Key Questions About Heart Health and Arrhythmias: A Patient's Journey

Some questions about the heart?

Hello, doctor.
Before I ask my questions, I would like to thank you for your patience in reading my message.
Thank you.

Height: 183 cm, Weight: 101 kg (Hypertension before medication [five years ago]) -> 126 (last June) -> 118 (February) -> 110 (today).
Medical history: Hypertension, smoking and drinking habits.
I smoke half a pack to a pack a day and rarely drink alcohol.
About five years ago, one morning I experienced dizziness, swelling, and numbness in my chest, hands, and feet.
I was taken to the hospital and found to have hypertension (over 200/120).
I was hospitalized for 21 days and underwent various tests, but no cause was found, so I started medication (four antihypertensive medications).
Two months after discharge, due to discomfort in my heartbeat, I gradually reduced my medication to one pill (Aprovel 150 mg).
During these two months, I also gained 20 kg.
Now I am taking Aprovel 300 mg (1/4 pill).
About a year ago, due to gastrointestinal issues (frequent diarrhea, bloating, gastroesophageal reflux), I gradually started to slow down my eating pace, and my weight began to decrease.

Before the Lunar New Year in February, one morning after having breakfast at McDonald's, I felt food poisoning symptoms all day (abdominal pain, dizziness, diarrhea, nausea).
After that, I began to experience premature beats (my pulse would pause, and I felt very uncomfortable in my chest).
Initially, the frequency was severe, with my heart stopping for 2-3 beats at a time.
However, when I went to the hospital, they said there was nothing particularly wrong.
I then sought traditional Chinese medicine, and the practitioner said it was due to my stomach causing the premature beats.
I started taking Chinese medicine, and since then, the frequency of the premature beats has decreased (when frequent, 5-6 times per minute; otherwise, once every one or two minutes, or sometimes not at all).
They tend to occur after eating or when I haven't eaten for more than 6 hours.

The most recent ECG (4/18) shows: Normal sinus rhythm with sinus arrhythmia, Non-specific intraventricular conduction delay, ST elevation, consider early repolarization, pericarditis, or injury, Abnormal ECG.

I would like to ask the doctor:
1.
Does this ECG require further detailed examination at the hospital? If so, what tests would you recommend?
2.
I have been experiencing continuous colds recently; could this be myocarditis?
3.
Will exercising cause problems when experiencing premature beats? I am a bit worried as I want to start exercising.

4.
My heart rate is approximately 70-80 when lying down, 90-100 when sitting, and 100-120 when standing.
However, in the past two days, since I started quitting smoking, I noticed something strange (my heart rate was below 60 when I measured it in the morning after waking up).
But I am overweight and do not usually exercise; is it unusual for my heart rate to be below 60?
5.
A doctor suggested that I could stop taking my antihypertensive medication (currently taking Aprovel 300 mg, 1/4 pill; resting blood pressure is about 135/85-90).
What is your advice on this?
Finally, thank you for your patience in reading this, and I wish you a wonderful day, doctor.

A Ku, 20~29 year old female. Ask Date: 2016/04/19

Dr. He Dongjin reply Cardiology

1.
The electrocardiogram report appears to be normal.

2.
Based on the symptoms, it does not seem necessary to visit a cardiology clinic for further examination.

3.
In theory, premature beats should not affect exercise; however, during the smoking cessation process, there may be some fluctuations in heart rhythm or discomfort such as chest tightness and palpitations, which are considered normal responses and not harmful.

4.
A heart rate below 60 beats per minute should not be a concern; monitoring is sufficient.

5.
It is advisable to stop the medication and then observe.
Changhua Hospital cares about your well-being.

Reply Date: 2016/04/19

More Info

Thank you for sharing your detailed medical history and concerns regarding your heart health and arrhythmias. It’s clear that you have been through a lot, and I appreciate your openness in discussing these issues. Let’s address your questions one by one.

1. Further ECG Evaluation: Your recent ECG indicates a normal sinus rhythm with sinus arrhythmia and some non-specific intraventricular conduction delay. The ST elevation could suggest early repolarization, pericarditis, or myocardial injury. Given these findings, it would be prudent to follow up with a cardiologist for further evaluation. They may recommend additional tests such as a 24-hour Holter monitor, echocardiogram, or even a stress test to assess your heart's function under exertion. These tests can help clarify the nature of the ST elevation and whether there is any underlying heart condition that needs to be addressed.

2. Concern About Myocarditis: While recent viral infections can lead to myocarditis, your symptoms of palpitations and early beats are more commonly associated with arrhythmias rather than myocarditis itself. However, if you have been experiencing persistent symptoms such as chest pain, shortness of breath, or significant fatigue, it would be wise to consult your healthcare provider. They may consider blood tests for inflammatory markers or cardiac enzymes to rule out myocarditis.

3. Exercise and Palpitations: It’s understandable to be concerned about exercising with a history of palpitations. Generally, if your palpitations are infrequent and not associated with other concerning symptoms (like chest pain, severe dizziness, or fainting), moderate exercise can be beneficial for your heart health. However, it’s essential to start slowly and listen to your body. If you experience increased palpitations or discomfort during exercise, stop and consult your doctor.

4. Heart Rate Variability: A resting heart rate below 60 beats per minute can be normal for some individuals, especially if they are physically fit. However, given your history of obesity and lack of regular exercise, a low heart rate could also indicate an underlying issue, particularly if you feel symptomatic (dizzy, fatigued, etc.). It’s essential to monitor how you feel and discuss these observations with your healthcare provider.

5. Blood Pressure Medication: The decision to continue or discontinue blood pressure medication should be made in consultation with your physician. Your current blood pressure readings suggest that you are within a reasonable range, but it’s crucial to consider your overall health, lifestyle changes (like weight loss and smoking cessation), and any potential withdrawal effects from the medication. Your doctor may suggest a gradual tapering of the medication while closely monitoring your blood pressure.

In summary, it’s vital to maintain open communication with your healthcare providers regarding your symptoms and treatment options. Lifestyle modifications, such as a balanced diet, regular exercise, and smoking cessation, can significantly improve your heart health. Additionally, ensure you have regular follow-ups to monitor your heart condition and adjust your treatment plan as necessary.
Thank you for your thoughtful questions, and I wish you the best on your journey to better heart health.

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