Homme de 26 ans souffrant de palpitations cardiaques sévères mais les médecins ne parviennent pas à poser de diagnostic AIDEZ MOI

Santé cardiaque et vaisseaux sanguins
1

Hi,

I’ll tell you a little bit about myself, please dont judge me. I am a 26 yr old male who gets severe heart palpitations after working out. This occurs a few days after working out and varies in severity. It has now been an ongoing issue for over 2 years and I am at the point of losing all hope, it’s making me so incredibly worried and depressed and I have nowhere to turn. I feel have exhausted all channels available to me (Which took so long because of damn COVID) consisting of hospital tests and my own research which have been dismissed by my GP. This is my last resort to get answers, which I never thought I would have to do.

I have had blood taken, 24 hour ECG and 48 hour ECG and an ultrasound and I have just opened the letter back from the doctor telling me that the ECG results were “Essentially normal”. I feel the 24 hour ecg was worthless as I got practically no palpitations, 48 hour ECG maybe showed 30-40% of how bad the palpitations / frequency could be and the ultrasound was a quick 2 minute thing and I got no palpitations at all and got told that it looked completely fine.

What I am feeling is absolutely NOT normal and having the doctors doubt me and tell me I am fine is making it all so much worse at this point.

The worst of the palpitations come on after I have been working out (about an hour workout). But they come about 1-2 days AFTER working out. The best way I can describe it is: I get a sensation in my chest before the palpitation that feels maybe like a build up of pressure and the beat takes longer than any others to finally happen. Then my heart does a very forceful beat (The palpitation) and loads of rapid small beats that follow. Sometimes they are incredibly bad and regular (after working out) and others are bearable.

My work can be quite physically demanding and I have, on numerous occasions got slight twinges of pain in my chest (left side) and I have had severe shortness of breath before where I am breathing so heavy and it doesn’t feel like the air I am breathing is actually being absorbed into my bloodstream and going to my muscles properly. I have felt slightly feint during these times (sometimes worse than others) but I have not had anything serious happen yet.

I have been prescribed Propranolol (40mg) which help, but definitely does not cure the issue.

I have an appointment at the hospital for 2 weeks time to undergo an exercise test, for which I will be working out over the next few weeks (as much as I feel is safe / as much as my heart permits before the palpitations get unbearable) in order for the test to hopefully bring something to light.

I am losing my mind over this issue and my whole life is revolving around me being worried, frustrated, not looking forwards to the future as each day my emotions are solely dictated by how bad these palpitations are. I am wondering whether the hospital looked at my ECG closely enough as in the second one there were DEFINATELY a few quite bad palpitations and one really bad one.

Like I say, I can not workout with my heart the way, out of fear that the palpitations will be so bad I will have a heart attack or pass out at work. I am at the end of a dark tunnel solely because of this going on in my life and have nowhere to turn. If it wasn’t for this I would be at quite a happy point in my life with a good job and future prospects looking relatively good.

Can somebody that has had a similar experience or similar symptoms please get in contact and speak to me or even reply to this message as I am so desperate right now and feel like the hospitals just dont believe what I am going through.

I have thought about possible things such as Sick Sinus Node Syndrome and a Mitral Valve problem but this is just from research I have done on the internet.

Further info: I have not drunk alcohol in months, I have had problems with this in the past but right now I am trying to be as healthy as possible. I do not smoke, I quit smoking 2 years ago. I have recently started vaping because I am so god damn upset with this issue in my life. (The issue is present when I dont vape as I have spent 1.5 years smoke and vape free and the issue was still there. I try working out regularly, but this issue does get in the way and I can not work out more than once every week or 2 because of this. It is seriously impacting my quality of life.

PLEASE HELP! Thankyou.

2

Hi, hope I can be of some help.

Blood tests, 24/48hr ECG and echocardiogram (ultrasound test) will have ruled out almost everything ‘dangerous’ that could be wrong with the heart. They will have ruled out ischaemic change, valvular disease (such as mitral stenosis, regurgitation or prolapse), cardiomyopathy and hypertrophy, common and uncommon arrhythmias (including sick sinus syndrome) and inflammatory issues such as pericarditis and myocarditis.

That will hopefully provide some reassurance. However, this doesn’t provide you with a diagnosis, or any relief from your symptoms.

Hospitals can become quite dismissive when they have ruled out everything that might kill you / make you sick, and can be quite bad at clocking on to the fact that some people are really struggling with the symptoms of more ‘benign’ conditions, but an exercise tolerance test sounds like a sensible next step towards getting a formal diagnosis and suggests to me that the hospital are taking you seriously - these are not cheap!

From what you have said above, especially given that you experienced palpitations that the hospital dismissed, I suspect you are experiencing ‘ectopics’. These are normal jumps in the regular rhythm of the heart, which occur in everyone, however, each person experiences them differently, with most not noticing them at all. I would suggest asking your cardiologist / arrhythmia nurse if this is what was noted on your ECG. If not, I would suggest asking if they could do a 7 day ECG with an option for you to press a button when you feel the palpitations.

The shortness of breath and chest pain you mention sounds a lot like a panic attack. These are relatively common and can absolutely occur without necessarily feeling overtly stressed out or panicked. However if you experience severe chest pain or shortness of breath at any time you should attend hospital immediately.

Finally, it is worth noting that maintaining a healthy BMI, eating healthy foods low in fat and regular cardiovascular exercise are really important for heart health. Conversely I would recommend not working out in advance of your exercise tolerance test - the more stressed your heart is on the day, the better the results of the study. I hope you get to the bottom of what is causing your symptoms and get some relief.

3

Hi,

Thankyou so much for the detailed reply, it means a hell of a lot to me to read through what you have written and I appreciate all the effort you have gone to! Sounds like you know a fair bit on the matter.

Your response has certainly provided a certain amount of reassurance knowing that it shouldnt be life threatening, whatever it is.

However I am still in a situation where I can not live life the way I would like (Healthily with regular exercise to get in shape etc) due to this problem. BMI suggests I am overweight (13.5 stone, 5 ft 10) but I’ll take that with a pinch of salt. I would like to lose wait and excersise regularly but with this condition, it is preventing me from doing so and I am convinced it is slowly getting worse. It definitely continues to have more and more of an effect on my life every day.

Another recent letter sent by the hospital suggested “During exercise my heart was reaching sinus tachycardia at 180BPM” this was during the 48 hour ECG. However, despite them noticing this, my issue is not necessarily related to when I am working out. It is the days and weeks afterwards where the exercise causes the palpitations. If I do another workout whilst I have these palpitations they will get worse and worse to the point they are every minute or so. Huge thuds in my chest that there is no way I can ignore. Something in the working out is stimulating this response. I am 100% sure of this.

They also stated that I only had 46 ectopic beats over 2 days which was very low. I am not sure if that is the correct number of palpitations that I felt over those 2 days, I thought it would be slightly higher. If they caught me on a bad day then I know for a fact I get these palpitations (bad ones) every 2 mins or so, sometimes multiple times a minute. I am not sure whether my issue is visible on these ECG’s or whether it is different.

I do a fair bit of walking and heavy lifting for my job. Sometimes, when I am active with heavy lifting tasks and walking great distances (3-4 miles) for extended periods of time I get breathless. This is magnified when I have worked out days previously. I want to be able to work out 3 times a week or so but I know full well by this point (2 long years of this) that this will cause such a distraction and a worry and maybe potentially something worse happening that I simply can not do this.

I take Propranolol 40mg which I mostly take days after working out to mitigate the palpitations but they are still there. If I workout once or twice it is bearable, but still bad. Anymore than that and it is a constant flow of palpitations and more breathlessness etc which is distracting when diagnosing faults or just doing anything really.

I am curious to know why you say not to workout before the exercise test as I was planning (Starting from today) working out 2-3 times before in order replicate the issues I am facing and hopefully for them to be able to pick up on them. I don’t see how the results would be better like this?

I am going to be writing a detailed letter of my issue which I will present to the cardiologist during the stress test I am going to take and get him to pass it on to whoever reviews the results.

Thanks again for your time, it means a lot.

Kieran

4

Hope this post finds you doing much better. My definition of “severe palpitations” is very different from my cardiologists and my electrophysiologist. Sometimes I think if they could feel what I feel, they would freak out and maybe come up with a cure! My past holter monitors show mostly PVCs and some PACs. And as bad as they felt (big thud, heart feels like it stops then skips multiple times) my monitors reports showed only a 5% burden. Which meant if my heart beats 4,080 an hour, my palpitations were about 200 an hour. My electrophysiologist said he would need 10-20% burden to be able to schedule an ablation. That higher rate would ensure he could find the area where they are coming from and cauterize it while I’m under anesthesia. I told my cardiologists I was desperate to have these go away as it affected my quality of life so they prescribed a beta-blocker (Metoprolol) to control heartbeat racing and an anti-arrhythmic (Flecainide) to help reduce (but not get rid of) the number of palpitations. I also tried taking a magnesium supplement which I was told it would help reduce them. It did for a couple weeks but not much longer. Since on the medications, it has helped. I have days that I have none! Then some days I feel them strong again for a couple hours. I don’t panic as much as I used to over them since they convinced me it was not life threatening (but it felt like it was!!). I’ve had a couple of episodes of A-fib in the past so I can’t do intense exercising because it can be a trigger for another A-fib episode. I try to walk a mile a day and the skipping gets really bad while walking but I tell myself “it’s ok, keep going” and it eventually stops skipping. I pray you find a great doc to help you determine your condition and if medicine would be an option. A lot of us have to learn to live with it. If mine gets worse then I’d qualify for an ablation to help stop it. God bless and good luck!

5

I read your story and it sounds like copy / paste from what I am experiencing. Yesterday was excercizing and I had palpitations again. This time so bad I almost fainted. Had to call medics and we went to hospital. Just like any other palpitation related appointment last 10 years. I had 4 cardiologist visits and all of them say im fine.

So from what I hear from you it looks we have very similar problem. I will do stress test in 2 weeks, but honestly I think they will simply say to me I have palpitations and its nothing. But I cannot continue living like this - everytime after training I have massive amount of them. Sometimes i cannot sleep because of palpitations.

How are you doing now? Any news, development in diagnosis?

6

Hi there,
i have every sympathy for you as i have suffered severe palpitations. Mine were/seemed to be caused by adrenaline or stimulants eg caffeine/alcohol. They improved considerably following an ablation where they basically destroy the faulty electric pathways in your heart. They have not completely gone as one of the pathways was too close to my heart’s natural pacemaker. The surgeon could have tried but if it went wrong i would have ended up with a pacemaker which i didn’t want. Having said that, when i now get them occasionally my heartbeat returns to normal much quicker and it is certainly much more manageable. The procedure is straightforward and carried out whilst you are awake. It may be worth asking your cardiologist about this. Not sure if this helps as i am no dr but it may be worth a mention. I wish you well.

7

kieran when you say 40mg propanolol is this the immediate release tablets of the XR capsules? varying heart palpitations might be better controlled with the XR version and 60 mg is the starting dose. it takes time to build up in your system so id suggest minimum 60 or better yet 80 mg XR once a day and give it a few weeks to see if it helps. It helped my palpitations that scared me thinking i was having a heart attack of something. unfortunetly i am in process of tapering off it because it seems like its making me fat. also the higher doses seemed to make me lazy and unwilling to function. at the lower dose now i still dont get palpitations but my blood pressure has started creeping up again. anyway itmight be worth trying the long acting form and in your case getting to at least 80 mg. looks like its been a couple years since the post but i am curious how the issue is going?

8

Have you ever taken your heart rate when these episodes or things happen? I think if you have an apple watch you need to immediately stop what you’re doing and take a ECG real quick, so maybe it can pick up on those palpitations. Are there any other symptoms you’re feeling? Like do you feel like you have to use the bathroom (#2) when these episodes happen? And does your brain feel fuzzy or does your blood pressure go up?