Ask a doctor on the topic of Internal medicine

Heart problems

September 2, 2012 | 20,00 EUR | answered by Dr. med. Kathrin Hamann

Dear Sir or Madam,

I am reaching out to you out of sheer desperation, hoping that you can help me or provide some advice. I am 50 years old, 1.69 meters tall, weigh 80 kg, and am a smoker. Additionally, I am currently going through menopause.

Since around February 2012, I have been experiencing the following symptoms: Whenever I get up, even just to go from the couch to the bathroom, I experience strong palpitations with arrhythmias, and my blood pressure shoots up (highest values: 175/100, pulse 140). My heart beats so strongly that I feel like it's going to jump out of my chest. I also shake all over (mostly in my legs), experience dizziness, and nausea. Out of sheer panic, I immediately lay back down, and within a minute, my blood pressure and pulse return to normal. I have always had low blood pressure. I have been experiencing heart arrhythmias for 20 years and have a mitral valve prolapse. I also sometimes wake up at night due to heart palpitations.

In March 2012, I visited my cardiologist, and the doctor's report states the following:
ECG findings: Sinus rhythm, heart rate 83/min, left type, slight repolarization disorders
Holter ECG findings with ST segment analysis 03/12: SR, no pauses, min. heart rate 51, max. 145, average 80/min, few SVES, few VES, no significant ST segment depressions.
Echocardiography findings: Left atrium slightly dilated at 41 mm, left ventricle normal size, concentrically hypertrophied with diastolic dysfunction, good systolic pump function parameters, no relevant valve defect, no confirmed regional contraction disorders.

A 24-hour blood pressure monitoring was not requested. Due to orthopedic reasons (I have a bad knee), it was not possible for me to undergo a stress ECG. The doctor's therapy recommendation is "lifestyle change", especially cessation of smoking, and a diet rich in potassium and magnesium. Due to my knee problems (partial stiffening and arthritis), I am unable to engage in physical activity. I can't even go for a walk.

Since my visit to the cardiologist, it has gotten so bad that I am too afraid to get up, except to go to the bathroom, for fear of having a heart attack or stroke.

During a blood test at my general practitioner's office, the following results were found:
Iron 180 (Normal: 45-145), Cholesterol 288 (Normal: 150-240), Triglycerides 512 (Normal: 50-170), LDL 190 (...).

Dr. med. Kathrin Hamann

Hello,

I am happy to help you further.

As you describe it, the long-term ECG and echocardiography are normal, except for the slightly enlarged left atrium, which can be explained by the mitral valve prolapse. The current symptoms (heart palpitations and dizziness upon standing up) suggest a condition called orthostatic dysregulation. A tilt table test would be useful to determine blood pressure and heart rate and confirm this suspicion.

I also see smoking as critical and recommend reducing or even better, quitting altogether.

For exercise, I would recommend regular swimming, as it puts less strain on the joints.

Please continue to seek further examination and targeted treatment.

All the best and a speedy recovery!

Best regards,

Dr. K. Hamann