Bradycardia and SVT with PVC's Athlete very fit

[omrider]

I have been complaining to doctors and Cardiologists for 3 years about a rapid onset of Insomnia combined with pain in my heart and the feeling of a pounding heart rate and lack of energy.  I am a lifetime athlete and each time I spoke with a doctor, I was dismissed as Anxiety patient(I believe my extremely fit physique influenced the doctors to think I was just "crazy).  It took absolute persistence and advocating for myself to finally(even after a trip to ER), get my Cardiologist to listen.  Evidence showed up on my second 3 week event monitor showing that my HR is down to 34 BPM when in bed and resting often around 47 BPM and then jumps up to 100 BPM when I stand up and then I nearly pass out and I'm dizzy. Also each time I exercise my heart goes into SVT at 168-178 BMP and I feel faint, woozy, and weak.  I had one event where I woke up from dead sleep with confusion, dizzy, nausea and could not catch my breath, and nearly blacked out before my dad dialed 911.  Vitals were normal when EMTs arrived, so again they thought Anxiety... 3 psychotherapists(specializing in mood and anxiety disorders) dismissed me and said I do not have Anxiety(never had panic attack in my life). So, My Cardiologist now wants to do EPS and tilt table test... What questions should I ask him regarding his "record" on these procedures, should I risk shopping around for the best and hope another scary event doesn't occur????     Does anyone recommend an EPS specialist in the Pacific Northwest?  I'm seeing Dr. Jack McAnulty...but thinking about Mayo clinic or Dr. Natale in Austin.  Any help on this issue is greatly appreciated:) :) :)

[itdood]

TatiSD makes a good suggestion.

omrider, what are your chief concerns?  List those out in short list and attack each of the problems one at a time.  You've got a big list of concerns, and you're tying them all together in your head.  I've done similar, so I know.  It just makes for a big unsolvable problem.  Instead, divide and conquer the issues.

For instance, on the night time brady issue.  What is the actual cause of the brady?  

I suspect that it is idiopathic, else you would have heard about it.  If it's idiopathic you need not worry about a circuit issue such as an AV block.  If you had an AV block you'd know it, it's really easy to spot on an EKG.

If you know it's idiopathic, but symptomatic enough to cause you concern, what can you do about it?  write out your options.   remember that one of the options is always "do nothing and live with it".  Trust me, we are in constant change with our bodies.  Stuff will either get worse or it will get better.  If you eliminate the "it might get worse" part with testing and checkups, it has no where to go but up.  

Attack each of the problems in this manner.

Also, I think the night time brady could possibly cause the PA.  There are studies around blood CO2 levels causing PA-like symptoms.  With Brady your O2 sat will still be good but CO2 exchange might go down.  It's not a big deal.  The body's PA reaction certainly gets the job done to take care of this, with increased heart and respiration rates.  Also check for apnea.

I too suffered with anxiety/painc in my early 30s.  For 2 years, I swore there was something wrong, mostly around my brain and balance because I always felt this dizzy sensation which I interpreted to be me about to pass out.  I had MRIs, CTs, ENT visits, neurology workups.  For 2 years I did this before I accepted what was happening.   It's practically gone these day.  When I get the rare occurrence it doesn't bother me anymore.

[TatiSD]

Just a suggestion.  You may want to get your electrolytes, magnesium, potassium levels checked.  Being such an intense athlete, perhaps you're depleting minerals which in turn affect most of your symptoms.  Good luck to you.

[omrider]

Essentially they have not reported that I have a "serious" arrhythmia".  So far they have reported from just listening to my chest with good ole stethoscope, that I have "irregular heartbeat" and "extra beats".  I wore one 3 week event monitor and it mostly picked up(each night) Bradycardia(33-40s) and bradycardia sometimes throughout day(when I sit down, HR is usually in high 40's to 60).  The event monitor also picked up SVT events each time I exercised and I think a few times during "events with my girlfriend"(exercise I guess).  The first time i wore the monitor the electrodes would come off each time I went to gym from sweat and they only picked up one SVT(the day it stayed on).  This last monitor I made myself go to the gym and run outside, do yoga and live as active as possible(been exhausted so it was a challenge), but the electrodes stuck this time and almost each time I pushed myself they picked up SVT. Usually topping out around 180, but mostly in the 168-177 range.  I have done 3 treadmill tests and passed all 3 really well, however they did pick up the extra beats last treadmill.  They also say I have several PVCs through day.  The best I can explain, for example today, went to gym wore my own HR monitor and had a great workout felt almost like old self, probably worked harder than your "average Joe" and my HR averaged 135 and hit a high of 169.  I felt Goood!!! Took a short sauna and then it is the after workout syndrome I seem to get...felt shaky, had dull ached pain in heart, and it begins to feel like a slight "buzzing feeling" in my heart, this draws my energy and focus and I usually need to just sit and relax afterwards.   The separation from the past is, I used to finish a workout and feel buzzed, energized, etc...now when I finish I have less energy and stuck with pain in chest.  Feels like heart has worked too hard or something.  However I'm not doing anything more than in the past, actually quite a bit less.  So, my cardiologist is an EP also and he has taken things very slow with me, he just wasn't seeing "evidence" of dangerous arrhythmia, but after seeing the EKGS from the last event monitor something changed his tune...along with watching me lose 25lbs and continual weakness and lethargy.  Remember, I am someone who had just taken sabbatical to surf, do volunteer work, study spanish and travel, so life couldn't be better when this all came on...so anxiety or depression didn't really fit.  Yes it ***** to put your dreams on hold, but I feel so lucky to have voluntarily stopped working and only having to give up my radical sabbatical, could be worse.  However spending my life savings on heart tests and following dead ends on every other diagnosis, makes me long for a guest appearance on a "real world Dr. House episode":)  The doctors are just as lost as I am and I've realized just how complicated the human body and mind can be and how they are inextricably linked.  Another one of my biggest indicators something was up, even my yoga and meditation were effected greatly(felt the heart feeling during breathing)...been at it for over 10 years, so I am very "tuned in" to my body's signals.  Wow, what a long answer to your question..."man of few words" will not be written on my tombstone, ha, ha:) Sorry for wordy response and thanks again for listening!

[itdood]

Hi omrider,  what type of serious arrhythmia did they say you have?  What was your cardiologist's response?

[omrider]

Thanks for your message, much appreciated:)  Believe me, I sincerely hope that the event that occurred on Dec. 28th(ER visit) was a nocturnal Panic attack, the alternative is much more scary for me.  I think I'm in a position where my "gut" or instinct after visiting 3 premiere specialists in anxiety, all of whom cleared me from anxiety disorder tells me to err on the side of caution and pursue cardiac answers.  However, I am a strong believer in the mind being a powerful component in our general health and have read how scary a PA can be, so I am still open to this answer.  It just seems strange since, I never had one before this moment(under more stressful times) and since this visit to ER it would stand to reason that I'm even more at risk of a follow up PA and I have not had one since???  I know that doesn't mean I didn't have my first that morning, but the event also correlates with the exact hours on my daily heart event monitor that my heart rate drops into the 30's during sleep(20+ events auto-detected at this hour and sent to company as "serious" arrythmia).  So, when they call me and wake me up asking for symptoms, I would always say, I'm tired and maybe have dull ache in chest, but that is all. I would then feel very poorly the rest of the day.  So, it seems like I could deal with the HR going up to 110 each time I stand and feeling faint, but I can't feel exhausted each time I wake up and I think my HR going so low during the night effects the restorative nature of my sleep.  Just a theory...  Anyway, I will continue to get treatment for anxiety(receiving accupun. now and will get more therapy), but I think I might go forward with the EP study.  Again, thanks for your help and advice, it is incredible to have people who offer help.  Cheers and have a great day!

[omrider]

Wow, thanks so much for your reply:) Yes, doctors are indeed people(two of my best friends are doctors), and I certainly need to let go of my frustration and get into the positive zone of treatment and management of the "condition".  My cardiologist is also and EP and he is great, but I am the type of person who even when looking for a knee doctor, will seek out a few opinions(i.e. best technology, # of procedures, success rate), so it is in my nature to research more than the average person.  The thing that stood out to me so much was how this all has come out from age 31-34 after being a constant athlete.  The biggest symptom for me was my inability to sleep or take naps for that matter when my heart seemed to be "off track or buzzing in my chest".  I would feel my heart beat much stronger in my chest wall and feel my pulse "bounding" throughout my body.  I would surf on these days for 4 hours at times do 2 hours of yoga(pre-condition, I would sleep like baby that night) and then not sleep a wink(no mind racing, only feeling that my body wouldn't shut off).  This might go on for a week until I finally mentally and physically collapse.  Not even Ambien or other sleep meds could over-ride my system(only tried sparingly, hate pills).  Gradually my exercise and other activities were effected as I would be faint or weak while doing a short cardio session and then barely get through the rest of my workout.  Did you do an EP study?  I have literally put my life on hold because I can't do anything on a consistent basis and at this point I'm building up the courage to take on the study.  I just want to thank you for taking time to respond to me, it is so great to have others who understand.  peace and thanks again:)

[rilesnic]

I agree that it sounds like you've had a nocturnal panic attack. Symptoms of a panic attack do mimic heart symptoms.

[itdood]

You sound very anxious in your post.

169-178 bpm during exercise is not out of the ordinary.  Technically, yea it's SVT.   Sinus tachycardia is what speeds your heart when you are exercising, and sinus tach is a form of SVT.    The bradycardia would be a concern if it stayed slow when you become active, but apparently your heart rate responds normally to outside stimulus.  If you had documented PSVT, then you might want to seek treatment.

I disagree that you've never had a panic attack in your life.  You just described a nocturnal PA perfectly, when you woke from a dead sleep with what was a PA.  Nocturnal PAs are not uncommon.

I agree with the tilt table.  The EPS not so much but it's your money.

My heart will jump to 90-100 when I stand up.  Never thought much of it.  When I'm relaxed it will fall to 48ish, but I feel like I always do.  When I'm in the 40s, I can literally jump out of my chair and fly up 16 stairs in 3 leaps when my kids need me.  I'm very grateful that I can still do this.  My doc said I had brady when I sleep and asked me if I have any symptoms.  I said no, so we didn't make an issue out of it.

Can you describe why you think you almost passed out?  Was it just because you were dizzy or felt disconnected from your body, any other signs you can remember?

[chuparosa]

I'm not sure I can be of much help but I have all three conditions. However, I think it is somewhat normal for very fit athletes to have low heart rates when at rest. In my case, I actually feel a lot better when exercising. My pvcs disappear when I am doing any cardio and even walking seems to make me feel better. My cardiologist, who I just love, recommended my ep doctor. Why not ask one of your cardiologists for a referral? I understand your frustration with doctors but they are people too. You just have to be persistent like you are being. I think it's worth having the ep study to get to the bottom of things. Good luck and hope you feel better.