I have some symptoms of serious heart conditions. How urgently should I seek a medical opinion?

July 26, 2008 10:11 AM

I'm a 29 year old female. I've had a pretty significant arrhythmia for about three years. It's unpredictable, but quite frequently my heart beats much faster when I inhale and then very slowly as I exhale, and also otherwise irregularly. I also have several other concening symptoms.

I had a baby about a year ago, and while I was pregnant my midwife sent me to a doctor to get this condition checked out. The doctor gave me an EKG, said that the actual beats of my heart looked healthy, and that she couldn't explain the irregularity but wasn't concerned. I also had started to have a tiny bit of chest congestion when lying on my back at this time, but the doctor attributed that to the extra strain of pregnancy and was still not concerned, so I didn't think much more about it.

Since having my baby, the congestion has increased somewhat rather than decreased. I always kind of intended to get it checked out eventually, but I did a little research yesterday and realized that these are actually pretty scary symptoms. I am definitely going to go to a cardiologist, but my question is, is this (and would my health insurance plan consider this to be) an emergency? Is it fine to wait until monday, when most health services will be open? How long should I be willing to wait after that for an available appointment, before I consider seeking emergency care?

Besides the symptoms mentioned above, I have occasional palpitations, sometimes as frequently as daily, sometimes more like once a month or less. also, about four months ago I woke up with a stabbing chest pain, but since it resolved itself within a few minutes I didn't think too much more of it. I haven't been particularly fatigued or had pain at other times.

Bonus question: when I do see a doctor, what questions should I ask to make sure they take my concerns seriously and figure out what is going on?

posted by lgyre to health & fitness (16 comments total)

How about calling your GP (General Practice) or Internist and asking he/she what THEY think? They know you better than we do, and can better guide you. Even if another physician is covering the call, they will be able to better field this question than someone on the internet.

I wish you the best.
posted by 6:1 at 10:34 AM on July 26, 2008

Maybe this is what 6:1 is saying, too, but your insurance company/doctor may have some kind of service for over-the-phone advice about what's an emergency when it's after hours.
posted by Airhen at 10:46 AM on July 26, 2008

If you need a referral for your particular insurance, call your GP. She will probably refer you to a cardiologist.

This question is very difficult to answer because none of us can advise you on something as serious as a cardiac problem or emergency. If you believe you are having a cardiac emergency, call 911. Most likely, you will *know* when you are having an emergency.

Also, try not to read the internet about signs, symptoms, etc. They can be alarming, misleading, and cause more stress than they are worth.
posted by LoriFLA at 11:02 AM on July 26, 2008

well, i think you're more worried than you were before, because you have more information (and not necessarily the right information). if you think you're having an emergency--are you having any distress, or have your symptoms increased markedly in the past few days?--go to the ER.

if you are just realizing that you may have had a serious problem untreated for three years, it may feel like an emergency, but it isn't. wait until monday. in the meantime, take it easy and don't run any marathons.

for the doctor, list all of your symptoms, including what seems to bring them on and what helps alleviate them, and bring the results of the ekg. good luck!
posted by thinkingwoman at 11:23 AM on July 26, 2008

Ok, so you don't have daily symptoms of shortness of breath, palpitations, heart racing, difficulty exercising, lightheadedness, dizziness, fainting, nausea and vomiting, room-spinning, fever, chills, etc. The fact that these symptoms are not always with you are a good sign. However, the fact that they occur occasionally in someone who is (presumably) otherwise healthy is worrisome. I would do the following:

1) Write down your exact symptoms. When you felt them, what you were doing, what they exactly felt like. Any associated feelings? What you did to make them feel better? Etc. Be as detailed as possible. Your doctor will weed out what is important.

2) Get to your Primary Care Physican ASAP. Say that you have these problems and would like to get extensively evaluated by a Cardiologist. Yes, these symptoms could turn out to be "nothing". However, you have every right to get a thorough evaluation and explanation by a Cardiologist that satisfies you. This is what you pay health insurance for.

Good luck!
posted by ruwan at 1:33 PM on July 26, 2008

i'm about your age (30) and have paroxysmal atrial fibrillation for about three to four years now. i'm not sure that's what your facing but it's fairly common and very manageable and you'll get similar advice/treatment for many arrythmias. when it first started happening it was scary as heck, my heart would beat out of my chest and i'd sometimes get lightheaded/dizzy enough that i thought i'd fall over. the fear of it just made it worse and happen more.

if it is afib, getting in to see a doctor is important but probably not life-threatening. if it's not always happening, they may give you a holter monitor, which is just like a time-loop ekg that you wear 24-7. when you think your heart is doing something funny, you press a button and it saves a minute or two before and a minute or two after. this lets them really get a feel for what your heart is doing and how to treat it.

one of the other good things you can do now is to join an atrial fib group - i joined this one and while i think i only posted once the group is really good about helping new people understand that it's not the end of your life as well as the options available to you, from medications (i'm on toprol xl) to procedures. it's good to read about people going through something similar and people that have gone through something similar that can tell you 'you're going to be alright'.
posted by noloveforned at 2:44 PM on July 26, 2008

Relax.

Breathe. This is in all probability not an emergency. You'll be fine until Monday. In fact, you'll be fine in general.

I have atrial fibrillation too. (I am quite sure this is what you have.) Yes, it can be a little scary. It's been perhaps 20 years since the symptoms manifested (I am 58) and I was undiagnosed for about five years. My cardiologist assures me that this is not a life-threatening situation. I was even off meds for a year and a half or so and although my heart did a lot of drum solos in that time (yeah, it was sometimes a bit scary, particularly at night when I was lying in bed with my heart thundering in my chest, wondering if This was It) I was never incapacitated and essentially did not reign in my busy life.

My symptoms are under control with aspirin and Vytorin, although I was on coumadin for a while and a few other things while the docs figured out what was going to be the best way to proceed. Now my heart occasionally does the old buck-and-wing, but never for more than a minute or so unless I am dumb enough to do something like down three or four shots of vodka in a row. Then it gives me some shit for a while.

By all means, talk to your Primary Care physician as soon as you can, but in the meantime, relax. You'll be fine.
posted by Guy_Inamonkeysuit at 2:52 PM on July 26, 2008

Respiratory sinus arrhythmia can cause symptoms similar to some of what you describe. It is actually normal and healthy; decreased heart rate variability is a sign of disease. When you go to a cardiologist/other physician he can tell you what you actually may have as opposed to the random thoughts of strangers on the internet. I could give you a whole list of scary but unlikely diagnoses but there is little point in that. There is no way to tell whether or not this is an emergency over the internet; you have to trust your own judgment there. In general something that has been going on over a year is not likely to be an emergency, but if it has gotten suddenly worse it might be more serious.
posted by TedW at 3:24 PM on July 26, 2008 [1 favorite has favorites]

Another one here with some arrhythmia experience. I will echo other comments that it can be a scary thing, but in most cases, not necessarily medically dire (or even significant).

Several years ago, during a time of major life stresses (major changes, anxiety) I experienced an episode of "lone atrial fibrillation". I think that "lone" meant they found no underlying physiological problem. It happened in the middle of the night, and basically my heart started beating wildly -- both very fast and without a proper rhythm. I was extremely freaked out (which surely didn't help), figured it was "the end", and called emergency. Long story short, they eventually "rebooted" me with a quick jolt and all systems instantly returned to normal. It was pretty wild. While at the hospital, they did explain that the risks from being in this highly arrhythmic state were actually quite low. Apparently it is somewhat more commonly seen in old people (I was early 30's), some of whom experience it as a regular and ongoing situation. For them, there are increased risks of clotting due to the effects on circulation from irregular pumping, but they weren't terribly worried about this in a younger person.

Prior to and after this episode I have also been known to experience flutters -- very brief period of "fast/weird" beats -- that last just a few seconds. I've been told several times by docs that it's nothing, common, and benign, even though it does generate a quick jolt of adrenaline and accompanying anxiety.

Following the lone atrial fib episode I began several medications -- cardizem and a betablocker -- both to address this and high blood pressure. These have significantly reduce the frequency and intensity of the "fast/weird" flutters. They still happen from time to time, but I've learned (mostly) to accept them as not a big deal.

One little self-test I remind myself when the flutters happen is that the rest of my body is still functioning normally. For example, if they happen while working out, I can continue working out. Clearly, blood is flowing, muscles pumping, body functioning.

Of course, none of us can diagnose your situation. But I did want to echo the idea that there are (somewhat common) conditions that involve symptoms you describe and that are not medically serious, though they can be scary.

Sorry that went on long.
posted by thebordella at 4:15 PM on July 26, 2008

Like TedW said above, I'm pretty sure your heart rate is supposed to change when you breathe in and out (i.e. Respiratory Sinus Arrythmia).

About the palpitations thing - I have something called Premature Atrial Contractions that is apparently pretty common. It feels like a sudden strong beat out of nowhere (sometimes I can feel it in my throat) and then some erratic beats for a few seconds. The doctor says it's harmless, so not all strange heart sensations necessarily mean something is wrong. I feel it with more or less frequency depending on a lot of factors like alcohol, body position and lack of exercise.

Until you do see a cardiologist and get some real answers, please don't allow yourself to obsess by checking your heart rate constantly and trying to self-diagnose, because that just leads to stressing out all the time. Plus, make sure you get some good closure from them -- you don't want to worry about it forever. In my case, having a name for it helped me stop worrying. Good luck!
posted by Post-it Goat at 5:43 PM on July 26, 2008

if it is afib, getting in to see a doctor is important but probably not life-threatening.

True! Strokes from a-fib usually only leave half your body permanently paralyzed, often with loss of all ability to receive or express language as a bonus! Your life is in no danger at all, at least not in the first day or two.

Thanks for the stupid advice, MetaFilter!

quite frequently my heart beats much faster when I inhale and then very slowly as I exhale,

This is normal.

palpitations / increasing chest congestion / stabbing chest pain

These are not normal. It will be fine to wait until Monday for this, unless it is not fine and you die from an arrhythmia in the meantime. Nobody on this website can say whether you will or not. If you go to the emergency room with these complaints you will receive an EKG.

For your information, in your age range cardiac arrhythmia is the second most common cause of sudden death, after traumatic injury (mostly car accidents.) You are getting warning shots across your bow. If your steering con rod had broken with a loud *BANG*, would you still be going 75 mph on the freeway?
posted by ikkyu2 at 9:30 PM on July 26, 2008 [3 favorites has favorites]

Call or see your GP. Tell him/her (don't ask, tell, but do it nicely) that you would like a referral to an electrophysiologist rather than a cardiologist. Electrophysiology is a sub-specialty of cardiology, and EP docs specialize in rhythm disorders. In my experience, it's harder to get in to see an EP without your regular doc opening the door first. It is uncommon for someone your age to have a "heart condition" the way most people think of one (i.e. blood pressure & cholesterol issues), but it's quite common for someone your age to have rhythm issues. I am in no way a doctor, but I have worked in cardiology for 18 years, with the last 8 in EP. You know your body better than anyone, and if you don't feel right this weekend, go to the ER. And if the arrhythmia kicks in this weekend, go to the ER. It's a huge help to the EP doc if you have the arrhythmia documented on an EKG so he/she knows what he/she is working with. The Heart Rhythm Society is a good place to look for an EP doc, and make sure he/she is board certified in Clinical Cardiac Electrophysiology. Feel free to mefi-mail me if you like.
posted by dogmom at 10:22 PM on July 26, 2008

Lgyre, you need to ignore every single other piece of advice in this thread and read ikkyu2's. He may not be your doctor, but he is a doctor, which makes his advice more professionally qualified than anyone else's in this thread.

(And I assume you read through the satiric tone to realize that he's advising you to go to the emergency room.)

For what it's worth, this layman agrees with him. Hell, for my own completely selfish piece of mind, I'd push for you going in as an emergency, just because if you die this weekend I don't want to be plagued by the thought it was a result of my advice.

Please go. Please go now. It may not be an emergency, but look at it this way: if it is not an emergency and you go, what's the worst-case scenario? An extra outpatient hospital visit onto the course of treatment for this condition, covered by any sane medical insurance. If it is an emergency and you wait, what's the worst-case scenario? Death.

I know which one I'd risk having, with a choice between the two.

(on preview: dogmom's advice looks useful — but an immediate E.R. visit is nonetheless highly recommended, but don't "ignore" her advice as I suggested in the first paragraph)
posted by WCityMike at 1:51 AM on July 27, 2008

He may not be your doctor, but he is a doctor, which makes his advice more professionally qualified than anyone else's in this thread.

He is also not the only physician in the thread.

And to add a little to his answer: Palpitations and short, stabbing chest pains can be pretty common and may be self-limited and benign or symptoms of something more serious. And does the original poster mean the same things a medical professional does when she uses these terms? Without a one-on-one conversation it is impossible to get all the information one needs to assess these things. The congestion, on the other hand, is more concerning, mainly because it is not getting better. But once again, what does the poster mean by "congestion"? Does it still get worse when lying down? Is it suggestive of a pulmonary condition rather than a cardiac one? Would a chest x-ray/CT be more useful than an ECG? Once again, these questions cannot be answered without an actual history and physical exam. It is never bad advice to say "go to the E.R." but the reality is that it may entail a prolonged wait and a lot of out-of-pocket expense for many people ("sane" and "medical insurance" are words not often used together in this country). The other reality of a weekend ER visit is that you are much more likely to receive a lower quality of care at night and on weekends, and thus the poster may be better served by waiting for a regular appointment. That is where her judgment is needed; most patients can make the call whether or not to go to the ER without any advice from the internet.

As to all this talk of a-fib, yes it is potentially very serious and not to be taken lightly, but there is also no way to know if that is the problem here based on what the original poster said. As I mentioned in my original answer there are a whole host of things that could be going on ranging from very serious to normal, but giving a lengthy list of "it might be this, that, or the other thing" is not likely to be helpful. I hope the original poster follows up and lets us know how she is doing.
posted by TedW at 4:01 AM on July 27, 2008

I assume you read through the satiric tone to realize that he's advising you to go to the emergency room

No. I don't give medical advice to people who aren't my patients. I don't give any advice to this person, because there is no doctor-patient relationship.
posted by ikkyu2 at 11:31 AM on July 27, 2008

ikkyu2: "I assume you read through the satiric tone to realize that he's advising you to go to the emergency room

No. I don't give medical advice to people who aren't my patients. I don't give any advice to this person, because there is no doctor-patient relationship."

I stand corrected. Sorry, I know that's a loaded verb for doctors.
posted by WCityMike at 10:17 AM on July 28, 2008