Heart Issues?

Today, I had a panic attack-type event.

I was editing a document and sipping on coffee and suddenly my heart went crazy, and I was dizzy, nauseated and shaky. I took my BP four times in my left arm and it was up and down from 155/64 to 111/69, and the heart rate from 73 to 151. I used two different machines in case one was broken.

Then I did the right arm and it was 120/67 with a 79 heart rate on both machines.

As this all occurred I got tinnitus in my left ear and the outside of my ear became tingly and numb. The outside is normal now but I still have tinnitus nearly 8 hours later. In addition to my left side, my chest is achy and I have pain in my back.

I don’t know what to do. I am worried I could be having minor heart attacks regularly—but is that crazy? Would it have shown up on EKGs, a chest X-ray or in blood tests by now? These things have been going on for years.

I don’t want to go to the ER because of COVID and because an ER was so fucking dismissive of me before, probably because of my age at the time.

My doctor agreed I should have the heart scan because of family history but she also said she suspects the pains I have are musculoskeletal and not cardiac because my tests always have been fine.

What could be going on with me? I feel like shit right now and I am worried. I have all of the symptoms associated with heart attacks that information says should send you directly to the ER but some of those symptoms can also be panic attack symptoms.

All I have done since yesterday is email my doctor and wait for a reply. My friends have told me to meditate. I just don’t know.

Can someone lend you a Xanax?

I’d also recommend a magnesium drink called Natural Calm which makes you chill the fuck out. Most adults are deficient, and it affects blood pressure. I take it at night to knock myself out. Took it recently during the day and it made me feel totally relaxed and drowsy. It could not get worked up about a single thing.

There’s heart disease in my family; grandfather and mother both dropped dead of massive coronaries and so did my MIL. We all have to die of something and I’d rather a big fat heart attack that takes a few minutes than endless suffering of cancer. Look on the bright side! There are much worse ways to die.

A beta blocker will help, it's often used for anxiety because it slows heart rate.

JUST REMEMBER once you're on a beta blocker if you miss doses your heart rates goes up very fast. And if you go off, you have to wean yourself off.

Obviously you are not having a heart attack or the hospital would've kept you. Your heart can stand up to 220 beats per minute (BPM) and while it gets uncomfortable at 120bpm a rapid heart rate isn't so bad. It's the strength and regularity that count.

If you are having tinnitus you probably are having balance issues which cause more anxiety. Your ears control your balance, so when they are blocked or stuffed up all sorts of weird things, like vomiting, spinning and unable to stand up and weakness can happen.

Anxiety can produced skipped heart beats, and then you inhale too much and hyperventilate which makes the heart rate worse. Try breathing into a bag.

R2 😟 I didn’t want to die this young.

But I guess you are right.

R3 I wasn’t at a hospital. I was at a radiology center for a CT scan. Only techs work there.

I have a cardiologist and we had a Zoom office visit in April. I think you should arrange to see your doctor online. I'm sure they'd prefer to do it that way too. I also had a zoom visit with an internal medicine doctor in my doctor's group because he was away from the office that week. That went well also and I was able to schedule these right away. You are probably just anxious from all this Covid stuff and remnants of your Lyme disease maybe? Get yourself a white noise app--there's lots of free ones in the App Store (I use White Noise). You can go through them and get just the right calming sound for you. When I do it, my heart rate gets nice and slow and regular (and I have hypertension and coronary artery disease--I'm old). Good luck. You don't have to necessarily share your parents' health conditions. Thank God.

Here is one thing you can do if you think you're heart is beating too fast.

You massage the carotid artery. That is the artersy on the side of your neck where your jaw meets your ear.

Go to where you jaw meets your ear and put your forefinger and middle finger there. Slowly move down till you can feel a pulse.

Then as firm as you can press. Then massage up to your jawbone and the down and then up. Do up to thirty seconds. Rest, then do it again.

This will slow your heart rate down.

Warning NEVER do both sides at once. You can massage your left or ride side without fear. but it is possible (though unlikely) if you massage both sides of your neck at once, you can make yourself pass out. If this happens, nothing bad would happen, unless you fell over and hit your head. But you don't want that. This is safe for one side of your body only.

OP: Have you had a 24 or 72 hour Holter monitor test? (little box you wear, electrodes, etc.; sends an electrocardiogram printout to your doc)

It's the standard way to diagnose an arrhythmia. It's not always right - the episodes can be infrequent and so you miss it, but if it picks up a blip, they know what to look for.

No, R8, I have not yet been to a cardiologist. I will probably end up asking my doctor for a referral if she doesn’t suggest it herself.

OP can I have your stuff?

You should have called me years ago.

I agree it sounds like panic/anxiety because I have gone through a lot of that myself and that's what it turned out to be. But I've gone to the hospital to get checked out for heart problems for sure. Keep going to the doctor and they'll keep saying your heart is fine. Eventually you'll go to a psychiatrist and get anxiety pills.

Unless you really have a heart problem. In that case, the doctors will figure that out and treat it.

It sounds like you have an arrhythmia that you go in and out of where your heart rate gets very fast, perhaps SVT or similar tachycardia. You need to have a Holter monitor test where you wear a monitor for an entire day or more to see what it shows.

Sorry if this was answered upthread. What kind of shape are you in? My dad had 3 heart attacks around 50. One of them he drove himself to the hospital.

I would quit obsessing on the genetics and concentrate on diet and exercise. You are obviously convinced that your family history is going to catch up with you.

My dad died almost a year ago at 92. He wasn’t a triathlete, but he walked a lot and my mom made sure he ate prison food. (Code for oatmeal, veggies, etc) he did the Atkins diet for a while and eventually settled on equal amounts of meats and carbs. I used to sneak him steaks every now and then.

Long story short, like everything else, watch what you eat and get plenty of exercise. Even if it is just walking.

I'm a cardiovascular sonographer, and I agree with the posters above that recommended you see a cardiologist and do a Holter monitor. Based on what you're telling me, I suggest you look for a cardiac electrophysiologist, rather than a standard cardiologist.

It sounds very much like you have some sort of arrhythmia. Something is off with the electrical impulses regulating your heartbeat. This has nothing to do with clogged coronary arteries or high cholesterol. It's probably an electrical issue, not a plumbing issue. I wouldn't suggest you go on beta blockers until you see the cardiologist. He can prescribe them to you if he think you need them after he figures out what's going on with you.

In the meantime, try to relax. When it comes to arrhythmias, some are pretty benign, others require treatment. Some people have them, and aren't even aware. Other people have them, feel them, and are able to shrug them off. And some people, like you, have them, feel them, and it kinda freaks them out and scares them.

Don't freak out. Lay off caffeine for the time being. Avoid stress.

Good luck!

And are you tender to the touch, Dear?

R14 What kind of shape am I in...I’m not obese or even technically overweight, but I am borderline overweight. I’m 5’11”, about 178 pounds and wear a 33” waist pants. More or less a couch potato.

I am pretty careful about what I eat. I used to commute to work on foot, 1.4 miles each way, every day but I have been working from home since March and so not doing that.

I desperately want to exercise but my body does not let me. Because of my mast cell disease, when I do cardiovascular exercise that heats me up, I break out in hives minimum and I have had anaphylaxis a couple of times—so I am not supposed to do that. Theoretically, it could kill me. (I am including a link because I know that sounds insane.)

Mast cell activation syndrome is an acquired mast cell activation disorder and mastocytosis is a disease with identical symptoms (but which can become cancerous) people are born with. It can cause tachycardia in addition to a lot of other issues, but this pain in my left arm/on my left side is beyond tachycardia and it’s consistent with heart attack and so it scares me. It really does scare me.

During the lockdown, I decided to try to exercise moderately and intermittently throughout the day. Every time in recent years that I habe tried to lift weights, my body has reacted with a major inflammatory flare-up, including the severe pain on my left side that I worry could be heart related.

I started with crunches and push ups (I could barely do two when I started), and then added in squats and curls and shoulder presses with dumbbells. Over the course of four or five weeks, I got up to over 100 push-ups a day, 17 to 21 per set, and 200 crunches and 50 leg lifts on each side.

I have been thrilled that I have been able to do this. Then—BAM—last week, terrible stiffness and pressure pain on my left side. I waited a couple of days and did a couple sets of curls and the pain was twice as bad, so I stopped. Since then, back to being basically sedentary.

During my 20s and until I got really sick from Lyme in my 30s, I used to bike 30-35 miles on weekends, did cardio 4-5 days a week and weights 3-4 days a week. At one point I was squatting (in a cage with free weights) 450 pounds. And now...my body will not tolerate exercise.

Thank you, R15. I really appreciate your advice. More than you know. Thank you!

Careful, OP. Every beta blocker out there gave me MASSIVE--and I do mean M A S S I V E--headaches. This mystified me because they are often prescribed for chronic headaches.

I found a brilliant non-invasive cardiologist at Johns Hopkins who put me on a cocktail of Losartan 100 mg, HCTZ 25mg and Doxazosin 2 mg and magically I now have the blood pressure of an eighteen-year-old long distance runner.

Allergic to heat??!

I call bullshit on that one, OP.

R20 I don’t blame you but it isn’t bullshit.

Allergies are inflammatory reactions, usually caused by histamines. Antihistamines are used to suppress histamine release. Histamine is released by mast cells.

Mast cells also release cytokines. You probably have heard of “cytokine storms” that have killed a lot of people who have COVID-19. Cytokines, like histamine, cause inflammation.

Mast cells are like bubbles that contain different little facets that work as part of the immune system. When an allergen triggers mast cells, they break open (It’s called mast cell degranulation.) and the particles—histamine, cytokines and others—flood the area and cause inflammation.

Mast cells are in epithelial cells—skin, the lining of your sinuses, your digestive system and your organs.

People who have mast cell activation syndrome have unstable mast cells. They degranulate more readily than those of normal people. Heat is a trigger that causes them to degranulate. For me, so is aspirin and all NSAIDs. Reactions to heat range from a runny nose and hives all over my body to extreme swelling. The last two times I did an elliptical machine, my whole body got itchy and then turned lobster red and my left arm swelled up so much that the skin hurt and I couldn’t bend my arm. If it had been my throat that swelled up like that instead of my arm, I probably would have died because I didn’t have an epi pen.

Again, it seems so crazy to me that I didn’t even believe it enough to pursue it as a health problem. When I learned what I had, all of these crazy quirks of my body fit the profile. It’s really bizarre.

Mastocytosis has the same symptoms but it functions differently. Instead of people’s mast cells being too sensitive, people with mastocytosis are born with far more mast cells than average people are. Because they have so many more mast cells, any normal allergic reaction results in a flood of histamine and cytokines that puts them at very high risk of fatal anaphylaxis. They can also be severely allergic to heat, including exercise-induced heat. And their mast cells reproduce like crazy, and sometimes turn into malignant cancerous tumors.

OP try the herb Holy Basil.

Holy Basil works as a mast cell stabilizer and can lower blood pressure & heart rate. Take it at night. It worked for me with MCAS. Still go to the doctor for tests.

R21 You need Xolair. It’s a biological for asthma and OK’d for mastocytosis and mast cell activation syndrome that blocks the histamine release. It’s an injection once a month. I used to have episodes monthly. I’ve been on it for three years next month and haven’t had any more since I started on it.

If you don’t get it, at least get some IM Benadryl and syringes to give yourself a shot when it starts. It usually short-circuits the urticaria quickly.

Lay off of the coffee

R23 Biologics scare me.

You're fucking nuts for posting this level of detail here and expecting anyone to give you actual useful advice and not dangerous misinformation. Since you're under ongoing medical care, why are you even posting here? Aren't these questions for your doctors?

I must be, R26. Thank you for your thoughtful and useful comment.

OP update. I got my cardiac calcium score results today: my score is zero. That puts me in the zero percentile risk group for cardiac disease.

And there was an asterisk: my aortic root is dilated to 3.7 centimeters. Normal/healthy ones are under 2 cm. 4.5 cm is considered an aneurysm.

So it’s a good thing I got this scan. Now I need to figure out what next steps are...I am guessing I will need scans of my thoracic and abdominal aorta to check for dilation/aneurysms. I’m scared.

But this is DL and no one cares, so moving on!

R15 here (the cardiac sonographer).

What diagnostic method did they use to diagnose the dilated aortic root?

We've always used 3.8 as the upper limit of normal for an aortic dilation (anything 3.9 or above is considered enlarged). Individual mileage may vary, based on body surface area...but unless you're a smaller-than-average person, I can't imagine 3.7 being considered enlarged. It's the upper reaches of the normal range. Unless, of course, they've changed the criteria and I haven't heard about it yet, which is entirely possible.

In any case, even if 3.7 were to be considered an enlargement, it would be an extremely mild one.

R29 I don’t know what method was used. I wrote what is written on the lab report: “*Aortic root is dilated up to 3.7 cm.”

But what did you have done? Was it an X ray? A CT scan?

R31 It was a CT scan, a calcium scoring test or “heart scan.”

My worry is that the scan only shows the heart and not the thoracic and abdominal aorta. I wonder if the dilation of the upper aorta could become further dilated further down the aorta. I don’t know anything about this at all. I just worry because my father has an abdominal aortic aneurysm and I’ve had so many other health problems that I am admittedly paranoid and anxious.

OP, I think you would also do well to do psychotherapy. Yes, you have struggles, but it seems like you're adding extra obstacles in your path. Yes, with your family history, consult a cardiologist. Based on your posts, it has to be someone patient who can listen & sift through what you're saying.

Did you ever smoke?

R33 I have been in psychotherapy for many years and I like my therapist a lot and she has helped me a lot (believe it or not). But I am stressed out about some physical issues and I have used this anonymous forum to vent and ask for shared experiences and suggestions if anyone is willing.

Can you copy/paste here, word for word, what the report says about the aortic root?

R34 I have never smoked a cigarette in my life; however, both of my parents were heavy smokers inside our small townhouse throughout my whole life with them.

I have had afib for about 4 years. On beta blockers. Have occasional episodes - usually after a day of strenuous activity or excessive heat. It sucks - and I am certain I will have a stroke someday. Beta blockers help and are a vast improvement over 50 years ago. But basically you live knowing you can have a stroke anytime.

We live in this false fantasy that every sickness and disease can be cured. It can’t - despite the pharma commercials promising otherwise. We can do our best to prolong life - but I know afib will get me at some point. I just hope it’s after 60 - and not before like 3 people I know.

R36 I can’t copy and paste because I only have a paper document. But I can transcribe word for word what it says about the aortic root:

“Comments

*Aortic root is dilated up to 3.7 cm.”

That’s it.

OP, my dad died relatively young from a burst brain aneurysm. Is there any way you can check for stuff like that? That is an immediate risk.

R40 I don’t have any reason to think I have a brain aneurysm and I don’t have any family history of that. I have had several brain MRIs over the years when I was becoming progressively sicker with serious neuro issues that doctors thought probably were caused by MS, and my brain always was found to be “unremarkable”—no lesions, no tumors, no aneurysms visible.

R40 I am really sorry about your dad, by the way! :(

OK, and where did you get the information that said that a normal aortic root measures less than 2 cm?

R43 I got it from the linked article...

“The size of the aorta decreases with distance from the aortic valve in a tapering fashion. The normal diameter of the ascending aorta has been defined as <2.1 cm/m2 and of the descending aorta as <1.6 cm/m2.1 The normal diameter of the abdominal aorta is regarded to be less than 3.0 cm. The normal range has to be corrected for age and sex, as well as daily workload.”

Another article, about Ehler-Danlos syndrome, included tables that profiled characteristics of subtypes of the disease and for all, the tables listed <3.7 cm as normal and 3.7 cm or greater as concerning.

R41 / R42 , aneurysms can happen in other areas of the body (besides the brain). I'm the one whose dad died of a burst brain aneurysm. Recently, a woman colleague (middle aged) died of a burst aneurysm in her abdomen area. She had been feeling pain the previous day & went home early from work. Made a doctor's appointment for the next day. Never made it to the doctor's appointment.

If you feel any pain like that, go to the ER. My mom said that my dad had been having headaches, so there are signs.

Good luck, OP.

Dear OP for Lyme get some treatment in Eastern Europe if you can, I’ll ask for the hospitals/clinics from a nurse I know if you’d like. It’s not that expensive but the thing with Lyme is that it’s usually not sufficiently treated. You get a short treatment too little antibiotics and it festers on. Whenever you feel you have a heart attack take some aspirin lie down and call 911. In case of a brain aneurysm lie down move as little as possible and call 911.

OP stated earlier that he cannot take aspirin.

Sorry for that R47 and OP didn’t read every post I did mean well though

You need the following:

Halter monitor test

Beta blockers (continue it)

Mindfulness based stress reduction practices (I recommend Smiling Mind app)

Plant -based diet or at least strive for 80% of the time. Eat foods abundant in potassium

Coenzyme Q-10 supplement

Omega-3 supplement like krill oil

Physical activities, doesn’t have to be strenuous just aerobic

Hey OP,

R15 (sonographer) here again.

OK, a few things are really jumping out at me.

First, the article you linked where it's talking about the 2.0 measurement being the average is talking about the ascending aorta, while your scan is talking about the aortic root. Those are two different things. The aortic root is the very beginning of the aorta, where it meets with the left ventricle. It consists of three basic landmarks: the aortic annulus, the Sinus of Vasalva, and the sinotubular junction. The annulus is the very, very start of the aorta, where the aortic valve is. If the aortic valve is the door between the left ventricle and the aorta, the annulus is the door frame. Then the vessel immediately widens, and the center of that widened area is the Sinus of Vasalva, which is what I've always been taught is the proper place to measure the aortic root. I'm pretty sure that is where the 3.7 cm measurement they obtained on you is referring to. Then it immediately narrows again, and the point where the root ends and the ascending aorta begins is called the sinotubular junction.

So, think of two parentheses facing each other. Then, imagine them rotated until one is on top of the other, so you basically have a circle with the right and left ends chopped off. The left-most measurement between the two parentheses would be the aortic annulus. The very center of the parenthese, where the distance between the two is greatest, is the Sinus of Vasalva. And the right-most measurement between the two parentheses is the sintotubular junction. And from there, the ascending aorta begins.

Long story long, you are looking at the measurement from your scan, which represents the Sinus of Vasalva, and comparing it to what is supposedly the average measurement for the ascending aorta...two completely different parts of the aorta. And you are thinking "oh my God, my aortic root is nearly double the size it's supposed to be! It should be about 2 cm, and it's nearly 4cm!" No wonder you're freaking out.

Second, it looks like you are comparing two different units of measure as well. I'm not 100% sure what cm/m2 actually represents, but I'd venture to guess it's a volume measurement (math peeps, feel free to correct me on this), which you're then comparing to a straight point-A-to-point-B diameter measurement. (Don't feel bad, when I was in school, the professors would routinely put this kind of question, sneaking in a different unit of measure, on tests to trip us up, because it's such an easy mistake to make.)

Third, again, I just want to reiterate to you that a 3.7 cm aortic root diameter is nothing to be alarmed about. According to the cardiologist I work for, it's the high end of normal. Apparently according to some others, it's a tad above normal...a very mild dilation. I had a patient this past Tuesday whose aortic root measured 4.2 cm, with a 4.0 cm measurement on the ascending aorta. The reading physician on the report referred to both as mild enlargements.

I don't know how accurate CT scans are when it comes to measuring the aortic root, but I wouldn't even take that measurement as gospel. Get an echocardiogram done for confirmation of that aortic root measurement. Worse case scenario, it's something you keep an eye on by getting it checked every year or couple of years. They don't even consider it as something that requires surgical repair until it reaches 5.5 cm, so you're very far from being in any danger.

Thanks for getting back to us and letting us know what's going on.

R50 THANK YOU. I. LOVE. YOU. As a human being, I honestly love you for all that.

I couldn’t visualize all you wrote at the beginning, but the rest is clear. I will avoid “Dr. Googling” any further about this.

You’re really calmed my anxiety, and I can’t thank you enough. I’m now glad I posted here even if it bothers some people because I could not find any straightforward explanations elsewhere and my physical/follow up with my doctor is in three weeks.

Thank you, thank you, thank you for being a friend.

You need to go to a cardiologist, preferably one that specializes in prevention. There are various tests available for getting all this info you're concerned about. I do know that while it is good to have a low coronary calcium score (I have a high one), you can still have a heart attack for other reasons--genetic variations where young healthy people (usually men in this case) can get an HA at a young age. Not common but it does happen. I used to go to a message board called Track Your Plaque--this is year's ago, don't know if it's still active.) I learned a lot but in fact there was too much info on the site, There was a yearly membership fee. It's run by a doctor called William Davis. He also had a free site. He's probably on Instagram now--this was about 10 years ago. Good luck. Having a low calcium score should reassure you but since you have a strong family history, go see the specialist.

Welp. Something is very wrong.

Ended up going to my doctor and then to a cardiologist. I have tons of blood tests on Wednesday. After that, I have to schedule a CT scan of my ‘greater vessels’ to look for some kind of blockage or disease around the blood vessels on my left upper side. After that, a mammogram and ultrasound of my left breast. And then finally back to the cardiologist for an ultrasound of my abdomen and sternum and possibly my left arm. The cardiologist is less concerned with my heart than with my blood vessels and potentially my lymph. She thinks all the pain I have on my left side, as well as the rash, seem nerve-related. I am bracing myself for inflammatory breast cancer or lymphoma.

Both my doctor and the new cardiologist say it is possible some of these symptoms have to do with my mast cell activation disorder and may have no explanation—that would be the best possible outcome. But I am really afraid. I’m 42. I don’t want to live as such an unwell person or to die.

Honey, you need to see a cardiologist.

Not the ER, where the staff are currently dealing with COVID and don't have much time for anyone who isn't going to die on their shift, not your PCP who clearly doesn't have a good handle on what's going on.

A cardiologist, a cardiac specialist! Insist on it until you get your way! You've got every cardiac symptom a person of your age can have except actually dropping dead of The Big One, and your PCP hasn't done much of anything. Send messages to the PCP, send emails, make an appointment and tell the scheduler it's to talk about a referral to a cardiologist. Make it absolutely clear that you aren't satisfied with your care, mention lawyers if you must, just get that referral.

R54 See R53...I did see a cardiologist last week, the day after I saw my doctor. The cardiologist, based on our conversation, is less concerned about my heart than my blood (and potentially lymph) vessels and she ordered a bunch of tests. Tomorrow I have 19 blood tests, and then I have a CT scan of my blood vessels, a mammogram with ultrasound, and then an ultrasound of my aorta and possibly my left arm. The cardiologist said she thinks that the pain on my left side is a nerve pain and not a heart-related pain.

Sorry you're going through this, OP. It's wise to be prepared for all eventualities, but being tested may be a process of ruling things out from the specialist's perspective. Obviously they're tight-lipped at this point because they can't say for sure. Unfortunately a chronic illness guarantees unexplained symptoms and the impossible task of trying to judge what is a feature of the illness and what is potentially sinister. It's something that becomes more of an issue as you get into middle age. Good luck with everything.

Wow - you have a great doctor if they are willing to do all those tests! I wish I had a doctor who was willing to do all that. That’s is way above and beyond.

Thank you, R56 and R57, for your empathy. I do appreciate it. I understand why some people here have lectured me and told me this is not the place for this. I just need somewhere to channel all my anxieties and my despair. I zoomed with my psychiatrist yesterday and she wants me to take more clonazepam—to sedate myself—to quell the panic. And I will do it. Normally I’d resist but I am really distraught. I’m 42 and I want to live. My shrink, who is an MD, was concerned last month when I told her some of the symptoms but she has known me a long time and knows about my history with Lyme and Bartonella and she has watched me having Parkinson’s-like convulsions from summer heat (a symptom of my mast cell disorder)—so she knows my body is fucked up. But she seemed newly concerned when I described the cardiology visit and she kept mentioning my lymph, which is also my worry. Anyway, she told me to try to be hopeful and to do things to take my mind off of it as much as possible until I am able to get the tests.

This is very new to me. Years ago, I had symptoms that were very much like MS and went to many doctors who would test me and find nothing wrong and assume it was all anxiety. Now doctors just look at me and say something is wrong. So in a way that is heartening; it may prove to be very serious or just another inexplicable series of symptoms, but at least now there are visible signs and I don’t have to ‘prove’ that something is fucked up with my body. That was a source of extraordinary anxiety and depression. Now I am just really anxious about what tests may show.

So what ended up happening, OP?

R59 see R53