I know I should relax.
Thank you so much, for all your help.
XXXX
Should I insist on ECG or holter? When I submitted my test results for echo, I was not asked for EKG report. I certainly am not having 20,000 PVCs but is the difference between say 10 and 900 significant?
Brief Answer:
My answer as follows:
Detailed Answer:
Dear XXXX,
I understand your concern, but I would explain that if you would have any PVC the doctor would notice them during your exam.
The fact that he didn't insist on ECG, means that he came into the conclusion that you didn't need one, because your heart was functioning normally and you had a normal heart structure on ultrasound.
As I have already explained to you before, every healthy person can experience some ectopic heart beats during the day. There are more prominent during physical or emotional stress.
The palpitations you have during this period are related to anxiety. You can easily understand this as you are going through a lot of stress lately.
There is no need to perform any ECG or Holter monitoring, to ensure you that every thing is OK.
If resting ECG is needed for the medical clearance, they will ask for that and you will have to perform it, even though I am sure that it will result normal.
So, just relax!
I would strongly recommend to uninstall that unnecessary application, which is causing just some more anxiety, but is not to any help to your actual condition.
Your heart seems to be perfectly normal during this period. Try not to think about those bad thought who come forcefully into your mind.
You should try to make the difference between reality (which is that your heart is quite normal) and your bad thoughts (who are continuously reviewing the past and making suppositions for any possible re-occurrence).
Everything is going to be OK. If you try to see the reality without making any analysis, your anxious mind will calm a little and you will feel better.
Just follow the steps indicated by your doctor and the medical clearance.
I am at your disposal whenever you need me again!
Regards,
Dr. Iliri
My answer as follows:
Detailed Answer:
Dear XXXX,
I understand your concern, but I would explain that if you would have any PVC the doctor would notice them during your exam.
The fact that he didn't insist on ECG, means that he came into the conclusion that you didn't need one, because your heart was functioning normally and you had a normal heart structure on ultrasound.
As I have already explained to you before, every healthy person can experience some ectopic heart beats during the day. There are more prominent during physical or emotional stress.
The palpitations you have during this period are related to anxiety. You can easily understand this as you are going through a lot of stress lately.
There is no need to perform any ECG or Holter monitoring, to ensure you that every thing is OK.
If resting ECG is needed for the medical clearance, they will ask for that and you will have to perform it, even though I am sure that it will result normal.
So, just relax!
I would strongly recommend to uninstall that unnecessary application, which is causing just some more anxiety, but is not to any help to your actual condition.
Your heart seems to be perfectly normal during this period. Try not to think about those bad thought who come forcefully into your mind.
You should try to make the difference between reality (which is that your heart is quite normal) and your bad thoughts (who are continuously reviewing the past and making suppositions for any possible re-occurrence).
Everything is going to be OK. If you try to see the reality without making any analysis, your anxious mind will calm a little and you will feel better.
Just follow the steps indicated by your doctor and the medical clearance.
I am at your disposal whenever you need me again!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr Iliri,
I am trying hard to calm down and remember that I had a totally normal echo just two days ago. It is so hard to be calm about my heart rhythm when I had a malignant arrhythmia not long ago.
I know, once I'm sure everyting is ok, that I must delete that app which may or may not be accurate but this was my heartrate after dinner, for no other reason. I dont eat heavily, or drink caffeine or alcohol.
I am noticing these higher rates throughout the day but not all day. Usually in the 70s. At night, once calm, can still be in 50s.
So scared I am relapsing and will need to be on beta blocker again. I have been off for 9 months. My cardio said heartrate was 70 in office.
I know this has happened before, when heartrate just seemed to go crazy. Do you think this is merely anxiety?
Thank you so much,
XXXX
I am trying hard to calm down and remember that I had a totally normal echo just two days ago. It is so hard to be calm about my heart rhythm when I had a malignant arrhythmia not long ago.
I know, once I'm sure everyting is ok, that I must delete that app which may or may not be accurate but this was my heartrate after dinner, for no other reason. I dont eat heavily, or drink caffeine or alcohol.
I am noticing these higher rates throughout the day but not all day. Usually in the 70s. At night, once calm, can still be in 50s.
So scared I am relapsing and will need to be on beta blocker again. I have been off for 9 months. My cardio said heartrate was 70 in office.
I know this has happened before, when heartrate just seemed to go crazy. Do you think this is merely anxiety?
Thank you so much,
XXXX
Brief Answer:
My opinion:
Detailed Answer:
Dear XXXX,
I understand your concern and would explain that your heart rate values are quite normal.
It is normal to have different values of your heart rate through the day.
Our heart rate depends on physical or emotional stress, body metabolism, etc..
There is always a new balance between sympathetic and parasympathetic nervous system related to our body needs. This makes the heart beat faster or slower according the the body organs need for blood supply.
From the other hand, the increased heart rate at the doctors office is quite normal, related to anxiety.
So, there is nothing to worry about!
I just would recommend uninstall that application, which is causing more anxiety.
Everything seems to be OK with your heart rate. Your cardiac ultrasound is normal.
So, just relax and take a deep breath.
If you have any other uncertainties, please do not hesitate to ask me!
Greetings,
Dr. Iliri
My opinion:
Detailed Answer:
Dear XXXX,
I understand your concern and would explain that your heart rate values are quite normal.
It is normal to have different values of your heart rate through the day.
Our heart rate depends on physical or emotional stress, body metabolism, etc..
There is always a new balance between sympathetic and parasympathetic nervous system related to our body needs. This makes the heart beat faster or slower according the the body organs need for blood supply.
From the other hand, the increased heart rate at the doctors office is quite normal, related to anxiety.
So, there is nothing to worry about!
I just would recommend uninstall that application, which is causing more anxiety.
Everything seems to be OK with your heart rate. Your cardiac ultrasound is normal.
So, just relax and take a deep breath.
If you have any other uncertainties, please do not hesitate to ask me!
Greetings,
Dr. Iliri
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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