My apologies in advance for the long story and the many questions...
My story: I'm 22 yrs old, woman, non-smoker, not overweight, fitness level is not super but okay.
I sometimes have arrhythmias, they don't bother me, even though I can feel them, but to be sure there was no problem I went to a specialist. Bike-test, echo and ECG. I coincidentally had an arrhythmia: ventricular extrasystole. Harmless according to the doc. Bike test was good: 100-125 watts to get my heart beat up to 160. Echo: very slight prolapse of (mitral?) heart valve: it still closes perfectly, no murmur, no regurgitation. But the doc freaked about my heart rate though: 100-110 before even starting the bike test, 120-125 when talking. It went down to 88 at the end of the exam. Diagnosis: high heart beat, and also a very variable heartbeat. Sympaticotonia: overreactive heartrate, and bloodpressure, very stressreactive. Doc suspected overactive thyroid, but the tests were fine. He prescribed betablockers: Inderal (propranolol) 20mg/day. Let me just mention: I don't like the fact that he prescribed betablockers that quickly. Especially because the doc said I don't have a problem, but I could POSSIBLY have a problem in 15-20 years time.
Usually: resting heart beat (flat on my back, right after waking up) 70, 80-90 sitting up, 100-120 when stressed or during light exercise. So the situation in the doc's office wasn't average, but he took it to be average.
He also mentioned I shouldn't go above 160, because it's my submax heart beat (my max is around/above 200)
A week later I joined my boyfriend for his exam. To my surprise the doc started examining me! Hyperstress of course: high heart rate AND arrhythmias. (I swear I saw joy on the doc's face to find something wrong with me) Anyway, again the betablocker thing came up: "you have to take betablockers if you have a lot of extrasystoles" etc.
While I would prefer to find a more "natural" solution, I don't like taking medication on a "whim".
My questions: do I really have a problem? What risks would I run if I didn't get treatment? Should I worry about the prolapse getting worse? Why shouldn't I go above 160? Or is he overly careful? Would meditation and improving my fitness level be a good alternative treatment?
Also I've been taking the Inderal, but more as an experiment: to find out what the effects are, so I can compre with alternative treatments. I've been taking 10mg per day. Effects: lower resting heartbeat, when exercising my heart rate sometimes seems higher tha normal, sometimes lower, less stamina than before, an oppressive feeling (like I can't breathe enough, like hyperventilating) and MORE arrhythmias (more than I've ever had) Are there others who've had this opposite effect?
The only thing I think you have to worry about is whether your doctor knows what he's doing!
It doesn't sound like you have any sort of significant heart problem, so it seems odd that your doctor was so aggressive about putting you on medication (I wouldn't like that either). It was my understanding that beta blockers were only used to increase patient comfort, and that they don't make you any safer, so it's better if you can tolerate the symptoms and not take them. Can anyone tell me if that's correct?
Your heartrate might be a bit fast, but it doesn't sound all that bad. Before my stress test, I was very nervous and my heartrate and BP was up a bit. They also referred to me as a "stress responder", but they didn't seem concerned. If your heartrate came down to 88, after being brought to 160 with exercise, that seems quite normal to me.
What sort of problem does he think you could "possibly" have in 15-20 years? Is he saying the beta blocker is going to prevent that? I don't know, I think you need a second opinion.
Are you seeing a cardiologist, or a general practitioner? If it's worrying you, you'd probably feel much better seeing the former. You didn't mention wearing a Holter monitor, and if that's the case, how can your doctor know how many irregular beats you're having?
I don't think you should worry, but I do think you should think about getting some better medical advice.
Don't let it get you down, and have a great weekend
The doc recommends a holter test, but without writing down what I'm doing, eating etc. Which seems unprofessional, no? He's not a cardiologist or GP, he's a doctor of internal diseases (sorry if this is the wrong wording, I don't know how to translate). And he has several Phd's as well.
The risk long-term was heart enlargement I think...
Anyway, the second exam he did simply GAVE me extrasystoles, pure stress, but the doc has got it in his mind that it's constantly like that. And a holter won't be for the near future, I've been having sooo many arrhythmias since the betablocker that he's totally freak out and give me bigger doses
If betablockers are for patient comfort, then I sure as hell shouldn't be taking them. MORE extrasystoles instead of less (and the extrasystoles don't even bother me, even though I can feel them). I feel anxious. (the doc sais Inderal would make me calmer, yeah right) Less stamina and endurance (the doc said I'd have more endurance) I want my blood results, and I don't think he'll be seeing me again...
I'm sensitive to stress, which is my heart problem, and this doc has only given me more stress by making me feel like I could drop dead any second, while I felt healthy before *sigh* (One thing I appreciated though: he did all the tests WITH bra on, so another doc will have to do the same, I ain't going topless :-) )
Oh yeah, some other things... My dad has the same thing as me, fast heart beat, and my mom too... Though I do think I'm in better shape than them :-)
Anyway, aside from the stress sensitivity, there's a clear link with my breathing: my heart beat is a lot quicker while breathing in, compared to breathing out. And if I get arrhythmias, holding my breath will make them go away... Strange... But nice to know I can control them... :-)
First off, this is the realm of the cardiologist. Your internist is getting in over his head.
Often a high heart-rate in the young is just a sign of being unfit and some regular exercise will get the resting rate down quite a lot. Athlete's typically have resting heart rates near 60 and couch potatoes MUCH higher.
Propranolol is a short acting beta-blocker and 10 mg. is a tiny dose although it can be fatiguing for up to 6 hours after taking it. Even that small dose will lower your resting and exercise heart rate and decrease the occurrence of extra beats. I'd say, take it if it feels good or leave it if it doesn't.
But DO getr on a good exercise routine, both aerobic and anaerobic if you have the time and inclination...otherwise go aerobic (daily running, biking, long swimming and the like!)
As you age, your heart-rate is likely to decline naturally.
As the BEST supplement, take daily magnesium...start with 500 mg. and if that does the trick, taper back to 250 mg. Any magnesium compound that provides enough is okay. MgO is probably the cheapest in the health food store.
Since you are speaking of exercise in WATTS are you UK?
Maybe a Holter is a good idea? Your doctor is thinking that perhaps writing things down might make you anxious and skew the test???
"Often a high heart-rate in the young is just a sign of being unfit and some regular exercise will get the resting rate down quite a lot. Athlete's typically have resting heart rates near 60 and couch potatoes MUCH higher. But DO getr on a good exercise routine, both aerobic and anaerobic if you have the time and inclination...otherwise go aerobic (daily running, biking, long swimming and the like!)"
Well, I know I'm not terribly fit, so definitely room for improvement there :-) I'm taking up running, and I'm already a member in a gym, so things should get better soon...
QUESTION: should I limit myself to a heart rate of 160, or can I go higher? 160 seems so low, and I thought anaerobic was above 160.
"Propranolol is a short acting beta-blocker and 10 mg. is a tiny dose although it can be fatiguing for up to 6 hours after taking it. Even that small dose will lower your resting and exercise heart rate and decrease the occurrence of extra beats. I'd say, take it if it feels good or leave it if it doesn't."
Feels bad. I took 10mg for a while, then increased the dose to 20mg. Felt bad, and INcreased extra beats.
Also, I just noticed: I forgot to mention that my extrasystoles don't happen while I'm exercising, only when sitting still. So they're harmless, yes?
"As the BEST supplement, take daily magnesium...start with 500 mg. and if that does the trick, taper back to 250 mg."
I've still got magnesiumsups around, so that should be easy. Cheap too...
"Since you are speaking of exercise in WATTS are you UK?"
Nope, I'm in Belgium... Poor little Belgium ;-)
A week after the bike test at the doc's, I did 100 watts on an indoor bicycle on my own, and my heart rate didn't even come near 160. Is this normal, the difference?
"Maybe a Holter is a good idea? Your doctor is thinking that perhaps writing things down might make you anxious and skew the test???"
A holter in itself would make me anxious, I'm positive my heart rate would be higher than normal, and probably more extrasystoles too...
The doc simply wants the Holter to see how many extrasystoles I have. As for the fact of not having to write down what I'm doing/eating etc.: I don't think it's because it would make me anxious. My boyfriend didn't have to write those things down either. Just unprofessional I guess...
Anyway, maybe I'll do the Holter thing after the side effects of the propranolol are gone AND my fitness level is higher.
Should I worry about the mild prolapse? I'm worried that going above a heart rate of 160 could make the prolapse worse. The doc said I shouldn't go above 160, but I'm not sure if this was general advice, or advice specifically for me.
You sound exactly like me. My doctors told me the very same thing. I think they give out general information for mitral valve prolapse. Your symptoms are textbook, and apprently there is nothing to worry about. Stop taking the Inderol if after three months you don't see any positive change. Also, birth control pills can aggravate the MVP if you're taking them maybe try an alternative method. I was told that this is generally a "normal" occurance in young adult females and that the only time I should worry is if I started to feel pain shotting down my arms or up into my jaw with a tightening of the chest. Otherwise all you can do is excercise regularly and find a way to control your stress and anxiety.
One other thing, they said it won't go away if you have MVP. It'll just calm down and flare up again depending on how stressed you are. I've been having pretty bad symptoms for 5 months now. Good luck!
personally i dont think your doctor is right. I think your heart is fine. My reasoning for believing this. When you are worrying about your heart, especially if you are worrying about it being tachycardic, your HRV increases soo much. hrv is heart rate variability. for example, when i excersize on days i dont worry aobut my heart, my heart is fine, but on the days when i start for no apparent reason to worry and get anxiety over it, my heart rate increases too quickly and takes it forever to go back down. i disagree with your doctor and i think that your heart and its variability is fine. Suggestion: buy fish oil supplements, they help your heart out so much.
No, don't worry. My mom always said worrying never solves anything, be proactive, not reactive.
I also disliked my physician dispensing meds without further testing and, when he did, I refused to take them. Maybe I'm dumb but I'm 60 and still here, feeling okay without all the meds prescribed over those 40 years (that I didn't take!) Note: I have a new physician and I do like and trust him.
I recently had a situation, regarding doctors, similar to yours. My internist sent me to a cardio guy, the cardio guy said I needed a pacemaker after looking at Holter Monitor results and when I went for the second opinion to a cardiologist/electrophysiologist he said a pacemaker wasn't necessary. My only option is to get a third opinion if I am still concerned.
Stars, I would not ignore my symptoms though. If you think something is wrong you should get further testing from a board certified cardiologist associated witha good hospital. I had crazy symptoms for ten years, from 1984 to 1994 and after about 30 opinions, all wrong, I found out that I had late stage lyme disease. Prior to that they were suggesting a therapist as it was 'all in my head'. I know my body and I KNEW something was wrong.
You won't get false Holter Monitor results when you're sleeping as you won't be thinking about it and that's when all of my arrythmias showed up, during sleep! Suggestions regarding the Holter Monitor are probably good advice. It doesn't hurt, you'll forget it's there and no matter how much you stress about it during the day, as I said, when you are relaxed and asleep you can't fool the monitor!
I know how you feel as I have been stressing over these very different diagnoses for a few weeks now; all it does is make me feel worse and when I stress I go into a panic mode and I get worse and on and on.
The best advice to you that I read is regarding your doctor. Perhaps looking for a new physician would help. It seems you don't have much faith in his judgement and, if that's the case, you'll never be without stress and will always be second guessing any diagnosis he makes.
There's a wondeful site on the internet. Go to Google and then put in Cleveland Heart Clinic Forums. A doctor from the Cleveland Heart Hospital, number 1 heart facility according to US News and World Report (for about ten years in a row) will answer your questions. Note: This site is very hard to post on. The best time to attempt to post is about 10:00AM Eastern Standard Time. (I don't know what time that is in your location) They take only a few posts a day so that the physician can answer all of them. Keep trying. It's worth the peace of mind to hear from them that all is well. If he thinks something is amiss he'll tell you that also.
You can write up your question in Word and then be ready to cut and paste to the forum when you finally get in. Check the rules of the forum first. There's a limit on the number of characters you can use but it's more than enough to explain your concerns.
Stars, just think about this. Thirty years ago, when I first had some medical problems, I worried every day. I wish I hadn't wasted that time and just went out and had fun. I look back on that today and think how I'm still here and how worrying did nothing but add to my woes.
I just watched Forrest Gump again. His mom was right. "Life is like a box of chocolates. You never know what you're gonna get." So have fun and when you're sixty years old you'll have no regrets. Good Luck. Linda
Wow, I hadn't checked the boards in awhile, and I have some replies! :-)
Well, maybe an update is in order... I stopped taking Inderal after about 6 weeks because I constantly felt lousy from all the side effects and MORE extrasystoles. I never saw the doctor again, because I don't trust him and feel that he treated me with disrespect. My boyfriend told him about how the beta-blockers gave me more extrasystoles. His reaction? He basically said it was my own fault, that I had been stressing out about taking the medication, etc. Made me furious, a doctor who thinks he can judge me, and thinks he knows me, after having seen me for an hour in total. And he was soooooo wrong too. Good riddance.
I decided that, since I feel perfectly healthy, I'm going to live as a healthy person. I've started running to improve my fitness level, and I'm trying to lose some weight. Also I'm going to start deep breathing exercises, to make me more relaxed, and because I have the feeling that the extrasystoles are linked with shallow breathing.
Maybe I'll go to a specialist in a couple of years time, but not anytime soon.