Aa
I'm not sure if I should seek a second opinion?
Hello all! I'll start off by stating that I'm a 24 yr old female. A little over a year ago, I began to experience palpitations. They happened very rarely, so I didn't think much of them at first. Over the course of a few months they became more frequent and worse. It got to the point to where my breathing became hitched whenever I had them and I began experiencing chest pains, so then I went to visit my PCP. She did an ekg and it came back abnormal, so she referred me to a cardiologist. The cardiologist did another ekg said it was abnormal, but he couldn't understand why, since I'm young and otherwise healthy. He ordered a chest X-ray, blood work, and a Nuc med stress test. During the time that I was waiting for my stress test, I went to the hospital because my chest pain got worse and I felt aches/stabbing pains in my arm and felt numbness. The hospital staff became worried when they saw the results of my ekg, so they admitted me, one of the nurses looked at my heart monitor and said it looked like left branch bundle block, but then they did blood work and said there was nothing of concern and they weren't going to worry about it because I was so young, so then I was discharged. Fast forward to my Nuc med stress test results, my cardiologist said "you're young, ill do a bubble study, but I don't think it will be anything, if anything I might just write this off as anxiety related" kind of annoying to hear because the palpitations I experience aren't triggered by anything. I can be sitting down, not doing anything and get hit with a palpitation or be walking around at the grocery store and they happen. I was able to obtain a copy of my results to give to my PCP, I haven't been able to make an appointment with her yet, but I read over the results and saw in the comment section of the paper that said "small fixed anterior wall defect noted in both images, ST depression consistent with ischemia, recommend do rest images" I tried speaking to my cardiologist about other symptoms I'm noticing, like how the sharp pains I experience in my chest, I'm now experiencing in my neck, where you can feel the heart beat, and how my legs go numb, almost like how you feel when you have them crossed for too long and one major thing I've noticed is that when I go to stand up, either from sitting or laying down, my leg veins feel super tight and then I get the sharp pains in them. not sure if it's related, but either way, it seemed like it went in one ear and out the other. He just didn't seem to care. I even tried to tell him about an episode that happened to me at work (I'm a physical therapist tech) I was helping a patient with one of their exercises when all of a sudden I felt extreme dizziness and the left side of my face get heavy. One of my coworkers knows I have been having heart related issues and when she saw me having trouble she came over just in time to catch me from briefly passing out. If I had no family history of heart disease, I wouldn't be concerned, I would go about my day, but that's not the case. My great grandfather died of a heart attack, my grandpa had a heart attack and has other heart related issues, and my sister was born with heart defects. I know I'm young, but I feel like my cardiologist is overlooking all of this just because I am young. As bad as it sounds, I try not to pay too much attention to what's going on, because then I feel like I'll overlook into things and make them bigger than they seem, but I just keep noticing how much harder things are becoming for me. I can't workout with ease anymore, I become tired and feel sick before I even really get into my workout and lately I've been so fatigued and weak. I know my heart size is normal because of the comments on the stress test, so it's not left ventricle hypertrophy. I'm not sure what I should do at this point. Advice would be much appreciated. Thanks in advance!
To keep things brief, I am going to quote your most relevant questions and answer those:
"Fast forward to my Nuc med stress test results, my cardiologist said "you're young, ill do a bubble study, but I don't think it will be anything, if anything I might just write this off as anxiety related"...I can be sitting down, not doing anything and get hit with a palpitation or be walking around at the grocery store and they happen."
It would be useful to educate yourself more about palpitations and their significance, and there is good, general info about this here:
https://uihc.org/health-library/heart-palpitations-frequently-asked-questions
The article lists certain things that are thought to have an effect, but the bottom line is that the basic cause is unknown. However, it IS known that most palpitations are harmless--harmless--even if terribly annoying. It is also known that they can *cause* anxiety, and that anxiety does make them worse. It is also known that they are more likely to occur when the heart rate is slower, as when you are calm and resting. The physiological reasons for this are a bit complicated, but it's worth noting that exercise will often stop palps by speeding up the heart, so that's a good reason to keep exercising vigorously if your doc has told you it’s OK.
"I was able to obtain a copy of my results said "small fixed anterior wall defect noted in both images, ST depression consistent with ischemia, recommend do rest images"
Ask your cardio guy about doing the ‘rest images’ mentioned above.
The only other test I would sort of like to see, one you haven’t mentioned, is wearing a 24-hour Holter monitor. Its advantage is that it can pick up heart hiccups that are sporadic and might not be caught by brief EKGs. However, if, when you were in the hospital, you were hooked up to continuous monitoring, a Holter probably would *not* add anything useful.
"I tried speaking to my cardiologist about other symptoms ...like ...sharp pains...in my chest...in my neck, where you can feel the heart beat...legs go numb...my leg veins feel super tight...sharp pains in them...He just didn't seem to care."
You haven’t studied the heart, but if you had, you’d know that none of these symptoms is related to heart disorders. Your doctor knows that, but he doesn’t have time to give you a medical education. He is correct, though, in that that what you describe is related to hyperawareness of meaningless bodily sensations, which is very much related to anxiety disorder. This is also true for shortness of breath and chest pain, for although most people do know that these symptoms are often associated with heart disease, they *don’t* know that the *exact* location and the nature of the pains are significant if they really are heart-related. They often honestly describe symptoms that point more towards emotional problems and away from heart trouble, rather than towards it.
"...My great grandfather died of a heart attack, my grandpa had a heart attack and has other heart related issues, and my sister was born with heart defects."
The history of older, deceased male family members with heart trouble has very little bearing on the heart health of a young female descendent without other risk factors. As for your sister, some heart defects are hereditary, and others are simply not. You should ask what her precise condition is called. Unless a doctor told you or your parents that it’s hereditary, the chances are that it is not related to what you’re experiencing.
"I'm not sure what I should do at this point. Advice would be much appreciated."
Apart from the additional imagery recommended in your nuclear med report above, and perhaps a Holter monitor, it looks as though your heart has been well and truly checked out. If these two tests are done, then I would have to say that at some point, you are going to have to accept highly educated medical opinion that your symptoms are being caused by something other than your heart.
You do sound very anxious and as if you are flirting with what is called a ‘cardiac neurosis,’ a stubborn but unfounded fear about your heart’s health. You can google it. In addition, I suggest a small, inexpensive paperback by Dr. Claire Weeks, called 'Hope and Health For Your Nerves." It addresses many of your fears.
I would suggest that you ask your PCP about the need for any more medical tests. For the sake of your mental health, I believe you should also ask her what she thinks about anxiety or panic being the cause of your problems.
I’ve been there, and I can tell you that a good shrink and sometimes a good anti-anxiety medication can give you your life back, freeing you from spending your days in pointless obsession about your heart.
"Fast forward to my Nuc med stress test results, my cardiologist said "you're young, ill do a bubble study, but I don't think it will be anything, if anything I might just write this off as anxiety related"...I can be sitting down, not doing anything and get hit with a palpitation or be walking around at the grocery store and they happen."
It would be useful to educate yourself more about palpitations and their significance, and there is good, general info about this here:
https://uihc.org/health-library/heart-palpitations-frequently-asked-questions
The article lists certain things that are thought to have an effect, but the bottom line is that the basic cause is unknown. However, it IS known that most palpitations are harmless--harmless--even if terribly annoying. It is also known that they can *cause* anxiety, and that anxiety does make them worse. It is also known that they are more likely to occur when the heart rate is slower, as when you are calm and resting. The physiological reasons for this are a bit complicated, but it's worth noting that exercise will often stop palps by speeding up the heart, so that's a good reason to keep exercising vigorously if your doc has told you it’s OK.
"I was able to obtain a copy of my results said "small fixed anterior wall defect noted in both images, ST depression consistent with ischemia, recommend do rest images"
Ask your cardio guy about doing the ‘rest images’ mentioned above.
The only other test I would sort of like to see, one you haven’t mentioned, is wearing a 24-hour Holter monitor. Its advantage is that it can pick up heart hiccups that are sporadic and might not be caught by brief EKGs. However, if, when you were in the hospital, you were hooked up to continuous monitoring, a Holter probably would *not* add anything useful.
"I tried speaking to my cardiologist about other symptoms ...like ...sharp pains...in my chest...in my neck, where you can feel the heart beat...legs go numb...my leg veins feel super tight...sharp pains in them...He just didn't seem to care."
You haven’t studied the heart, but if you had, you’d know that none of these symptoms is related to heart disorders. Your doctor knows that, but he doesn’t have time to give you a medical education. He is correct, though, in that that what you describe is related to hyperawareness of meaningless bodily sensations, which is very much related to anxiety disorder. This is also true for shortness of breath and chest pain, for although most people do know that these symptoms are often associated with heart disease, they *don’t* know that the *exact* location and the nature of the pains are significant if they really are heart-related. They often honestly describe symptoms that point more towards emotional problems and away from heart trouble, rather than towards it.
"...My great grandfather died of a heart attack, my grandpa had a heart attack and has other heart related issues, and my sister was born with heart defects."
The history of older, deceased male family members with heart trouble has very little bearing on the heart health of a young female descendent without other risk factors. As for your sister, some heart defects are hereditary, and others are simply not. You should ask what her precise condition is called. Unless a doctor told you or your parents that it’s hereditary, the chances are that it is not related to what you’re experiencing.
"I'm not sure what I should do at this point. Advice would be much appreciated."
Apart from the additional imagery recommended in your nuclear med report above, and perhaps a Holter monitor, it looks as though your heart has been well and truly checked out. If these two tests are done, then I would have to say that at some point, you are going to have to accept highly educated medical opinion that your symptoms are being caused by something other than your heart.
You do sound very anxious and as if you are flirting with what is called a ‘cardiac neurosis,’ a stubborn but unfounded fear about your heart’s health. You can google it. In addition, I suggest a small, inexpensive paperback by Dr. Claire Weeks, called 'Hope and Health For Your Nerves." It addresses many of your fears.
I would suggest that you ask your PCP about the need for any more medical tests. For the sake of your mental health, I believe you should also ask her what she thinks about anxiety or panic being the cause of your problems.
I’ve been there, and I can tell you that a good shrink and sometimes a good anti-anxiety medication can give you your life back, freeing you from spending your days in pointless obsession about your heart.
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