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Feeling Like Fainting, Sweating, Fast Heartbeat, Paresthesia On Arms. Done ECG And Ultrasound Of Heart

Posted on Thu, 7 Nov 2013

Question: I am having several episodes when i feel like fainting, first thing i feel very warm, i start sweating, and feel my heart racing, then i feel paresthesia on my arms, shoulder and a tight pressure on my front neck right hand side. Recently i also felt a sudden burning feeling in my upper chest and shoulders, before it has never happened. My symtomps started 20 days ago, i was admitted at ER and stayed in tachicardya state for more than 12 hours, i was scared to die. My HR was 120/130 and mild high pressure 150/95. But they said my heart rythm was constant. Next day i did ECG and ultrasound of the heart. They just found i have mild mitral valve prolapse with trace mr, trace tr, reverse a/e and dystolic dysfuntion I stage. I was put on nebivolol 5 mg, and since then my pressure is ok and HR also stays in the 60's when laying down and 80's when standing. Anyway I still have those episodes, i cant understand whats going on. I am not an anxious person, i have a good life, good job, why should i have panic attacks? Cannot be something related to vagus nerve, or other sympatic nerves which they are stimulated somehow? They checked my brain and neck with MRI without comtrast and they said it was clear. Why always i have that pressure on my jugular? Thanks.

Answered by Dr. Anantharamakrishnan (3 hours later)

Brief Answer:
Additional possibilities need to be investigated

Detailed Answer:
Hi friend,
Welcome to Health Care Magic

You may need further assessment and assistance

     Condition like Pheochromocytoma (episodic outpouring of adrenaline) may have to be investigated – it can cause increased rate / increased pressure / sweating / anxiety …
     HOLTER (24 to 48 hour ambulatory monitoring) is often done to detect an occult arrhythmia and plan for further management. It may also detect silent (no symptom) ischemia.
      TMT – Treadmill exercise ECG; may be with thallium isotope – is necessary to evaluate ischemia (reduced blood flow / Coronary Artery Disease)
     If there are no clues and if the problem is still bothering to the extent of interfering with life style, one may need Electro Physiological Studies (EPS) > it resembles angio – a catheter is put inside the heart / electrical activity recorded / stimulation and suppression tests are carried out / suitable medicine tested and so on. Though the test is the gold standard, it is INVASIVE and is not generally done unless there are compelling indications. This super-speciality expert is called ELECTRO-PHYSIOLOGIST.

     The body's balancing mechanism is in the inner ear. An ENT (Ear Nose Throat) specialist is the one to see - they have special tests to confirm or exclude the contribution of the ear.

The treating doctor may suggest them depending on need, based on his assessment of the situation.

Take care
Wishing all well
God bless
Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (40 minutes later)

Hello,

Thanks for reply. I attach my tests i have made on my heart, because doctors excluded i have heart problems. I am not sure anymore. Can you please check it?

Answered by Dr. Anantharamakrishnan (2 hours later)

Brief Answer:
Seems well..

Detailed Answer:
Hi

ECG – early repolarisation (Normal variant / possible inferior wall ischemia cannot be excluded…]
ECHO – Excellent ejection fraction / mild prolapse and early diastolic function need not be of great concern…

There are no significant pointers in them… no clues to suggest something serious
Hence the need for more tests - especially if symptomatic!

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (4 minutes later)

Thanks for reply. So do you suggest an holter to detect a possible silent ischemia? When i was in hospital they put on me a holter and kept it for more than 24 hours, but they told me it was ok.

Answered by Dr. Anantharamakrishnan (11 minutes later)

Brief Answer:
Yes..

Detailed Answer:
Hi

Repeat Holter (or event monitor) / thallium Stress EKG / urine VMA - are some of the tests that can give clues...

All the best

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar