concerned about heart - ECG abnormalities and "coronary sinus syndrome"?

Hi,

I am a 20 year old man who has had a spate of poor health in the last 9 months. I have near constant chest discomfort which feels like a chest infection, palpitations (particularly when lying down, felt in the abdomen), and occasional painful stabs in the centre of the chest.

Currently I am on beta-blockers (1x propanolol 80mg in the morning) for anxiety and migraines, as I had both attacks near daily between July and September. One particularly bad one in a cinema at night got me to the emergency room, but the ECG and blood pressure was fine. The beta blocker helped for a while, but these symptoms have recently returned, along with many others like dizziness, feeling spaced out, upset stomach, more chest pain and more palpitations.

Since July I have visited the emergency room 3 more times for 'panic attack' and palpitations, all ECGs coming back fine. The most recent one (late January) showed slight arrhythmia within normal boundaries, indicating partial branch block, but the doctors said it was fine to leave untreated. This trip to A&E coincided with two extremely sore palps that felt like something was going to burst in my chest, plus dizziness.

I wore a 24 hour Holter monitor 5 weeks ago and have yet to see the results letter myself, but a phone call to the doctor who has received them revealed that there were again some abnormalities (some technical talk, about a P wave?), which could indicate something called coronary sinus syndrome. Googling the syndrome (terrible idea, I know) only reveals information about "unroofed or partially unroofed coronary sinus syndrome", a type of heart defect. I cannot find any symptoms to go along with it, only info about surgical repair.

I have been referred to a cardiologist and have a doctor's appointment next week, so all I can do is wait and see what more tests I need done. Is there any cause for me to be concerned, as I am worried really sick right now on top of the physical symptoms. There is not a whole lot of info coming my way and the wait times are only making things worse.. I was wondering could it perhaps all be caused by the beta blockers? Or could I really have a congenital heart defect?

Update on this - after a particularly bad episode on friday night with chest pain, pre-syncope, palpitations and a fast heart rate, I was admitted to hospital for three days of monitoring. There they diagnosed "sick sinus syndrome" (as I exepected, not the other thing!), as there was arrythmia on the monitor. I was told to just stop taking propanalol, then an echo test was done which came back fine, no structural abnormalities.

Over the next few days my slow heart rate at rest increased, and my symptoms have gotten worse. I now find that whenever I get up from lying in bed, I get tachycardia up to 150bpm accompanied by strong painful palps and a few missed beats - the nurses told me that heart rhythm however is normal, it just goes fast. I overheard a doctor commenting surprisingly that my QT interval is very short.

Currently it is a mystery what is wrong. I have been discharged from hospital which I guess itself is a good sign, but i'm bed-ridden as a result and get extremely worried whenever I get up as it feels like a heart attack. I also dont sleep well, always waking up feeling like im dead and floating. I'm to get a 7 day monitor on thursday, so it's a tough week ahead.

My symptoms sound a bit like POTS syndrome, but they could be part of propanalol withdrawal too? Still no clue what is going on and the reassurances that I will not die are hard to take on board whenever I move at all..

I empathise. Ive been going through something a little similar. What has happened since?

A lot has happened since, mostly positive!

About a week after coming out the hospital I had an extremely bad attack of tachycardia, which felt a lot like a panic attack but much worse. I had to go back into hospital again in an ambulance where I was kept in for more monitoring. My symptoms were still unresolved, and I got rates of up to 170bpm and very painful palpitations just walking to the bathroom. The doctor I got was very good and, funnily enough, suggested to me that I may have POTS. He has something similar so was on the ball.

I was let out again after two days, and an adrenal ultrasound, 24 hour urine collection, exercise stress test, blood test and 7 day monitor later - no abnormalities found apart from sinus tachycardia (and elevated B vitamins in my blood from taking multivitamins lol). And I must have misheard the doctor's comment about QT apparently, as that was fine. I still have one more test to do, the gold standard for diagnosing POTS, called a tilt table test. The wait for that is 6 months though, but the cardiologist I have is excellent and decided that I could not go on like this for that long. I was put on a new 'wonder drug', ivabradine 5mg twice per day, which works like a beta blocker without being one. It has done wonders, as now my heart is about 60bpm all the time with just some mild palpitations.

I just had another appointment with my cardiologist this week and she has managed to move the tilt table test up to next month. She was almost shocked at how much an improvement I had made, and said that it is now up to me how I want to dose the ivabradine. Unfortunately I now get bad headaches, which could be caused by many things (ivabradine, being off propranolol, migraine, tension), so i've an appointment with my doctor and dentist to definitively establish the cause for them, and to see if there is some link to these heart problems. My next appointment with the cardio is a 6 month follow up, so all is going well now.

Even though I do not want to encourage it, going into hospital can work wonders for diagnosis because of the monitoring and quicker tests they do, and they said that it was the right thing for me to do in order to eliminate the chance of it being a potentially dangerous arrhythmia.

Really glad to hear you're doing much better!

My heart worries are really starting to drive me mad. Wish I could get fast answers like you, but trying to avoid the hospital.

Try posting a question on All Experts Cardiology forum. The cardiologists on there are usually pretty good and answer promptly.

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Originally Posted by WorriedMan

Hi,

I am a 20 year old man who has had a spate of poor health in the last 9 months. I have near constant chest discomfort which feels like a chest infection, palpitations (particularly when lying down, felt in the abdomen), and occasional painful stabs in the centre of the chest.

Currently I am on beta-blockers (1x propanolol 80mg in the morning) for anxiety and migraines, as I had both attacks near daily between July and September. One particularly bad one in a cinema at night got me to the emergency room, but the ECG and blood pressure was fine. The beta blocker helped for a while, but these symptoms have recently returned, along with many others like dizziness, feeling spaced out, upset stomach, more chest pain and more palpitations.

Since July I have visited the emergency room 3 more times for 'panic attack' and palpitations, all ECGs coming back fine. The most recent one (late January) showed slight arrhythmia within normal boundaries, indicating partial branch block, but the doctors said it was fine to leave untreated. This trip to A&E coincided with two extremely sore palps that felt like something was going to burst in my chest, plus dizziness.

I wore a 24 hour Holter monitor 5 weeks ago and have yet to see the results letter myself, but a phone call to the doctor who has received them revealed that there were again some abnormalities (some technical talk, about a P wave?), which could indicate something called coronary sinus syndrome. Googling the syndrome (terrible idea, I know) only reveals information about "unroofed or partially unroofed coronary sinus syndrome", a type of heart defect. I cannot find any symptoms to go along with it, only info about surgical repair.

I have been referred to a cardiologist and have a doctor's appointment next week, so all I can do is wait and see what more tests I need done. Is there any cause for me to be concerned, as I am worried really sick right now on top of the physical symptoms. There is not a whole lot of info coming my way and the wait times are only making things worse.. I was wondering could it perhaps all be caused by the beta blockers? Or could I really have a congenital heart defect?

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Hi I have second degree heart block that's all to do with the p waves. It just means the electrical signals don't reach where they should.i regularly see my cardiologist but don't panick it's not life threatening and at worst for me one day I'll have to have a pacemaker.the heart is an amazing thing it won't just pack up so wait and talk to your doc hope this helps?

I’m Amazed how helpful your hospital is, mine just fob me off every time

For example I was kicked out by security for missing my sick bowl when I was throwing up due to my anxiety

they even sent 1 of my results letters to me dated the day after my appointment and refused to reinstate me or accept fault so I was discharged for their cock up and had to start the whole process again!... Some of you may of herd of the hospital I’m speaking of (Stepping Hill) Not in my opinion the best hospital to have to go to!

But anyway I’m glad to hear ure getting better it’s nice to know there are some people out there getting the treatment they deserve!