Heart Issues: Managing Symptoms and Seeking Help

Is it a heart problem?

I have fainted twice in the past two months.
The first time was five minutes after hiking, and I lost consciousness due to brain numbness.
The second time occurred while I was brushing my teeth at home; I suddenly felt chest tightness but didn't pay much attention at first since I often experience palpitations (I have mitral valve prolapse).
However, the tightness worsened, and I felt increasingly uncomfortable until my vision went black, and I fainted.
It took about three minutes before I could sit up again.
Later, I went to the hospital for an examination, including an echocardiogram, an ECG, and blood tests, all of which indicated no issues, so I didn't think much of it.
Recently, my watch alerted me that my heart rate was around 46 beats per minute for over ten minutes, prompting me to see a doctor.
The doctor scheduled a 24-hour Holter monitor test.
However, that same night, my watch indicated that I experienced atrial fibrillation, and I was feeling chest tightness.
Later, I went to the emergency room, where the doctor prescribed sublingual tablets and administered morphine before sending me home.

Around 5 AM, I suddenly felt discomfort in my chest and could hear my heartbeat, which had risen to 122 beats per minute, accompanied by brain numbness.
After asking my family to take me home, I lay down to rest, but the same situation occurred again with chest tightness and a feeling of my heart racing, which was extremely uncomfortable.
My family then took me to a cardiology outpatient clinic, where the doctor prescribed antiarrhythmic medication for two days.
The first day was manageable, but on the second day, I began to feel as if my heart rate was trying to increase but was being suppressed, creating a sensation of two opposing forces pulling at me, which was very uncomfortable and made me feel nauseous.
This situation has been recurring.
What would be the best way to handle this?

A-Jia, 20~29 year old female. Ask Date: 2020/03/16

Dr. Chen Jili reply Cardiology

It is recommended that you discuss the above situation further with your attending physician to determine if any additional examinations are necessary.
Thank you, and wishing you good health!

Reply Date: 2020/03/16

More Info

It sounds like you are experiencing a complex interplay of symptoms that may be related to both your heart condition (mitral valve prolapse) and anxiety. The episodes of fainting, chest discomfort, and heart palpitations can be distressing and may lead to a cycle of fear and anxiety about your health. Here’s a comprehensive approach to managing your symptoms and seeking appropriate help.

Understanding Your Symptoms
1. Mitral Valve Prolapse (MVP): This is a common heart condition where the valve between the heart's left atrium and left ventricle doesn't close properly. While many people with MVP do not experience significant symptoms, some may have palpitations, chest pain, or even anxiety. Your history of MVP could explain some of the heart-related symptoms you are experiencing.

2. Fainting Episodes: Fainting can occur due to various reasons, including dehydration, low blood pressure, or heart rhythm abnormalities. The fact that you have fainted twice in a short period is concerning and warrants further investigation.

3. Anxiety and Panic Attacks: The feelings of chest tightness, heart racing, and fainting can also be exacerbated by anxiety. Anxiety can manifest physically, leading to symptoms that mimic heart problems. This can create a vicious cycle where anxiety about your health leads to more physical symptoms, which in turn increases your anxiety.

Steps to Take
1. Follow-Up with a Cardiologist: Since you have already seen a cardiologist, it’s crucial to continue this relationship. Make sure to discuss all your symptoms in detail, including the fainting episodes, palpitations, and any changes in your heart rhythm as noted by your smartwatch. A 24-hour Holter monitor can provide valuable information about your heart's rhythm over a longer period.

2. Consider a Comprehensive Evaluation: If your cardiologist has ruled out significant heart issues, it may be beneficial to explore other causes of your symptoms. This could include:
- Blood tests to check for anemia, thyroid function, and electrolyte levels.

- Echocardiogram to assess the structure and function of your heart more thoroughly.

- Tilt table test if you experience fainting spells to evaluate how your body responds to changes in position.

3. Manage Anxiety: Since anxiety can exacerbate physical symptoms, consider seeking help from a mental health professional. Cognitive-behavioral therapy (CBT) is effective for managing anxiety and can help you develop coping strategies. Mindfulness and relaxation techniques, such as deep breathing exercises, yoga, or meditation, can also be beneficial.

4. Lifestyle Modifications: Incorporate healthy lifestyle changes that can improve both your physical and mental health:
- Stay Hydrated: Dehydration can lead to low blood pressure and fainting.

- Regular Exercise: Engage in moderate exercise, as tolerated, which can help reduce anxiety and improve cardiovascular health.

- Balanced Diet: Eating a nutritious diet can support overall health and well-being.

- Sleep Hygiene: Ensure you are getting adequate sleep, as fatigue can worsen both anxiety and heart symptoms.

5. Medication Management: If your symptoms persist, discuss with your doctor the possibility of medication for anxiety or heart rhythm management. Sometimes, beta-blockers are prescribed for palpitations and anxiety, but this should be tailored to your specific needs.

When to Seek Immediate Help
If you experience severe chest pain, shortness of breath, or fainting that does not resolve quickly, seek emergency medical attention. These could be signs of a more serious condition that requires immediate intervention.

Conclusion
Managing your symptoms will likely require a multi-faceted approach that includes medical evaluation, lifestyle changes, and possibly psychological support. It’s essential to communicate openly with your healthcare providers about all your symptoms and concerns. By taking proactive steps, you can work towards better managing your health and reducing the impact of anxiety on your life.

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