My life with cardiac symtoms
Q-Wave
(lasting anywhere from 30 minutes to hours). I've been to the ER over
120 times (I'm serious). My troponin I and T have never been
elevated. My EKG is considered a normal variant and only changes when
I'm tachacardic (R wave becomes tall, S wave becomes deep). Is this
change normal?
In addition, I also have horrible sinus tachycardia and palpations
daily. My initial diagnosis was panic disorder, then inappropriate
sinus tachycardia with mild LVH, and now back to panic disorder.
I have a fixation on my cardiovascular system. I'm convinced
they've missed something. I don't see how all these symptoms (so
horrible) could be cause purely by a physiological problem. My first
echocardiogram back in 2003 was somewhat normal with the exception of
slightly think walls (septum was 1.1cm and free wall was 1.1cm with an
LA of 4.1cm). Since 2003, I gained quite a bit of weight and my latest
echo showed a septum of 1.2cm with a free wall of 1.1cm or so. However,
I have had other echo's that have shown my septum to be thicker,
around 1.5cm.
Being someone who worries a lot and after hearing about my echo
results, In March of 2005, I went to the Cleveland Clinic on Ohio to
see someone who specializes in Hypertrophy Cardiomyopathy. He told me
everything was fine and that my symptoms are anxiety related. He did
note however, that my EKG shows Q waves in the inferior leads, but he
felt this was a normal variant as most other doctors have concluded. My
first EKG back in 2003 showed the same pattern.
Even more recently (June 2005), I was admitted to the hospital for
chest pain and tachycardia. My heart was racing well into the 180's.
During the hospitalization, they performed a cardiac catheterization.
All the intracardiac pressures were normal, and they said my coronaries
look awesome. I stayed in the hospital for about a week all together,
hooked up to a 5-lead monitor. Once again, nothing other than horrible
sinus tachycardia. However, one doctor in the hospital, after seeing my
echocardiogram report, said I have Hypertropic Cardiomyopathy, but
later I was told he was inexperienced.
So where does this leave me? I've also had many other test... Blood
work, stress tests ect.. They did find gallstones on an abdominal
ultrasound, and my gallbladder was removed in August of 2005. I must
admit, since that surgery, my chest pains have become less intense. But
I continue to have horrible tachycardia. Even being a little nervous,
standing up too fast, eating too much, can cause my heart to race. In
the ER, it's been up to around 200bpm.
Is there some rare condition out there that could explain my symptoms
or am I really nuts?
Thanks,
Q-wave
liaM
How about starting a course in meditation, something simple like they
teach in yoga ? Meditation has helped me overcome pain and taught me
what being calm is like. Once you taste it, you'll know what to look for.
Andrew B. Chung, MD/PhD
> For the last three years now, I've suffered from horrible chest pain
> (lasting anywhere from 30 minutes to hours). I've been to the ER over
> 120 times (I'm serious). My troponin I and T have never been
> elevated. My EKG is considered a normal variant and only changes when
> I'm tachacardic (R wave becomes tall, S wave becomes deep). Is this
> change normal?
No.
> In addition, I also have horrible sinus tachycardia and palpations
> daily. My initial diagnosis was panic disorder, then inappropriate
> sinus tachycardia with mild LVH, and now back to panic disorder.
>
> I have a fixation on my cardiovascular system. I'm convinced
> they've missed something. I don't see how all these symptoms (so
> horrible) could be cause purely by a physiological problem.
You probably mean psychological.
> My first
> echocardiogram back in 2003 was somewhat normal with the exception of
> slightly think walls (septum was 1.1cm and free wall was 1.1cm with an
> LA of 4.1cm). Since 2003, I gained quite a bit of weight
Uh-oh.
> and my latest
> echo showed a septum of 1.2cm with a free wall of 1.1cm or so. However,
> I have had other echo's that have shown my septum to be thicker,
> around 1.5cm.
Sounds like you may very well have concentric left ventricular
hypertrophy.
> Being someone who worries a lot and after hearing about my echo
> results, In March of 2005, I went to the Cleveland Clinic on Ohio to
> see someone who specializes in Hypertrophy Cardiomyopathy. He told me
> everything was fine and that my symptoms are anxiety related. He did
> note however, that my EKG shows Q waves in the inferior leads, but he
> felt this was a normal variant as most other doctors have concluded. My
> first EKG back in 2003 showed the same pattern.
>
> Even more recently (June 2005), I was admitted to the hospital for
> chest pain and tachycardia. My heart was racing well into the 180's.
> During the hospitalization, they performed a cardiac catheterization.
> All the intracardiac pressures were normal, and they said my coronaries
> look awesome. I stayed in the hospital for about a week all together,
> hooked up to a 5-lead monitor. Once again, nothing other than horrible
> sinus tachycardia. However, one doctor in the hospital, after seeing my
> echocardiogram report, said I have Hypertropic Cardiomyopathy, but
> later I was told he was inexperienced.
Concentric left ventricular hypertrophy is not hypertropic
cardiomyopathy.
> So where does this leave me? I've also had many other test... Blood
> work, stress tests ect.. They did find gallstones on an abdominal
> ultrasound, and my gallbladder was removed in August of 2005. I must
> admit, since that surgery, my chest pains have become less intense. But
> I continue to have horrible tachycardia. Even being a little nervous,
> standing up too fast, eating too much, can cause my heart to race. In
> the ER, it's been up to around 200bpm.
"Eating too much" being a precipitant suggests underlying endothelial
dysfunction.
> Is there some rare condition out there that could explain my symptoms
> or am I really nuts?
Actually your symptoms and history suggest that you have metabolic
syndrome (MetS) which is not a rare condition and is often associated
with atypical chest pain and inappropriate sinus tachycardia.
> Thanks
You are welcome. All praises belong to the LORD, Whom I love with all
my heart, soul, mind, and strength :-))
Would be more than happy to "glow" and chat about this and other things
like cardiology, diabetes and nutrition that interest those following
this thread here during the next on-line chat (01/05/06) from 6 to 7 pm
EST:
For those who are put off by the signature, my advance apologies for
how the LORD has reshaped me:
Prayerfully in Christ's love,
Andrew
http://tinyurl.com/b6xwk
Q-Wave
> "Eating too much" being a precipitant suggests underlying endothelial
> dysfunction.
Eating too much can trigger the tachacrdia and anxiety, not the chest
pain. How does endothelial dysfunction cause tachacrdia? Would this
also explain the EKG findings (Q waves in II, III, and avf with normal
cath and wall motion on echo).
> Actually your symptoms and history suggest that you have metabolic
> syndrome (MetS) which is not a rare condition and is often associated
> with atypical chest pain and inappropriate sinus tachycardia.
How is this condtion treated? I am very overweight, 280lbs. I am also
19 years old. Would that also explain the LVH? Can LVH cause symtoms?
Will it go away with weight loss?
Also, have you seen patients before with such high heart rates related
to panic disorder?
With my history in mind, what would you suggest I do when I have chest
pain? I've been to the ER so many times..
Thank you once again,
Q-wave
Q-Wave
a panic attack?. If you'd like, I can send you my EKG's.
My resting EKG shows Q waves in II, III, and Avf with T wave inversion
in III and Avf. There is somewhat poor R wave progression and my latest
EKG's show a biphasic P wave in V1.
However the EKG has been called a "normal varient" by many doctors.
I've been told I have a "turned" heart becuase of my size, and the Q
waves look idiopathic.
Thanks
Andrew B. Chung, MD/PhD
> Thanks for your help Dr. Chung,
You are welcome :-)
> > "Eating too much" being a precipitant suggests underlying endothelial
> > dysfunction.
>
> Eating too much can trigger the tachacrdia and anxiety, not the chest
> pain. How does endothelial dysfunction cause tachacrdia?
By causing diastolic dysfunction.
> Would this
> also explain the EKG findings (Q waves in II, III, and avf with normal
> cath and wall motion on echo).
The Q waves would be explained by the concentric left ventricular
hypertrophy that can arise from MetS.
> > Actually your symptoms and history suggest that you have metabolic
> > syndrome (MetS) which is not a rare condition and is often associated
> > with atypical chest pain and inappropriate sinus tachycardia.
>
> How is this condtion treated? I am very overweight, 280lbs. I am also
> 19 years old.
By safe permanent weight loss.
> Would that also explain the LVH?
Yes.
> Can LVH cause symtoms?
Yes.
> Will it go away with weight loss?
Yes.
> Also, have you seen patients before with such high heart rates related
> to panic disorder?
Yes.
> With my history in mind, what would you suggest I do when I have chest
> pain? I've been to the ER so many times..
Would suggest you ask your doctor to consider the possibility of
variant angina so that s/he would be inclined to prescribe
nitroglycerin for you to abort these chest pain episodes possibly
obviating the need for you to go to the ER so many times in the future.
> Thank you once again
You are welcome (would be happy to look at your EKG if you will post a
link to it... attachments don't make it through the protective
shielding around my email account :-))
All praises belong to the LORD, Whom I love will all my heart, soul,
mind, and strength :-)))
Would be more than happy to "glow" and chat about this and other things
like cardiology, diabetes and nutrition that interest those following
this thread here during the next on-line chat (01/05/06) from 6 to 7 pm
EST:
For those who are put off by the signature, my advance apologies for
how the LORD has reshaped me:
Prayerfully in Christ's love,
Andrew
http://tinyurl.com/b6xwk
>
> Q-wave
Q-Wave
> > Eating too much can trigger the tachacrdia and anxiety, not the chest
> > pain. How does endothelial dysfunction cause tachacrdia?
>
> By causing diastolic dysfunction.
How would eating cause diastolic dysfunction? There have been times
after eating, that my pulse went up to 200bpm, but It also seemed like
I was having a panic attack. After the "attack", it slowed down over
time. I wonder why other doctors didn't mention this.. even at the
Cleveland Clinic?
> You are welcome (would be happy to look at your EKG if you will post a
> link to it... attachments don't make it through the protective
> shielding around my email account :-))
These are only a few of my many EKG's.
Resting -
http://www.fastsilicon.com/images/47/bab68f538d61afe423cf7446fbe6696a.jpg
http://www.fastsilicon.com/images/47/b74ed8242bb4ea7a701b8a9ccf2e4fc3.jpg
During Panic -
http://www.fastsilicon.com/images/38/0c21627f277b30a859ac36358fdc15f9.jpg
During the "panic" EKG, why are there those S and T wave changes?
Also, what does having a normal cardiac catherazation mean? Does having
normal intercardiac pressures rule out LVH? What is the significance of
having those normal pressures.
Thank you very much and I wish you a Happy New Year!
Q-Wave
Q-Wave
Here is another link:
http://www.fastsilicon.com/images/48/0c21627f277b30a859ac36358fdc15f9.jpg
Andrew B. Chung, MD/PhD
> Dear, Dr. Andrew B. Chung, MD/PhD,
You may call me Andrew since all my friends, family and patients do :-)
> > > Eating too much can trigger the tachacrdia and anxiety, not the chest
> > > pain. How does endothelial dysfunction cause tachacrdia?
> >
> > By causing diastolic dysfunction.
>
> How would eating cause diastolic dysfunction?
By way of causing endothelial dysfunction acutely especially if it is
the usual American fatty meal (more so these days with the low-carb
trends). Ischemia from coronary spasm from endothelial dysfunction
causes immediate diastolic dysfunction.
> There have been times
> after eating, that my pulse went up to 200bpm, but It also seemed like
> I was having a panic attack. After the "attack", it slowed down over
> time. I wonder why other doctors didn't mention this.. even at the
> Cleveland Clinic?
Cardiologists with specialized training in vascular biology are rare
even at the Cleveland Clinic.
> > You are welcome (would be happy to look at your EKG if you will post a
> > link to it... attachments don't make it through the protective
> > shielding around my email account :-))
>
> These are only a few of my many EKG's.
Nice quality scans.
> Resting -
>
> http://www.fastsilicon.com/images/47/bab68f538d61afe423cf7446fbe6696a.jpg
>
> http://www.fastsilicon.com/images/47/b74ed8242bb4ea7a701b8a9ccf2e4fc3.jpg
>
> During Panic -
>
> http://www.fastsilicon.com/images/38/0c21627f277b30a859ac36358fdc15f9.jpg
>
> During the "panic" EKG, why are there those S and T wave changes?
Would suggest that the coronary spasm is occurring in the PDA
(posterior descending artery).
> Also, what does having a normal cardiac catherazation mean?
It means the ischemia is not coming from a fixed obstruction.
> Does having
> normal intercardiac pressures rule out LVH?
No.
> What is the significance of
> having those normal pressures.
It excludes hypertension as the reason for the concentric left
ventricular hypertrophy.
> Thank you very much and I wish you a Happy New Year!
You are welcome :-)
All blessings belong to the LORD, Whom I love with all my heart, soul,
mind, and strength :-))
May you also continue to be blessed through 2006 and beyond in Jesus'
most precious and holy name :-)))
Q-Wave
1. Do you think I have varient angina?
2. If so, how do I treat this condtion?
3. How do I go about finding a good cardiologist in my area (Oklahoma
City)
4. What do you think of my EKG's? Is the resting EKG normal?
Take care and I wish you the very best Dr. Chung
Andrew B. Chung, MD/PhD
> Thank you for all the support:
>
> 1. Do you think I have varient angina?
Yes.
> 2. If so, how do I treat this condtion?
By reducing or eliminating all known risk factors for coronary disease
because these risk factors tend to be detrimental to the health of your
coronary endothelial cells. For example if you smoke, you will need to
stop. If you are around second-hand smoke, you will have to reduce
your exposure. If you have been eating fatty fried foods, you will
have to curtail that. You may be already eating less fats since having
your gallbladder removed because this tends to make folks less fatty
food tolerant. You will need to avoid various stimulants and
decongestants. This includes the various ergot and triptan
preparations given for migraine headaches. You will need to work with
your primary doctor to determine whether you have metabolic syndrome
(MetS) which should be aggressively addressed if you have it.
The latter is best achieved by having your doctor supervise your use of
the 2PD-OMER Approach:
http://www.HeartMDPhD.com/wtloss.asp
> 3. How do I go about finding a good cardiologist in my area (Oklahoma
> City)
Rely on your primary doctor to steer you to one that will work with
him/her along with you.
> 4. What do you think of my EKG's? Is the resting EKG normal?
The Q waves are likely a normal variant for you based on your history.
The inferior T wave changes that are occurring when you are having your
symptoms are not normal.
> Take care and I wish you the very best Dr. Chung
Thank you for your kind thoughts :-))
You will be in my prayers dear neighbor whom I love in Jesus' most
Q-Wave
> > 1. Do you think I have varient angina?
>
> Yes.
For the last three years, I have struggled to find answers and help for
my problems (without medical insurance). You are a wonderful doctor,
and your help and guidance is greatly appreciated.
Tomorrow, I will look for an understanding cardiologist in my area. I
will bring my records with me, but I have a few more questions for you,
if you don't mind (you must be very busy).
What leads you to variant angina? Is it the T wave changes in the EKG?
Or the S and R wave changes during my "attacks"?
I take medication for pain (Lortab, Oxycontin); are these safe to take
with variant angina?
When I see my new cardiologist, what tests will s/he most likely order
to confirm my diagnoses?
Could it be possible that my tachycardia is also related to panic
disorder? Is there a chance of sudden death during these "attacks"
I have?
Once again, thank you very much...
Q-Wave