Cardiac risks

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Submitted by Dr T on January 10, 2013 – 1:00pm

AFib event months ago lasted aprox 5+ mins.  On/off with no rhyme or reason chest pain that radiates across chest and up neck, very intense lasting 15-30 mins.  Had an episode that woke me from sleep. Cardiac work up EKG, u/s, nuclear testing, stress test normal.  Halter monitor PVC 1900 in 48 hrs. 44 yr old female, family hx of CAD/CHF father had 3 attacks, 1st at 39yrs. Passed at 72yrs.  Just frustrated no answer with these episodes I experience.  Thoughts?

Hi Lisa,
Depending on your cardiac risk factors other than your family history, the approach by your doctors (to exclude coronary artery disease) is the same I would have taken. You can calculate your cardiac risk by answering a few questions with this link.

Once coronary disease as a source of your symptoms has been excluded, as well as other causes of arrhythmias, in patients with otherwise normal hearts, sometimes Beta blockers are used to reduce the frequency of PVCs while it is common treatment for AF. If Atrial fibrillation (AF) is an ongoing problem it requires a different approach the also includes anti-coagulation. All new onset AF should be managed with a blood thinner such as Warfarin (Coumadin) to protect against blood clots that may cause a stroke, Pulmonary embolism (PE), or a clot to other parts of your body.
Read more here:

Hope this helps,
Dr T


Submitted by Dr T on January 14, 2013 – 1:30pm.

Hi Tanya,

I am not convinced your cardiac evaluation is complete, because some of your symptoms are consistent with heart failure. There is a test that calculates your ejection fraction, but that test doesn’t always all questions of cardiac function. I specifically think of some forms of cardiomyopathy, called restrictive cardiomyopathy, or another condition called pulmonary hypertension.

I also miss information about a final evaluation of these “tachycardias” and “extrasystolic beatings“. The fact you were treated with IV meds for control, suggests there was a real problem. You should ask your doctors to review your medical records from that time to make sure there your palpitations and arrhythmias were not serious and disappeared when you delivered your baby.

Here are some common tests used to evalaute a pregnant patient with an arrhythmia:

This should be considered an integral part of the investigation of any pregnant patient with proven arrhythmia to diagnose structural and functional disease.

This can be reasonably carried out during pregnancy providing exercise is not contraindicated for obstetric reasons. Care should be taken not to exceed the woman’s normal exercise capability and the test should be stopped if hypotension develops as this may impair placental perfusion.

While there has been experience of this in pregnancy, it is usually possible to delay this investigation until after pregnancy. It is also difficult to do beyond 24 weeks as women are unable to lie flat on their backs as the gravid uterus impedes inferior vena cava flow.

  • Pharmacological testing   

A pharmacological challenge may provide important diagnostic information, particularly in narrow complex tachycardia.

  • Electrophysiological studies       

This is rarely required in pregnancy as the arrhythmia can usually be managed pharmacologically until after delivery.

If it is not your heart, swollen lymphe glands, fatique and a severely decreased exercise tolerance can point to other illnesses. This is something you should discuss with your doctors.

Hope this helps,

Submitted by Dr T on January 11, 2013 – 9:52am.

Hi Lisa,

All the tests have excluded coronary artery disease as a source of your chest pains, and likely other more unikely acute causes such as a pulmonary embolism or other chest diseases (check with your doctor). Chest pains during an arrhythmia can be a result of the understandible associated anxiety it causes.

Hope this helps,

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