What could be causing heart weirdness?
September 20, 2012 7:50 AM   Subscribe

Medical advice... What could be causing extended and ongoing heart weirdness? Long-ish details inside...

My wife had a fairly sudden onset of heart symptoms about a month ago, and they've been ongoing since. At their worst, she called a nurse-line and they recommended a visit to emergency. At emergency they detected the symptoms but said: "your ECG is good." They sent her for x-rays (which came back normal) and blood-work (which came back mostly normal, except for fairly low (but not drastically) iron and low blood pressure (in the "abnormally low" range, but barely). She's scheduled for a Holter test tomorrow, but wanted to go in to her next meeting with the doctor as informed as possible. As well, the results of the test may take a couple weeks, so if she can do anything to help her heart in the meantime, she's obviously eager to do so.

Symptoms (and I'm not going to use any medical terms, in case they're not used correctly):
- Frequent skipped beats and fluttering (including beats that are sometimes weaker than normal). This isn't a once-in-awhile thing... the skipped beats happen every 5-10 seconds and go on for days.
- Occasional chest pain. This is not a sharp pain but a dull ache. It comes and goes and she describes it as a 3/10 level of pain.
- Tingling and pain in hands (worse in the evening). It comes and goes.
- Numbness and a "pulling" sensation down the inside middle of her left arm (occasionally, comes and goes, worse in the evenings)
- Exhaustion (comes and goes, worse in the evening)
- She did a fairly vigorous 20 minute workout yesterday. She felt good during, but about 30 minutes later she had noticeable chest pain for 15 minutes or so.
- Moving around seems to help -- it's worse when she's at rest.
- Bananas -- she thought it might be a potassium issue; bananas seem to help somewhat, temporarily.

Since the visit to the emergency, she's been taking:
- Iron supplements (daily) [this was on earlier advice of the family doctor] -- taken with vitamin C to help with absorption
- Magnesium (daily) [on advice of the internet, as something that has helped people facing similar symptoms]
- B12 (daily)

Additional info that may be relevant:
- Female
- 38 years old
- Taking no other medication
- Good cardio fitness and health
- Resting heart rate is, normally, around 70ish
- Vegetarian
- Thyroid was tested and no results have come back (the doctor said they would only call if results were abnormal)
- No history of heart problems in her family

- Any idea as to causes? Is this likely a condition, or a symptom?
- Any advice for how to fix it?
- Idea of how dangerous this is... They sent her home from emergency, so it doesn’t seem critical, but should she be being extra cautious?
- Should she be getting more/less exercise right now? Any other advice on things to do/avoid?

thanks so much for your help.
posted by Ziggurat to Health & Fitness (25 answers total)
I'm just going to jump in here and say that a good friend of mine had some strange heart symptoms recently and it turned out to be Lyme disease. She ended up being hospitalized. Was there a Lyme test conducted already?
posted by lakersfan1222 at 7:59 AM on September 20, 2012

My first thought was that magnesium might help. I see she is taking that. She might be able to improve on that. It should be taken with calcium in a 2:1 ratio. Calcium needs to be taken away from iron. They don't absorb properly when taken together. Calcium needs to also be taken with vitamin K and I think one other nutrient. Magnesium glycinate is considered the gold standard of bioavailability/best absorbed.

My second thought is: infection. I used to mistake some of my heart issues for low blood sugar symptoms. Treating for low blood sugar didn't always help. Someone pointed out to me that the heart also drives the lymphatic system, not just the blood. Now I use certain heart symptoms as evidence of activity in that system and have gotten better results.
posted by Michele in California at 8:01 AM on September 20, 2012

- Occasional chest pain. This is not a sharp pain but a dull ache. It comes and goes and she describes it as a 3/10 level of pain.
- Tingling and pain in hands (worse in the evening). It comes and goes.
- Numbness and a "pulling" sensation down the inside middle of her left arm (occasionally, comes and goes, worse in the evenings)
- Exhaustion (comes and goes, worse in the evening)

- Idea of how dangerous this is... They sent her home from emergency, so it doesn’t seem critical, but should she be being extra cautious?

Now I'm just a boyscout 25 years removed from earning my First Aid merit badge, but... those are symptoms of a heart attack. The ER may not have known what they are doing, and dismissing women with symptoms of heart trouble is a thing. Get an appt. with a cardiologist, soonest.
posted by Slap*Happy at 8:05 AM on September 20, 2012 [1 favorite]

I am not a doctor, but I am a heart patient.

I would try to rule out a blockage in her arteries. I had similar symptoms, good EKG, occasional pain in my chest (after exercise), normal blood pressure and routine blood work. For some reason, my doctor insisted I check into emergency room. Cardiologist insisted on nuclear stress test. Had a significant blockage that led to two stents. YWMMV
posted by JohnnyGunn at 8:06 AM on September 20, 2012

Thanks everyone so far, and just to address your point Slap*Happy... Yeah, that's the stuff that first prompted the ER visit. But they definitely did the tests and the ECG and everything looked fine. Thankfully they weren't dismissive and definitely were taking her seriously.
posted by Ziggurat at 8:09 AM on September 20, 2012

Does she drink coffee, energy drinks, or anything else with cafffeine? I get heart irregularities from caffeine.
posted by Dansaman at 8:13 AM on September 20, 2012 [2 favorites]

First thought when someone talks about heart symptoms, and everything comes back normal: anxiety/panic attack. This is NOT the same thing as saying, "It's all in her head," or that it's not serious; the pain is real, and the worry will absolutely drain you and make life horrible. And once you have one panic attack they can just keep coming, and the general everyday anxiety builds, and the brain just runs away with itself.

IF tomorrow's tests and all the rest are still coming back negative, talking to a regular doc or a psychiatrist about a low-level anti-anxiety medicine to try for a week or two, just to see if it makes a difference, might be worth checking out.
posted by curious nu at 8:14 AM on September 20, 2012 [1 favorite]

My mother recently had similar symptoms and turned out she'd had a mild heart attack. They put in a stent.

She was then sent home and it turned out she kept getting the symptoms every single EKG and test she had was fine for months afterwards and they all told her she was having panic attacks. It was only when she was in the doctors for something else and passed out in his office and they slapped the EKG on her exactly while it was happening they caught the problem. Turned out she needed a pacemaker as she would be having random arrhythmia attacks.
posted by wwax at 8:19 AM on September 20, 2012

My husband gets the same thing, he's mid-30's as well, clean EKG. He finds it gets worse during stressful times, and that getting lots of sleep and avoiding caffeine, chocolate, and alcohol helps A LOT.
posted by bluebelle at 8:24 AM on September 20, 2012 [1 favorite]

Sorry ECG not EKG I think?
posted by bluebelle at 8:24 AM on September 20, 2012

Heart disease runs in my family. Both of my parents had heart attacks. When I had similar symptoms to your wife's at a similar age, I went to the ER. They ran me through all the tests and determined I was having panic attacks. As soon as I had the diagnosis, the symptoms went away. Still, several years later when I started having similar symptoms (and had also gained a lot of weight) I went back to the doctor to get my heart checked again. I had an echocardiogram and a stress test. Once again, my heart was fine. I lost weight and the symptoms went away.

If I ever have chest pains again, I am definitely not shrugging it off and I will go back to the doctor. It's always worth checking out, but it may not be anything serious.
posted by mimo at 8:45 AM on September 20, 2012

As you can see from the answers you've gotten so far, these symptoms can be associated with a whole host of things, so it would be nearly impossible for someone on the board here to diagnose accurately. The Holter test is going to give you a lot more information to help suss this out. Basically the ECG/EKG (both are ok, it's electrocardiogram with the EKG being based on German rather than English) takes a short recording of the heart's activity, and the Holter takes a much, much longer recording. ECG can miss things if you don't happen to be lucky enough to have an episode right when the recording is happening. The Holter will give you a longer window.

I think your best bet is to share exactly what you have here with her cardiologist. They'll know what to look for.
posted by goggie at 8:56 AM on September 20, 2012 [1 favorite]

Oops! I meant echocardiogram!
posted by goggie at 8:57 AM on September 20, 2012

I get heart PVCs (skipped beats) from caffeine. (actually they are not skipped beats, they are delayed beats. It seems like a skipped beat because there is a long pause, but then there is a double beat).

In addition to the PVCs I'll have an overall bad feeling (hard to describe) throughout my body when I have had too much caffeine. It usually takes several days of too much caffeine before onset and then several days to subside even after I stop all caffeine intake. (this is based on past experience. I avoid all caffeine these days)
posted by jockc at 9:00 AM on September 20, 2012

Does she experience any shortness of breath? Does she get light-headed if she stands up suddenly? I am not a doctor, but if her heart is not performing normally, it would seem she might get these symptoms.

In any case, the Holter test should help shed some light on this situation.
posted by Dansaman at 9:11 AM on September 20, 2012

I would want her doctors to look at her kidney function.

If the kidneys aren't getting rid of enough fluid she could be having symptoms of congestive heart problems, which include fibrillation (rapid heartbeat), and fatigue; and heart/kidney problems can cause pins and needles in extremities.

Bananas are a diuretic
, and that might account for the temporary relief they give, and the low iron results could be due to simple dilution of the blood from excessive volume.
posted by jamjam at 9:16 AM on September 20, 2012

Several of her symptoms are similar to mine, and I was diagnosed via a Holter test with frequent premature ventricular contractions (PVCs). I don't get pain associated with the skipped beats, though I do get chest pain from inflammation in the cartilage of my ribs (costochondritis). My gut feeling is that for me, the two are related: inflammation near the vagus nerve, and issues with the nerve itself.

When I'm stressed, I unconsciously hold my breath or breathe shallowly, which makes the heart symptoms worse. Meditation and regularly checking in with my body has helped a lot with that. Also, when I'm fighting off the flu or haven't slept enough, my PVCs are clearly worse, especially when I'm lying down. It helps to sit up, breathe calmly, and focus on sending warmth into my hands (a relaxation technique).

Also, don't accept that silence = normal when it comes to the thyroid results. My conventional doctors claimed that my TSH of 5-something was normal when by modern standards I was hypo and I had several other symptoms of thyroid trouble. My heart issues improved a lot when I went to a more up-to-date doctor and was immediately put on thyroid meds. I can now drink coffee without getting too-crazy heart symptoms.

Finally, I felt a lot sturdier overall when I stopped being a vegetarian and switched to eating meat, more fat, and a lot fewer carbs, but that could just be my own metabolism finding its happy spot.
posted by ceiba at 9:26 AM on September 20, 2012

A couple of other things: for me, dehydration makes it worse, bananas and magnesium seem to help, and moderate exercise helps, such as walking or dancing at a decent pace.
posted by ceiba at 9:30 AM on September 20, 2012

Sorry ECG not EKG I think?

My father is a cardiologist. He regularly uses both "EKG" and "ECG" for "electrocardiogram," which one would think would be abbreviated "ECG". Indeed, "EKG" is the preferred term, as far as I can tell. It's from the German "Elektrokardiogramm." German was the major language of science up until the mid twentieth century, when certain series of world events altered Germany's status as a world power.

But as far as ECG/EKG go, the terms are entirely interchangeable.

posted by valkyryn at 11:27 AM on September 20, 2012 [1 favorite]

Did they check troponin as part of her bloodwork?
posted by shiny blue object at 12:05 PM on September 20, 2012

Yes, ECG and EKG are interchangeable, and yes that does stand for electrocardiogram. An echocardiogram is an ultrasound of the heart.

IANYD, this is not medical advice, and I definitely don't want to comment on a case like this over the internet, but I will comment on the validity of the other comments.

Re: heart attack/coronary artery disease/artery blockage, this would be extremely rare in a healthy 38 year old woman. She has zero risk factors, assuming that she doesn't have a cocaine habit you didn't mention. Her ECG/blood work (including troponin) being normal on a single check is not a reliable indicator that she does not have CAD and was not having a heart attack - but there is very little reason to suspect that as a cause, given who she is (also - it's worse when she's at rest! Meaning it doesn't get worse when her heart's working harder, like a blood flow problem would).

Re: Lyme, the heart issues associated with that typically are something that would be picked up on an EKG (specifically, heart block/conduction abnormalities).

Regarding kidney function, that is almost universally tested on everyone who gets blood work in the ER, because it is part of an electrolyte panel (kidney function tests = BUN and creatinine). They almost certainly did this and would know if it was abnormal. Also, congestive heart failure comes along with other symptoms on history and signs on physical exam, and again, is very rare in young healthy people.

I typically tell my patients who come in with new onset of palpitations to avoid caffeine and alcohol until further testing can be done.

Also, in case it helps you - there are generally 3 types of malfunctioning that a person's heart can have. One is electrical/conduction system, the second is blood flow, and the third is structural - such as a valve problem or ineffective pumping of the chambers. A problem in one of these categories can cause problems in other categories. The symptom of palpitations (heart racing, heart skipping a beat) is suggestive of an electrical/conduction system problem, so first your wife's doctors have been looking directly at that via ECG and Holter monitoring, and looking at common systemic issues that can cause conduction problems, like thyroid issues or electrolytes.

Once she has had the Holter monitoring done, and if it is normal, they may move on to looking at potential for structural issues (typically done through echocardiogram or ultrasound of the heart, which evaluates the pumping function and the valves), and then possibly to the blood flow issue, usually via a stress test (they will do this right off the bat in any patient who has risk factors for coronary artery disease, but your wife does not from what you told us).
posted by treehorn+bunny at 12:09 PM on September 20, 2012 [1 favorite]

Does your wife have an actual cardiologist who is her doctor? If not, get one.
posted by gjc at 6:15 PM on September 20, 2012

Out of all these symptoms, I had palpitations (bad ones that lasted all day) and I was exhausted in the evenings when I had Vitamin D deficiency. I didn't have any of the other problems though...
posted by Ms. Moonlight at 12:17 AM on September 21, 2012

Thanks so much everyone for all the advice an ideas, we both really appreciate it.
It sounds like there's a good chance the Holter test will be illuminating, and now she has a few good follow-up questions to ask when she sees a cardiologist afterwards. thanks again!
posted by Ziggurat at 10:00 AM on September 21, 2012

Not a doctor. I am an RN. I'm not your RN. This is not medical advice, nursing advice, etc.

It sounds like the ED covered the basics- EKG is normal, electrolytes aren't out of whack, blood work sounds like it was okay. How low was the BP? Was the top number lower than 90? If so my guess is that they would have admitted her. Symptomatic hypotension (low BP) is definitely a good reason to stay in the hospital for a couple days. Did IV or oral fluids help bring it up? Anything above 90mmHg should be adequate (though not ideal) for getting blood to the whole body.

Treehorn+bunny is pretty much dead on. You need to get a ekg strip of what's happening during these events. The 12 lead EKG that they do at the ED is just a snap shot of what's happening at that time. A holter moniter is closer to a movie. It will also be pretty annoying to wear, especially if, like me, your wife is a stomach sleeper.

Previous posters are absolutely correct that heart attacks in women are often missed, but that's mostly due to the symptoms that women get. Women often present with abdominal discomfort, or other non-"classic" symptoms. That's, so far, not an issue with your wife. When I worked in the ED we did 12 lead EKG's like it was our job (oh wait, it was). My point being that we pretty much did EKG's on everyone who had any sort of torso/abdominal discomfort that wasn't obviously traumatic.

Anyway, I hope you guys get to the bottom of this.
Good luck.
posted by brevator at 9:55 AM on September 22, 2012

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