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Ask Dr .Saeed ahmed Your Own Question
Dr .Saeed ahmed
Dr .Saeed ahmed, Doctor
Category: Cardiology
Satisfied Customers: 4469
Experience:  MBBS/FCPS(R)/MRCP U.K(R), Senior Registrar Cardiology
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Cardio Issue or Something Else?

Customer Question

Hi, I am a 39 year old male, just under 6 foot tall and weigh 105kg. Im of stocky build and alot of my body fat i would say is in my upper torso. I have always been active and played sports eg. Football every weekend for a good 18 years up until last April 2013. My cholesterol readings have varied from 5.4 to 6.4mmol/l which was my last reading 5 months ago. I am currently a smoker and have smoked for 17 years, despite several unsuccessful attempts at quitting.

Ive had had a long fascination that i seem to have an underlying health condition with the functioning of the heart and cardiovascular system. It all started 13 years ago when out of the blue one night my heart started to palpitate very fast, i was feeling dizzy and could hardly stand, i was breathless and was having tingling sensations in my face and hands. I thought i was having a heart attack. I was rushed to hospital thinking i was about to die, after a few tests and investigations, it was not related to a heart problem, but diagnosed panic/anxiety attack. At the time i didnt know what that was and so decided to do some counselling/therapy with psychiatrists and psychologists to try to stop these attacks from happening. I was put on some SSRI's at 26 years old and i have been swapping from one SSRI to another through out these 13 years of hell. For the record i have been on Escitalopram, Citalopram, Escitalopram, Mirtazipine, Paroxetine and currently having a bad time on Fluoxetine these last 5 months. My anxiety/panic disorder is still an ongoing problem for me.

At 38 years old i was diagnosed with hypertension as my blood pressure would just shoot up to 170/110 for no obvious reason, and was put on an ace inhibitor called Lisinopril 20mg after an unsuccessful trial with a calcium blocker called amlodipine. Since starting these hypertension medication i noticed other things were happening to my body which to this day i am still unsure why as this is still happening to me today.

My Heart Rate seems to be all over the place, when i am lying down eg. Resting/Sleep it usually beats between 44bpm-56bpm, any slight movement would cause it to pick up pace to 70bpm ish and then it will settle back down, if i go from a lying down position to a standing position there would be an almighty jump and change to 100 bpm and i would feel very lightheaded and on occasions nearly fallen down with weakness and dizziness. If i tried to do any other activity eg Wash The Car by hand my heart would beat even faster 130/140 bpm and i would really struggle keeping this up for more than a few minutes as i would start to get pains in my chest, the dizziness especially going from a low position to a straight up position would increase and i would start to perspire alot rather too easily. Feeling all this would then plays on my anxiety/panic disorder, thinking im about to drop dead. When i use to play football and i over exerted myself i noticed that my heart beat would really be going at a fast rate 160/170 bpm and i would get an ectopic missed heart beat virtually every every 30 seconds unless i did something to lower my heart beat. With these ectopic beats i would get a flutter sensations in my chest area and when it happened i would feel very tired and weak. I have no choice but to stop playing and go home to rest. Whilst at home my anxiety would be obsessed with the missing heartbeat and the general feeling unwell, it would take over 4-5 hours for my heart rate to return to a normal level of 60-70 bpm and i have on many occasions gone to the Emergency Department as it was still missing after an hour or two. I have had a CT Angiogram, Echocardiogram, Treadmill Stress Test within the last 12 months and lots of ECG's whether be at home, hospital or the doctors practice. Nothing has shown up apart from the echocardiogram which picked up that my heart muscle was a little thicker on the left side and the cardiologists recommendation was to make sure i control my hypertension. Blood works show no problems. I am NOT a diabetic although it does run in the family. Everyday i suffer from chest pains and aches, dizziness and a brain fog like feeling without fail and i do not know why this is so?

Went for a walk to the local shop earlier and when i got home i took my pulse and it was 126bpm and all i did was walk 300 footsteps!!

During that walk i was getting breathlessness and towards the end i got a sharp poking pain between my shoulder blades for a split second. Its taken 10 minutes to get to 90bpm, and im lying down exhausted!

Sure there are times when these symptoms or sensations do all disappear and i feel normal, but they are very few and far between and over this last year rarely. Are the doctors missing something with regards ***** ***** heart/cardio or is it just me and my mental health disorder?

Submitted: 3 years ago.
Category: Cardiology
Expert:  Dr .Saeed ahmed replied 3 years ago.
Dr .Saeed ahmed :

Hello,

Dr .Saeed ahmed :

Thank you for your question.

Dr .Saeed ahmed :

You are suffering from what we call microvascular angina.

Dr .Saeed ahmed :

Presence of thick heart muscles and elevated cholesterol can put a person at risk of microvascular angina.

Dr .Saeed ahmed :

You are getting symptoms while exercising, your blood pressure drops low and you get chest discomfort all these are symptoms of microvascular angina.

Dr .Saeed ahmed :

You need to discuss this option with your doctor/cardiologist as this is most commonly missed

Dr .Saeed ahmed :

Let me know if you have questions.

Customer: Hello, thank you for your reply
Dr .Saeed ahmed :

you are welcome.

Dr .Saeed ahmed :

I hope answer was helpful.

Customer: How urgent or priority is this and can this cause me to have a heart attack.
Dr .Saeed ahmed :

It causes heart attack in around 1-2% of people which is a very low risk. near to general population so you are safe as all other tests are normal.

Customer: I assume this is not the usual angina type pain that people get diagnosed with
Dr .Saeed ahmed :

Yes it is less common type of angina

Dr .Saeed ahmed :

it is a relatively low risk angina as small vessels are involved still it need to be treated.

Dr .Saeed ahmed :

You have questions

Dr .Saeed ahmed :

I hope chat is helpful.

Customer: If i see a cardiologist and tell him this, what will the process be in confirming this type of angina. As you are aware i have had a ct angiogram and echocardiogram. When i did the treadmill test the operator did mention that as i did more exercise my blood pressure was actually getting lower under the activity.
Dr .Saeed ahmed :

Yes i read that you had CT and echo

Dr .Saeed ahmed :

these tests do not diagnose this form of angina

Dr .Saeed ahmed :

because it is at level of small vessels which cannot be seen by these tests

Dr .Saeed ahmed :

we use nuclear scans for this form of angina

Dr .Saeed ahmed :

You simply have to tell your doctor to consider microvascular angina as the possible cause

Customer: No doubt this type of test carries a risk? Would this test cause me more harm than good?
Dr .Saeed ahmed :

It is a low risk test same as CT scan

Dr .Saeed ahmed :

it carries more benefit as it will make your diagnosis certain and which will make it easy to treat.

Customer: Reason i ask is because when i had my ct angiogram with dye, i have experienced constant Indigestion type pains ever since and i do not know for certain if that caused my reflux problem.
Dr .Saeed ahmed :

Well it is very unusual for the CT to cause this problem for long term

Dr .Saeed ahmed :

it mainly causes such symptoms which improve after few days.

Dr .Saeed ahmed :

I hope this answers your questions.

Dr .Saeed ahmed :

Let me know if you have queries.

Customer: Final question, untiil i see my cardiologist or doctor, is there anything i should avoid doing?
Dr .Saeed ahmed :

high fat diet, excess exercise,

Dr .Saeed ahmed :

should be avoided till you see your doctor

Dr .Saeed ahmed :

any triggering factor should also be avoided.

Dr .Saeed ahmed :

these are the most things recommended

Dr .Saeed ahmed :

I hope i have answered your questions.

Customer: Yes, thank you for your opinion.
Dr .Saeed ahmed :

Kindly rate my answer if no further questions, you are welcome to come back anytime on this chat for more queries on this topic.

Dr .Saeed ahmed :

Have a nice day.

Customer: You also.
Dr .Saeed ahmed :

Take care.

Dr .Saeed ahmed :

Do not forget to rate, thank you.

Dr .Saeed ahmed and other Cardiology Specialists are ready to help you
Expert:  Dr .Saeed ahmed replied 3 years ago.

Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

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Customer: replied 3 years ago.
Hi, since speaking to you I am feeling very afraid that my heart is in trouble and that I could die any second from heart failure or heart attack due to micro vascular angina.
I am feeling even more pain and discomfort on and off in my chest and left armpit, and it seems to be worse when I eat something or just relaxing and lying down.
Expert:  Dr .Saeed ahmed replied 3 years ago.
Well this pain is related to stress and can increase with stress. So it should be avoided if possible. This type of angina is less dangerous than other angina, still it needs treatment and proper follow up with a cardiologist.
Customer: replied 3 years ago.

Could this possibly also be related to a syndrome called


Postural Orthostatic Tachycardia Syndrome


considring my heart rate seems to jump up when going from a lying to standing position, as well as other symptoms like dizziness, weakness from standing???

Expert:  Dr .Saeed ahmed replied 3 years ago.
Hello,

Welcome back..

How much your heart rate jumps when you stand up and how much your blood pressure drops ?
Customer: replied 3 years ago.
When I go from a lying position to standing position my heart jumps from 60ish to 108+
I am currently sat in a&e waiting with a pulse rate of 97bpm sat down.
Expert:  Dr .Saeed ahmed replied 3 years ago.
It is possible that your symptoms are due to POTS if they only occur when you stand up from sitting or lying position.

If they happen at other occasions like during activity or exercise then it is not POTS.