Thank you for your query at DoctorSpring.com.
Its difficult to say right away that your symptoms are non cardiac and certain investigations are warranted.
Firstly, you have chest tightness occasionally at rest and occasionally after exertion. Plus occasionally fatigue. To rule out a cardiac etiology the best test is TMT. That episode of chest discomfort and dizziness could be acute coronary syndrome or else it could have been just anxiety.
Troponin T or I should have been done at that time. If it was within the last 14 days you could still have the test done. If it's more than 14 days then it is of no use doing the test. An echocardiogram would be useful to rule out any myocardial infarction that has occurred during that episode of chest pain. Also it will also give us an idea about your left ventricular function.
You say your heart rate was less than usual at 60 per min during that episode of chest discomfort and dizziness. Were you on propranolol the previous day?
Meanwhile please get an echo and TMT and if within last 10 to 14 days, then please get a trop done to rule out an acute coronary syndrome at that time. This is all to rule out a cardiac cause of your symptoms which may turn out to be anxiety if the tests are normal.
Hope it helps, please feel free to discuss further.
Dr Vivek Mahajan
Patient replied :
Hi Dr Vivek,
Many thanks for your reply. Well, in the hospital the doctor didn't seem to think the blood test was needed because the ECG was OK and my blood pressure dropped off (I also took propranolol just before I called the ambulance...)
re: the day before, No,I didn't take propranolol the day before, but I had a strong chamomile and lavender tea with passion flower tincture in it).Unsure if that is related.
Having said all this, I've ordered Troponin T test now from the lab where I did Thyroid blood test on Wednesday (they still have my blood sample left), so I'll know more on Monday.(thyroid is fine)
At any rate, my GP has referred me to the cardiologist, but that appointment won't take place in the next two weeks, that's for sure. I'd like to do a stress test (TMT), so hopefully that will be sorted.
I guess if Troponin T comes back and it shows something bad, I'll need to check into the emergency, I presume.
Let me also note that after I took propranolol and went home from hospital, I felt OK, slept great that night (after a long time), and the next day had a burst of energy..I think I walked 5 miles around the town, doing things. It was the day after that the symptoms came back. Yesterday when I went for a run, I didn't feel right, like I said, but also I am constantly worried about running now because I don't want to push myself if something IS wrong physically. I can live with the anxiety, that would be a relief, so to speak. Although, I can sleep only few hours at night. I'm just worried if it's not heart related.
So, to sum up, no, I didn't take propranolol prior to the event on Monday morning, but after. I've now realised that my resting heart rate, after doing belly breathing is in fact 60-67.
Thanks for the follow-up.
A Troponin positive now wouldn't mean that you have to rush to the hospital. It only is a retrospective evidence that you had a cardiac event that day. Still the fact that you could walk around for 5 km around the town is reassuring. So hopefully you would have a normal TMT and you would have a documented evidence that all this is non cardiac.
Also the fact that your resting heart rate is 60 is reassuring because during that dizziness episode you have a documented heart rate of 60. If it were 40 something I would be worried that the low heart rate is causing the dizziness. Thankfully that is not the case.
Propranolol helps in anxiety. So your response to propranolol is also a pointer towards anxiety.
So lets wait for the trop and TMT. Dont worry about pushing yourself to limits during TMT. The doctors there will advise you regarding the limits of exertion during TMT. And you have medical personnel around in TMT lab even if something goes wrong. So just go into test relaxed and do it without fear.
Patient replied :
Many thanks for your informative reply. This is just to tell you that the Troponin T test has arrived and it is normal (4)...(0-14). That's what it says. I guess I'll now wait to see the cardiologist in a few weeks time and see if there is anything else. I'm also thinking this might have been a side effect of anxiety. The thing is that I've realised that recently I've developed a health anxiety of some sort, but it is hard not take the symptoms lightly when they wake you up in the middle of the night. That's why I want to check all these things so they don't feed my constant worry about it, because up until the tests came out, I've been caught in a loop (the chicken-egg paradigm, is the anxiety the product of some body disfunction or the body dysfunction is the product of anxiety). At any rate, you helped me a lot to understand the situation, so thanks once more and all the best.
It is a great news that your Troponin is normal.
And I feel that all this is related to anxiety. The tests are only to allay your anxiety and not take your symptoms lightly.
Thank you for your kind appreciation.
Dr Vivek Mahajan