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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for fluttering feeling in chest with smoking

Hi. For the past five years i have had intermittent episodes of fluttering/vibration/wobbling feeling in my chest near the left apex. It lasted for more than six months the first time and was bad enough that it extended throughout my circulation and i could 'feel' the blood moving left AND right between my shoulderblades (both lying down and when i walked). The vibration is felt not imagined but did not show up anything 'abnormal' on an ECHO (private as my doc would not refer me) except mild mitral leakage. After seventeen doctors i met a locum who detected a systolic murmur and prescribed proprnalol 120 mg daily for prophylactic reasons. I stayed on this for about a year and the internal wobbling/vibration very slowly dissipated (i quit my very high stress job and was in bed for most of the year) and eventually the symptoms disappeared completely. I reduced the propranalol down to 40 mg a day and then was able to stay off it for a year. But every six months or so, the 'wobble' comes back (it is a 'shaking' inside which is 'autonomous and i have no control over it. It is almost like a bad caffeine reaction which won't turn off but it's not a racing heartbeat; just a very strange regular vibration like the ascending aorta is bouncing up and down very slightly). The propranalol helps with anxiety but if the vibration gets really bad, i double and triple the dose and, normally, the vibration gets killed off over a few weeks and i can drop the dose back down to 40 mg. Sometimes i wonder if long-term use of Propranalol is actually causing the vibration; but apparently there is NO data on this available in spite of the drug having been FDA-approved for more than 60 years (rather strange?). Since Propranalol makes your heart 'think' it doesn't have to work so hard especially under stress, it makes me wonder what happens if you have a true underlying structural or mechanical problem; obviously, Propranalol will only mask any real cause. After fighting this for more than five years i am tired. Recently, my work has been extremely stressful (the environment is like that of an extremely busy Air Traffic Control) and my Mother passed away from cancer; but i was forced to travel 12500 km (twice) last year and this year to help her as she deteriorated, and i had to do it practically alone. A few weeks ago, the vibrations started again. They begin with a repetitive cycling and last all day; they get worse when i lie down and it takes hours for them to almost dissapear (but they do not unless i take 3x40 mg Propranalol at once)...when i turn on my left side to sleep, they get much worse and it is like there is a (loud) heavy rumbling inside my chest. They begin when i am asleep and often wake me up; and appear to be caused by sleep apnea which i was diagnosed with in 2005. But i refused to use CPAP as i felt i could never get used to it (and i only had one apnea episode lasting 1 minute and my oxygenation was normal; but i was asked to fork out $1000 for a machine and i felt i could do better). I do believe sleep apnea has contributed to a very mild structural defect which i probably have in the mitral valve; but the current situation would appear to indicate that i do not need any serious intervention (and i definitely do not want any...this is a very risky area to get involved in and in any case, i can't afford $25,000 for a mitral repair). However, i worry that over time, this vibration is indicating clearly that i have a growing (and i use the word literally) underlying internal heart problem or circulatory/pulmonary valve issue which should have early intervention. But the current status quo in the West indicates that i will be always treated as a head case or anxiety case and left to deal with this alone. That is highly disconcerting. The only thing i can think of is to get a new ECHO again (costs me $500 each time) and compare the numbers with those from the one i had a year ago; and a chext X-Ray to check shape and size. I really understand now (as i did not before) the dangers of premature/unnecessary intervention in the cardiac area; but i am also quite concerned that doing nothing will possibly exacerbate a real but untreated phsyical abnormality which is 'asking' for treatment. I can afford insurance but i am concerned that i will be denied and in any event, do not ever want to have to undertake any kind of surgery if at all possible. Note: i am a smoker of about 2 years and have been cutting back (less than 1/2 a pack a day). But the smoking actually seems to improve the fluttering...and i don't drink much caffeine or use drugs. Any suggestions as to how to eliminate this condition?
Fri, 27 Oct 2017
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Pulmonologist 's  Response
Thanks for your question on Healthcare Magic.
I can understand your concern.
Thanks for your detailed history.
You have gone through a lot of stress in your life.
Since your vibration feeling was improved by propranolol, possibility of stress and anxiety related palpitations is more likely in your case.
So better to consult psychiatrist and get done counselling sessions.
Try to identify stressor in your life and start working on its solution.
Newer anxiolytic drug flunarizine is a good drug for anxiety.
Along with flunarizine, counselling sessions will also help you.
Don't worry, you will be alright.
Avoid stress and tension, be relax and calm.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.
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