Ask a doctor on the topic of Internal medicine

Follow-up to Mr. Dr. Berg

August 22, 2014 | 30,00 EUR | answered by Dr. med. Ralf Berg

Dear Dr. Berg,

First of all, thank you very much for your prompt and detailed response.

I forgot to mention that an ultrasound examination of the abdominal organs (liver, portal vein and hepatic veins, gallbladder, spleen, kidneys, abdominal vessels, bladder, and genitals) was also performed. The findings were normal here as well.

My age: 28 years old.

What I forgot to mention in my previous post:
In the last ECG (performed by my general practitioner), it was noted that my sinus rhythm is regular, but my pulse is sometimes faster and sometimes slower. I have attached the ECG for your reference.

Additionally, my (self-measured) blood pressure readings have been slightly elevated on several occasions (also attached). A 24-hour Holter monitor test under everyday conditions is scheduled for next week (the previous one was done on a Saturday).

You mentioned that it is highly unlikely that I have a problem in the heart area.

To further ease my mind, I would like to know:
In June, I visited the emergency room because on two consecutive days (late evenings/nights), I suddenly experienced significantly elevated blood pressure, my heart was racing, and I felt a heavy pressure on my chest while at rest and without exertion. For example, the readings were 133/79/68, shortly after 141/90/81, then 162/85/98, and then 185/?/112.

I have been experiencing constant pain in the left chest regularly since mid to late July. In between, I mainly had issues with dizziness (feeling like I could faint at any moment, vision problems, weakness in legs).

Therefore, for reassurance, I would like to ask if, in your opinion, despite the heart examinations being some time ago, it is still highly unlikely that there is anything wrong in the heart area?

Can blood pressure readings rise significantly due to anxiety (psychosomatically)?

What makes you and the colleagues who have examined me so confident that everything is fine here? Do heart problems develop over a longer period of time? Can these examinations also exclude any potential future problems?

As I mentioned, these questions are for my peace of mind, as I have unfortunately been provided with very limited and vague information so far.

Thank you again for your efforts.

Dr. med. Ralf Berg

Hello again,

Even the new measurements and their additional findings are not threatening. You do not have to worry about any organic heart disease.

And yes, blood pressure levels can rise so high and even higher when you are excited.

Perhaps the following information might help you. At 28 years old, you are still very young. The younger you are, the higher the frequency variability. This means that in young adulthood, the cardiovascular system can adjust very quickly (i.e. increase or decrease blood pressure and heart rate). If you are sensitive to these changes and can physically feel them, it can lead to an anxiety reaction.

The fact that your heart behaves so dynamically, without any changes in the EKG or elsewhere, makes me and my colleagues confident that everything is fine. Your heart responds promptly and age-appropriately, can easily catapult your blood pressure up, but unfortunately also react to purely psychological stimuli.

It might be helpful if you start interval training. By short bursts of maximum strength and cardiovascular stimuli, you will be pushed to the limit. This may cause racing heart, restlessness, and even trembling. Perhaps you can perceive this state as normal and reproducible, simply as a sign of an agitated circulatory state, without any fear component.

Yes, maybe a sports program would be the solution. With the adaptation to hyperdynamic circulatory states and, of course, the beginning of the training effect, the circulation becomes more stable in the medium term and cannot easily be brought into a hypertonic situation without corresponding physical exertion.

Today, one can deal with it calmly, especially through cardiac ultrasound (echocardiography), where the function of the heart can be directly observed and any previously feared valve diseases could be easily seen.

I wish you a nice weekend. Best regards, Dr. Berg