Will someone please tell me what is happening to me…

[Lynette713]

Hello. My name is Lynette King. Age 23 Ht 5’1″ Wt 142

My main symptom is heart palpitations. Started nonstop 10/27/13

First serious episode started 8/15/13. I was in the gym weightlifting. When I finished, my heart rate would not
return to normal (my heart rate regularly gets very high immediately during exercise). Also had shortness of breath, and extremities began to tingle.
I sat down, walked around, and drank water for close to thirty minutes before returing to normal. I did not go to the hospital until three days later.
In the ER, my blood pressure was 135/69. Full blood workup normal, chest x-ray normal, ekg only showed sinus tachycardia.
ER doctor said I have a “high-sensitivity to stress” and was given fluids. Told to go light on workouts.

10/27/13
Did weighted crunches at end of workout. Same issues. Went to ER immediately. Given oxygen, bloodwork, ekg. Told by doctor
it was a panic attack. I was not stressed during workout and have only had one panic attack in my life five years ago, although
I am a nervous person.

10/30/13
Chest pressure, palpitations and shortness of breath have not eased. Went to work to be sent home four hours later. Have not
been able to return to work. Remain bedridden for close to three weeks. Doctors appt in two weeks.

11/6/13
Have an attack watching TV. Heart rate increases with no cause. Drink water. Eases in 10min.

11/7/13
Went to ER after having another attack while watching TV, about 2-3pm. Ate small breakfast, had multivitamin prior to event.
ER doctor discusses with me possibilities (cardiac and non-cardiac), and does EKG and echo. Heart structure normal. Sinus Tachycardia on EKG.

11/10/13
PCP appt. Heart rate high. Doctor wants me to follow-up with cardiologist. If it is not cardiac, she thinks it is anxiety.

11/16/13
GI appt. After research, I read something about Hiatal Hernia causing these symptoms. GI doctor suggests endoscope after I see
cardiologist.

11/20/13
Cardiologist does physical exam. Says it is stress, does not recommend any tests. Does not prescribe beta blockers because of already low-normal bp. Completely dismisses my issues.

Thanksgiving
Premenstrual, so I take ibuprofen. Have a severe attack.

12/6/13
Upper endoscopy reveals mild esophagitis, hiatal hernia, and gastrititis. Perscribed omeprazole for GERD. I ask about the palpitations and whether or not it was caused by hernia She says “it shouldn’t”.

I have palpitations when I wake up, stand or walk for more than a few minutes without feeling my heart pound. I will usually sit until it passes.

I am following the GERD diet. I have not been able to eat much anyway. I have bloating and painful trapped gas, which also sets off palpitations.

Pheochromocytoma was also mentioned to me, but it is low on my list.

I know I have anxiety. I’ve always had it and it is not this. I have this lower left chest tightness 24/7. Palpitations are worse in morning on empty stomach and anytime on exertion. I cannot keep my heart rate below 100. Shortness of breath only when eating. Palps when I take a deep breath.

Please help me. I need a doctor that will listen.

My heart rate goes to 111/85 with 170bpm standing. When I went to lie down, it was 99/79 with 95bpm. I had more of the same results yesterday

[Lynette713]

Not yet. I have an appointment Wednesday with PCP. But I’ve never had these problems before, so I’ve been treating the symptoms like an injury (vagus nerve maybe?) But I am definitely bringing up these points with my doctor.

[Barbara]

Hi Lynette,
I agree with Kerryokegirl, it does sound like POTS. Other things spring to mind too, were you dehydrated ? What was the effect of the IV fluids, did it calm things down ?

You say
“Palpitations are worse in morning” we are usually at our most dehydrated then
“on empty stomach” low energy reserves, remember the heart needs energy too
“and anytime on exertion” inability of the body to meet the demand

I need to say that drinking water alone will not hydrate you, you need salt to retain fluids.
My thoughts are also with Magnesium depletion because Ibuprofen worsens this. Insufficient Magnesium has an impact on energy levels too.

I’ve also looked at your cardiac output and it seems a little askew:-

You say – “In the ER, my blood pressure was 135/69.” Were you laying down, sitting, or stood up at this point ?
I notice your ‘Pulse Pressure’ is a little high. To calculate your Pulse Pressure you simply take your BP reading and deduct the Diastolic (the second figure) from the Systolic (the first figure), so using your figures above, your pulse pressure, on that occasion, is calculated at 66.

Once you know the Pulse Pressure (PP) you can work out the Stroke Volume (SV) as follows
(SV = PP x 2) The Stroke Volume is what the heart has filled with, so yours then was 132 ml.

To calculate Cardiac Output (CO) you also need to know your Heartrate (HR) which you didn’t mention on that occasion. The formula is as follows
(CO = SV x HR) this calculates how much blood volume in Litres per Minute the heart is pumping, so lets look at your figures for standing and sitting:-

“My heart rate goes to 111/85 with 170bpm standing.”
So PP = 111-85 quite low at 26, making your SV here 52ml, so your CO = 52ml x 170, which = 8.840 L/m, so your heart was beating so fast partially to counteract the low stroke volume but all things considered, the reason was probably more than that, maybe there was some ‘blood pooling’ in your lower body and your heart was probably trying to get sufficient oxygen to your brain

“When I went to lie down, it was 99/79 with 95bpm”
So 99 -79 = 20 (PP) x 2 = 40ml (SV) x 95 (HR) = 3.800 L/m (CO)

According to the video I saw, it says “Cardiac Output very much depends on body position
and level of activity with a normal range of 4 – 25 L/min
Averages:
SITTING at rest, feet down = 5 L/min
SUPINE (laying down) or SITTING at rest, feet up = 6-8 L/min
STANDING = 5 L/min
Level WALKING = 6-7 L/min
RUNNING = 15-25 L/min

So, for instance, 5 litres per minute when you lay down is not normal, except in a disabled person. A number means nothing in itself, it depends what the demand is. Standing takes more energy than sitting, so if the amount available is the same for sitting and standing, then you are better sitting.”

So bearing this in mind, looking at your calculated figures, things are not quite right are they ?
Barbara
(UK)

[Lynette713]

Barbara,
I have taken dehydration into account. I keep a gallon of water next to my bed. I also drink Powerade some days, and ensure for breakfast every morning. All bloodwork is normal except I am vitamin D deficient.

However, with that being said, I will note that I cannot get as much fluid and nutrients into me as I would like. Eating or drinking small amounts now keeps me painfully full for hours, (either because of the hernia or because of something else).

Also palps on empty stomach only seemed to bother me in the beginning. Now it mostly seems posture related. OAN symptoms also seem worse during PMS, I can barely stand right now when I was able to walk through the grocery store last week.

[Barbara]

The fact that you are not getting the right cardiac output for your posture/activity, suggests possible autonomic dyfunction of some sort.

You say you keep a gallon of water by your bed, do you normally drink a lot ? because the effect of over-hydrating, if you’re not retaining the fluid is that you pass, in your urine, a lot of essential minerals. A blood test is not very accurate at reflecting the cellular levels of minerals. For instance, blood (serum) Magnesium can say you are ok, when at cellular level you are very depleted.

You need Magnesium to help produce energy. The gut needs energy, without it motility is slow. Often people lack B Vitamins when there energy is low too.

Have you had these symptoms for long ? Did they come on suddenly ? If so, do you know what triggered it ? Or have they come on slowly over time ? Does anyone else in your family get similar symptoms ?
Barbara
(UK)

[Lynette713]

The fact that you are not getting the right cardiac output for your posture/activity, suggests possible autonomic dyfunction of some sort.

You say you keep a gallon of water by your bed, do you normally drink a lot ? because the effect of over-hydrating, if you’re not retaining the fluid is that you pass, in your urine, a lot of essential minerals. A blood test is not very accurate at reflecting the cellular levels of minerals. For instance, blood (serum) Magnesium can say you are ok, when at cellular level you are very depleted.

You need Magnesium to help produce energy. The gut needs energy, without it motility is slow. Often people lack B Vitamins when there energy is low too.

Have you had these symptoms for long ? Did they come on suddenly ? If so, do you know what triggered it ? Or have they come on slowly over time ? Does anyone else in your family get similar symptoms ?
Barbara
(UK)

No, I don’t drink anything close to the full gallon, just because of how long it takes for it to fully enter my stomach. I would say about a third max.

My symptoms came on at the gym. After Oct they are now here all the time. That’s why my other guess is the leaning toward an injury caused by the hiatal hernia. The GI said It’s not likely, but basic anatomy says the heart and stomach are close together. Even if it isn’t the proximity, the vagus nerves in the esophageal hiatus would either be trapped against the hiatus or rubbing up against it, triggering palps.

Either way, all these potential diagnoses tend to lead back to the vagus nerve. Almost never fails.

As far as my diet goes, I don’t really eat meat (only fish) and until recently little dairy. I have mentioned this in the ER and to all my doctors that I may be B12 deficient. They all dismissed it.

I have also heard to take magnesium, and was taking multivitamins. The pills seemed to trigger tachycardia (but this was before omerprazole). He’ll, even the xanax gave me attacks 5-10 min after swallowing (since I was told it was anxiety).

POTS seems to fit to me because of the standing high heart rate. It seems to always be in the high 90-low 100s supine, 120-130 sitting, then 150-170? Standing. However, if I “overeat” or have indigestion, I will have an attack. Sometimes if I burp (when I can) it helps.

[Dr. Diana]

Lynette, your symptoms and journey sound so much like what I went through over 10 years ago! A tilt table test (and a test of catacholamine function in supine and after being vertical for 10 minutes) will help diagnose possible POTS — maybe “hyperadrenergic POTS”. Your doctors will want to rule out the ‘regular stuff’ (as you mentioned, you don’t want to miss pheochromocytoma or carcinoid cancer/ brain tumor, blah, blah, blah), so unfortunately, you have to let them put you through the ringer of normal tests first. I remember telling doctors it was if my ‘body was having a panic attack without me’. (I didn’t feel panicked or nervous, but my body was responding as if I was). Sound familiar? Please hang in through these tests, and I know folks here will all do what we can to speed up your journey to answers ASAP. Gentle hugs…

[Author]

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