Should we ignore it or proceed with further examination?
Hello, doctor! I am 30 years old, have a regular exercise habit, and do not have hypertension, diabetes, or hyperlipidemia.
I have been smoking for over 15 years.
I have anxiety and panic disorder due to discomfort in my heart and tend to be easily nervous.
Recently, for the past two months, I have been experiencing chest tightness, irregular heartbeats, and very mild chest pain.
I visited a doctor, and the exercise electrocardiogram showed mild arrhythmia, while the echocardiogram only indicated mild mitral valve prolapse.
The 24-hour Holter monitor recorded approximately 1,200 premature contractions in one day.
My resting heart rate seems to be slower, around 40-60 beats per minute.
The doctor informed me that there is likely no major issue and that I do not need medication, but mentioned that the exercise electrocardiogram is only about 70% accurate and could potentially yield false negatives.
Should I consider further testing, such as a CT scan to examine my blood vessels? A few days ago, I intentionally ran at full effort; after about 15 minutes of jogging, I sprinted and experienced blurred vision, dimming, and saw a light spot in the center of my vision.
Closing my eyes made the spot more pronounced, but I felt physically strong and my awareness was clear.
After slowing down, I gradually returned to normal.
Is it necessary to confirm whether there is any blockage in my blood vessels or insufficient blood flow during intense exercise? Or could this be related to other issues, considering that my panic disorder is already being treated? Thank you, doctor, for your response.
Austin, 30~39 year old female. Ask Date: 2024/03/26
Dr. He Dongjin reply Cardiology
Hello, I believe that observation is sufficient, but if you feel anxious and uneasy, you can consider getting a CT scan to check your blood vessels.
Changhua Hospital cares about you.
Reply Date: 2024/03/26
More Info
It's understandable to feel anxious about your symptoms, especially when they involve your heart. Given your history of anxiety and panic disorder, it's crucial to approach this situation with a comprehensive understanding of both your physical and mental health.
From what you've described, you've already undergone several evaluations, including an exercise electrocardiogram (ECG), echocardiogram, and a 24-hour Holter monitor, which indicated some early contractions but no significant issues. Your doctor has reassured you that there is likely no major concern, which is a positive sign. However, your experience of symptoms like chest tightness, irregular heartbeats, and the visual disturbances you encountered during intense exercise warrants further attention.
Understanding Your Symptoms
1. Chest Discomfort and Heart Palpitations: These symptoms can often be linked to anxiety and panic disorders. The body’s response to stress can lead to increased heart rate and sensations of tightness in the chest. However, they can also be indicative of underlying cardiac issues, especially given your smoking history and the presence of mitral valve prolapse (MVP). MVP can sometimes cause palpitations and chest pain, but it is generally benign.
2. Visual Disturbances During Exercise: The experience of seeing "light spots" or having blurred vision during intense physical activity could be related to several factors, including dehydration, low blood sugar, or even hyperventilation, which is common during panic attacks. However, it could also indicate a more serious issue, such as reduced blood flow to the brain during exertion.
3. Heart Rate Variability: A resting heart rate of 40-60 beats per minute can be normal for well-trained athletes, but if you are experiencing symptoms like dizziness or lightheadedness, it’s essential to discuss this with your healthcare provider.
Next Steps
Given your symptoms and the potential for anxiety to exacerbate physical sensations, here are some recommendations:
1. Follow-Up with a Cardiologist: Since you have experienced concerning symptoms, it may be beneficial to consult a cardiologist for further evaluation. A cardiac CT scan can help assess for any potential blockages or structural issues that might not have been evident in previous tests.
2. Monitor Your Symptoms: Keep a detailed log of your symptoms, including when they occur, their duration, and any associated activities (like exercise). This information can be invaluable for your healthcare provider in determining the next steps.
3. Manage Anxiety: Since you have a history of anxiety and panic disorder, continuing to address these issues is crucial. Cognitive-behavioral therapy (CBT) and other therapeutic approaches can help you manage anxiety symptoms, which may, in turn, alleviate some of the physical symptoms you are experiencing.
4. Lifestyle Modifications: Consider reducing or quitting smoking, as it can significantly impact cardiovascular health. Regular exercise, a balanced diet, and stress management techniques (like mindfulness or yoga) can also be beneficial.
5. Emergency Plan: If you experience severe symptoms, such as intense chest pain, shortness of breath, or fainting, seek immediate medical attention.
Conclusion
While your initial evaluations suggest that there may not be a significant cardiac issue, your symptoms warrant further investigation, especially given the recent changes and your history of anxiety. It's essential to advocate for your health and seek further evaluation if you feel it is necessary. Remember, it's always better to err on the side of caution when it comes to heart health.
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