Arrhythmias and Vascular Issues: Expert Insights

Arrhythmias and vascular issues?

Dear Dr.
He,
Thank you for your persistent and patient responses.
Sometimes, visiting the doctor can feel rushed, and when doctors are busy, there are many questions that I don't have time to ask.
I am truly grateful that you can help us with our inquiries here.

During my visit on December 13, the reports from the cardiac perfusion and CT scan indicated that there are no signs of myocardial infarction, and there is no scar tissue in my heart, so it seems my heart is in good condition.
However, I need to continue taking medication and keep monitoring my condition.
(The report from October 13 showed that the echocardiogram was fine, but there were some issues with the MRI.
On October 12, I underwent cardiac catheterization and electrophysiological testing.)
I would like to ask Dr.
He a few questions:
1.
The doctor previously mentioned that I have coronary vasospasm, which should have been induced by the cardiac catheterization, correct? It shouldn't be something I had inherently? I am currently taking Isoptin for the vasospasm and VPCs, but does it also have side effects like palpitations and arrhythmias? Sometimes I feel dizzy, and on a couple of nights when lying down to sleep, my heart rate suddenly drops to 30-40 beats per minute (as measured by the pulse oximeter).
I wonder if this is a side effect? If so, would it be better not to take Isoptin? Is it possible to stop taking it?
2.
The electrophysiological test previously conducted still induced 2-3 seconds of ventricular tachycardia that then self-terminated.
I would like to know, do normal individuals also experience such inducement during testing? What could be the reason for inducing ventricular tachycardia in my otherwise normal heart? (Previously, on September 15, I had a 24-hour Holter monitor that also recorded about 3 seconds of ventricular tachycardia.)
3.
Is it true that the VT induced by three VPCs is very brief, so there is no need to worry?
4.
In the past month, I noticeably felt a missed beat lasting several minutes after eating, but in the last month, this occurrence has decreased or even disappeared, although I occasionally experience palpitations.
Is this a sign that my condition is improving?
5.
I know that the cause of my fainting on September 6 is now uncertain, and it has been three months since then.
Currently, it is confirmed that my heart is fine, but I still seem to have arrhythmias with VPCs, and I am quite worried about the possibility of fainting again.
I am unsure how to address this concern.
Thank you, Dr.
He, for patiently reading through my questions.

Jinzhang Konghuang de Ren, 40~49 year old female. Ask Date: 2023/12/16

Dr. He Dongjin reply Cardiology

Hello,
1.
The heart cannot stop; don't scare yourself.
Everyone is resting, and the heart is resting too.
A heart rate of 30 beats per minute is quite common.
If you feel fine, there's no need to worry.

2.
It's possible that even a normal person might trigger such findings during an examination; the reasons are hard to determine.

3.
Three ventricular premature contractions (VPCs) are not something to be concerned about.
It's not worth turning your life into black and white over just those three beats.

4.
Is it a sign of improvement? It's hard to say.
This condition can fluctuate, and it doesn't necessarily indicate that things are getting worse.

5.
As long as it's confirmed that your heart is fine, that's what matters.
Worrying won't solve anything, so try to relax.
I pray for your peace.
Changhua Hospital cares about you.

Reply Date: 2023/12/16

More Info

Understanding arrhythmias and vascular issues is crucial for managing cardiovascular health, especially for individuals experiencing symptoms like palpitations, dizziness, or fainting. Based on the information provided, let's address your questions systematically.

1. Coronary Vasospasm and Medication Side Effects: It appears that your physician has diagnosed you with coronary vasospasm, which can indeed be triggered during diagnostic procedures like coronary angiography. The medication you are taking, Isosorbide Dinitrate (often referred to as "依舒婷" in Chinese), is typically prescribed to help manage symptoms related to vasospasm and ventricular premature contractions (VPCs). While this medication can be effective, it is also known to have side effects, including palpitations and irregular heart rhythms. The episodes of bradycardia (heart rates dropping to 30-40 beats per minute) you are experiencing could potentially be linked to the medication, but it is essential to discuss this with your healthcare provider. Abruptly stopping medication without medical guidance is not advisable, as it may lead to a resurgence of symptoms.

2. Induced Ventricular Tachycardia (VT): The fact that your electrophysiological study induced a brief episode of VT does not necessarily indicate a severe underlying problem. It is not uncommon for individuals with structurally normal hearts to have inducible arrhythmias during such tests. The presence of VT can be a reflection of heightened excitability in the heart's electrical system rather than an indication of significant heart disease. However, the context of your overall health and symptoms is crucial in interpreting these findings.

3. Short Duration of VT: Generally, short episodes of VT, especially those that self-terminate, are less concerning than sustained VT. The transient nature of the VT you experienced suggests that it may not pose an immediate risk. However, continuous monitoring and follow-up with your cardiologist are essential to ensure that your heart rhythm remains stable.

4. Improvement in Symptoms: The reduction in the frequency of skipped beats and palpitations over the past month is a positive sign. It may indicate that your condition is stabilizing. Monitoring your symptoms and maintaining regular follow-ups with your healthcare provider will help assess whether this trend continues.

5. Concerns About Fainting and Arrhythmias: Given your history of syncope (fainting) and ongoing concerns about VPCs, it is understandable to feel anxious. While your recent tests indicate no significant structural heart issues, it is essential to maintain open communication with your healthcare team. They may recommend lifestyle modifications, such as stress management techniques, hydration, and avoiding stimulants, which can exacerbate arrhythmias. If you continue to experience symptoms or have concerns about fainting, further evaluation may be warranted.

In summary, while your heart appears structurally normal and your symptoms have shown some improvement, it is vital to continue working closely with your cardiologist. They can provide personalized advice based on your specific situation and help you navigate any concerns regarding your medications and symptoms. Regular follow-ups, lifestyle adjustments, and adherence to prescribed treatments will be key in managing your cardiovascular health effectively.

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