A careful heart exam showed the root of her problems – and perhaps those of others in her family tree. She has a genetic condition called hypertrophic cardiomyopathy, or HCM, which causes her heart muscle to grow too thick. The extra muscle blocked blood flow out of her heart when she was active, and made her short of breath just from walking in the mall.
A patient with such condition expressed her feelings (given below):
“My mood keeps fluctuating and at times I become intensely anxious with bouts of sweating, palpitations, hyperventilation, screaming and hostility. At other times, I feel lost and empty. I can’t get rid of the horrifying memories and the vivid images that remain in my mind. These memories, some of which are very patchy, seem to haunt me all the time and I become very distressed whenever anything —a sound, a smell or a sight—remind me of my ordeal. I dislike talking about my experiences and
avoid anything that reminds me of them. In addition, I feel very guilty that I have survived and so many of my work colleagues died in the incident.
A blood pressure reading records a systolic blood pressure—the highest pressure measured when the heart contracts with each beat, and a diastolic blood pressure—the lowest pressure measured in the arteries when the heart relaxes between beats. Optimal blood pressure is less than 120/80mm hg, read "120 over 80." Hypertension—high blood pressure—is defined as systolic pressure greater than or equal to 140 mm hg or diastolic pressure greater than or equal to 90 mm hg.
Individuals with short QT syndrome frequently complain of palpitations and may have syncope (loss of consciousness) that is unexplained. Some people with HCM find out they have it by chance, when they’re having other tests done, she says. Others might seek their doctor’s advice about heart-related symptoms they’ve been feeling — such as a “jumpy” heart rhythm, chest pain or shortness of breath — and find out through tests that they have HCM. And still others only find out when they tell their doctors that several people in their family have experienced sudden heart-related deaths, or have been diagnosed with HCM.
Palpitations are an uncomfortable awareness of your heartbeat. You may feel that your heart is beating harder or faster than usual or that it is skipping a beat or two.Palpitations are common and often normal. They are a symptom, not a disease. However, it is important to determine their cause.Your health care provider will review your symptoms and examine you. You may have an electrocardiogram (ECG) or other tests to help find the cause. You may be given a heart monitor to wear at home. You may have an ultrasound test of the heart called an echocardiogram or an exercise stress test to see if heart problems are causing the palpitations.
Now, a combination of better diagnosis, treatment and genetic testing is starting to help people with HCM, and their families, fight back against their inherited risk. People who have a family history of sudden heart-related deaths, or a relative with a diagnosis of HCM, can get a clearer picture of the risks that they and their children face. And that can help shape both treatment and preventive steps.
Although ventricular arrhythmias are the most common cause of sudden cardiac death, both bradyarrhythmias and the usually more benign supraventricular arrhythmias can lead to syncope or sudden death. Furthermore, arrhythmia therapies themselves can interfere with day-to-day functioning as a consequence of reactions to drugs, shocks from implantable devices, and physical limitations after arrhythmia operations. Some arrhythmias can be cured, and others can only be palliated. There are risks to both personal and public safety when patients with arrhythmias that may impair consciousness drive or perform public service functions such as commercial driving and commercial or military flying. Thus, efficacy of treatment and the implications of arrhythmia recurrence are especially important, regardless of the treatment approach, whether by drug, device, surgery, or catheterization.
A study was performed on 40 patients for the evaluation of palpitations. There were 17 patients with inappropriate sinus tachycardia diagnosed with an elevated resting heart rate and an exaggerated heart rate response to exercise in the absence of organic illness, they were excluded from the study. The other 23 patients [16 females and 7 males] were diagnosed as paroxysmal unexplained palpitations.The study concluded that palpitation is a common symptom that needs a careful work-up to assess the etiological diagnosis. Electrophysiological studies in these patients have a low yield and should be only considered in patients with documented sustained arrhythmia or highly suspicious for rhythm disorder.
One surprise is that women don't always suffer from the classic male symptom of crushing chest pain. About 15 to 20 percent of women having a heart attack specifically complain of pain high in the abdomen, shortness of breath, and profuse sweating. Preceding or during an attack women may also complain of chronic fatigue, indigestion, pain in the back or jaw, and heart palpitations. Such diffuse symptoms can easily masquerade as run-of-the-mill problems like heart burn or a favorite medical culprit - mental stress. Sex discrimination - namely a tendency for doctors to see women as more emotional and less trustworthy barometers of their own health - may further contribute to misdiagnoses. In this respect, female doctors may be just as guilty as their male colleagues - or so suggests a study of doctors in training conducted last year by psychologist Gabrielle Chiaramonte of State University of New York, Stonybrook.
Gender also plays an important role in the evaluation of cardiac risk factors. Early menopause, by depriving the body of estrogen's heart protective benefits, is an obvious example of a risk factor unique to women. Other major risk factors - elevated cholesterol, smoking, high blood pressure, diabetes and obesity - are shared by the sexes but vary between them in subtle and sometimes dramatic ways.
NEW YORK (Reuters Health) - In patients with infrequent, unexplained heart palpitations, an implantable loop recorder is a safe and cost-effective tool for diagnosing the cause, according to a study conducted in Italy and reported in the Journal of the American College of Cardiology.
Dr. Antonio Raviele, from Umberto I Hospital in Venice, and associates enrolled 50 patients with palpitations that lasted for more than 1 minute, but occurred only once a month or less frequently, in the study if their initial evaluation was inconclusive.
Twenty-six patients underwent implantation of a loop recorder (Reveal Plus, Medtronic, Inc.) under local anesthesia. Twenty-four patients had conventional testing, including wearing a 24-hour Holter monitor and 1 month of ECG monitoring using an external recorder. An electrophysiological study was also conducted if indicated.
The implantable loop recorder is an automatically activated monitoring system that records an ECG during the heart palpitation. The device is implanted during a minimally invasive outpatient procedure and does not restrict the patient's activities.
A diagnosis was made in five patients in the conventional group within an average of 36 days, and in 19 in the implantable loop recorder group within an average of 279 days.
Nine of the 19 patients who were not diagnosed in the conventional group switched to the implantable loop recorder group, and a diagnosis was obtained in 6 of these patients.
Various diagnoses were made including rapid, irregular and slow heart beats affecting different chambers of the heart and conduction disorders.
During follow-up of at least 1 year, palpitations were completely eliminated in 22 patients with arrhythmias treated with a pacemaker, drugs or ablation (removal of a section of heart tissue), the investigators report. Drug treatment effectively reduced the frequency of palpitations in 8 patients.
Despite higher initial costs with the implantable loop recorder, the cost per diagnosis was 6,768 euros using the conventional approach and 3,056 euros when the implantable loop recorder was used.
Still, Raviele's team points out that these results cannot be generalized, and the initial "characteristics of the (patient) population are critical to predicting the diagnostic value of the investigations."
They recommend that, if the cause of palpitations is not identified during the initial evaluation, "further investigations should be considered only in patients with structural heart disease and in those with associated symptoms in which palpitations can be due to important arrhythmias, and prove very troublesome."
f you have frequent episodes of heart palpitations, irregular or rapid heartbeats, unexplained wheezing or shortness of breath, fainting or near fainting, or feeling lightheaded, dizzy or weak, or if you have chest pain or discomfort, see your doctor promptly.
If someone near you collapses unconscious, take immediate action.
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