Is there a Cardiologist Maggot out there? Opinions needed

[MadPatSki]

So I had a bunch of tests done and saw the cardiologist this morning.

After a few tests (threadmill, heart monitor, EKG, echo), I was seeing a cardiologist at the Heart Institute.

Diagnosis from the time I went to ER. All the tests since were fine (copy & paste from Wikipedia).

Supraventricular tachycardia (SVT) is a general term that refers to any rapid heart rhythm originating above the ventricular tissue.

AV nodal reentrant tachycardia (AVNRT)

I was somewhat surprised, he suggested that I might want to have a procedure:

They wrote "Ablation Procedure" which would seem to be this: (here is the Wiki)Radiofrequency ablation has revolutionized the treatment of tachycardia caused by a re-entrant pathway. This is a low risk procedure that uses a catheter inside the heart to deliver radio frequency energy to locate and destroy the abnormal electrical pathways. Ablation has been shown to be highly effective: around 90% effective in eliminating AVNRT. Similar high rates of success are achieved with radio frequency ablation in eliminating AVRT and typical Atrial Flutter.

Other viable options:

- Medication for the rest of my life
- Do nothing - to infrequent.

The intern, afterward, seem to agree that this was primarily triggered by a high anxiety. I've had a similar issue back in 2001. Cardio at the time (or 5 years ago) didn't see anything either. I mentioned what they thought of a second opinion. I would also like to heard from skiers, plus if that skier is a cardiologist. I'm going to get my GP refer me to a separate cardiologist.



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Background:

- Mid 40s
- 5'10 / 155lbs
- Fairly fit and generally active
- don't smoke and doesn't really drink too much
- family history of heart issues

All this started when I blackout after the 3rd run (of a very short GS (25sec)) last month. I was super exhausted after my 2nd run. When back up, I had shortness in breath prior to that 3rd run.

I didn't have any fatigue after my 1st run, but I didn't go all out either. So right after my 3rd run in the finish coral, I felt dizzy, exhausted and the need to sit down. I sat down on the snow and then I passed out. Maybe for a few seconds, other racers around me woke me up. I stay there for a while then when back up the lift to get some clothes I left at the start area (we're talking about 120 meters vert lift).

This was night skiing. I hadn't eaten prior to leaving home. I raced to get to the hill. It was our first race of the season. The night before I did a few gates and I felt fatigued and somewhat dizzy after one run for pushing it. I hadn't had much serious skiing since a few days in the Alps last Summer.

I went back in to he bar (didn't drink, except water). I also eat maybe 2 burgers (I rarely eat meat, the rest of my family is vegan). I felt somewhat concern and not at 100%. As I was driving home, I became to have palpitations. The hill was about 20km from home. Once home, my wife drove me to the Hospital where they kept me under observation. I came in and my heart was racing at 150bpm plus BP was through the roof.

They is also the fact that I felt overwhelmed with a number of stuff including my mom's estate and tenant issues at her duplex 200km away over the Fall. I had a bunch of work to have done to the place and I had going back and forth for a number of weeks in the Fall. I arrived at the Holidays and I was exhausted. I've suffered a burnout in 2001 and I recognized some of the high anxiety level. I managed to keep everything under control...until the rubberband snapped (that is exactly the feeling I felt psychologically).

[Tuckerman]

I'm not a Cardiologist but I did stay at a Holiday Inn Express one time. I have had 3 ablations last last one being this past fall. I have/had WPW where a extra electrical pathway was formed. The first Dr was not the good at it I guess. The mapping they have now to find and burn these pathways is incredible. And thats the only reason I let them them do it to me again. Oh you also get a trim. This last time I said there was no way I was going to stay overnight but I should have, the amount of blood that car pour of is amazing and frightening all at the same time. And that the part that is of most concern they open up a major artery. If you have any specific questions fire away.

Lots of people will be looking at your junk so hot and some not, nut like I said the trim is nice.

[MadPatSki]

Thanks Tuckerman.

Besides the type of intervention, not sure if our heart conditions is/was. I was under the impression that if they do it...it should be it. It wouldn't require another intervention.

Talking with the intern (intern told me that all my tests were fine (except when I showed up at ER) and it would seem that it was stress-high anxiety related after I passed out. My palpitations started only after I was driving home over 90 minutes after passing out. It was the first time I blackout in over 20 years (hitting my head) and over 35 years for no reason at all when I was in Grade school.

So tests are fine...good. (the normal cardiologist I have scheduled to see got delayed at the airport). So then a cardiologist that was checking up on the intern's work come in and says...we have two options : intervention or meds. And that was a different answer I was expecting. It was my impression (I told them) that it would seem that it like killing a fly with a sledgehammer instead of a fly swatter.

I'm fairly active. The intern says it shouldn't stop me. Another think, is that my shortness of breath is more stress related (thoughts) than necessarily physical activities. What is the drawback of going ahead if there is a 5% of non-success. One of the worst case scenario is a pacemaker.

Tuckerman, what were your options prior? Was your conditions similar to mine (you can PM me if you prefer).

Full of questions...I just want to remain as active as I was recently (I've taken it easy this Winter since this happened).

[Tuckerman]

I was born with my condition (wpw) I told my mom it was her fault. Same type of thing I think, heart beats way over 200 bpm. I'm a ultra runner but when I first started to run I would see the huge spikes in heart rate (when I wore a monitor) and always thought it was normal. Until I went in for a routine day surgery and woke up some dude telling me he was my cardiologist, I was like WTF I think you have the wrong patient. Turns out it appeared to the staff in the OR I was having a heart attract cause by the extra electrical single. I spend a week in the ICU with a bunch of half dead people until they figured out what was wrong with the ticker.

Like you my Dr is afraid that I would pass out driving down the highway or something. Or the electrical single would create a loop in my heart and just keep picking up speed until it quit. The probability of the loop happening is vary small.

So I had the Ablation 3 or 4 years in the spring ago that summer I ran to 50 mile races. I could tell that they did not fix it and did not tell anyone, actually I could kind of control it with breathing. But as soon as my cardio got me on a echo machine she (I got a new cardio because the one I woke up with turned out to be a raging alcoholic and I think they took his licence to practice away.) could see in the pic of the heart beat that there was a extra pulse. I put it off until the following spring did it again the same guy did it I call him the electrician. I knew almost a week later that it had failed.

They talked to me about pacemaker at this point was had finished a 100 mile race and really did not want to do the Ablation again just because its a huge pain in the ass. They my cardio said she has a better electrician then the one who failed the first two times and that the mapping they use is way better now then 2ish years ago. I'm not sure it gone at this point or there is something going on just before it used to happen that still goes on and makes me think that they did not get it.

The new electrician killed the pathway from both the inside and outside of the heart where the last guy just did it form the inside. Its really not that big of a deal its pretty routine now a days and I would not want to take meds for the rest of my like or have a pacemaker.

[MadPatSki]

I definitely want to get back to you on this post, but trying to catch up at work and other stuff right now. I've been focus on my daughter tibia fracture operation yesterday. I've never seen one of my kids (or loved one) remotely close to the pain she was feeling last night. Yeah, she was on morphine too.

[good4nothing]

MPS:

I'm not a cardiologist, but am an anesthesiology resident, skier, and also have paroxysmal AVNRT. Mine nails me for very brief, manageable periods probably twice a year and I have a sustained episode that makes me super-dizzy, lightheaded, and comes close to dropping me every 3-5 years or so. I've never blacked out, but when it happens, it sucks. I had a similar adventure in medical workup after it hit me at a stop sign at the end of a long road ride during medical school, and did whole the echo, EP, yada yada yada shenanigan. We talked about all of the options you've been presented with, but in the end my EP doc was pretty minimalistic (as am I), and we decided to hold off on any meds and try the typical valsalva/carotid massage/cold-ass water tricks as needed. I've had a few short episodes since, but have been able to break myself out of them after with the above tricks.

It's hard to say anything specific about you without knowing any of the details, and obviously your cardiologist is the best person to talk to about a long term plan. That being said, all of the interventions and medications you've been presented with are not without their own risks and side effects, and you're right-on considering a second opinion. Ultimately you need to find a long-term cardiologist, and probably more-specifically a cardiologist who specializes in electrophysiology, who understands where you're coming from and is willing to come up with a plan that you're comfortable with. There are definitely a bunch of different ways to reasonably skin this cat.

Hope that's at least mildly useful, and you're welcome to hit me up if I can answer any questions.

[skinnyskier]

I'm a cardiologist maggot (maybe the only one?) and I think the previous post nailed it.

[MadPatSki]

Thanks for your input good4nothing and skinnyskier. I've been totally focuses on my daughter's injury and operation (broken tibia spin) in the last few weeks that I haven't paying attention to myself. Feel like its still happening (skied hard 3 days in a row on a planned trip (first hard skiing since I blackout) - no symptoms on the 1st day, but was disturbed in the afternoon of Day 2 (and I wasn't skiing that hard).

Leaving for a few days (Spring Break), but I feel that high anxiety is a serious issue right now for myself. My body feels it (I suffered from a burn out back in 2001). Need to calm by body down....once that is under control, I'll see how it goes. I have another appointment in 2 wks.

[Jethro]

MPS:

I'm not a cardiologist, but am an anesthesiology resident, skier, and also have paroxysmal AVNRT. Mine nails me for very brief, manageable periods probably twice a year and I have a sustained episode that makes me super-dizzy, lightheaded, and comes close to dropping me every 3-5 years or so. I've never blacked out, but when it happens, it sucks. I had a similar adventure in medical workup after it hit me at a stop sign at the end of a long road ride during medical school, and did whole the echo, EP, yada yada yada shenanigan. We talked about all of the options you've been presented with, but in the end my EP doc was pretty minimalistic (as am I), and we decided to hold off on any meds and try the typical valsalva/carotid massage/cold-ass water tricks as needed. I've had a few short episodes since, but have been able to break myself out of them after with the above tricks.

It's hard to say anything specific about you without knowing any of the details, and obviously your cardiologist is the best person to talk to about a long term plan. That being said, all of the interventions and medications you've been presented with are not without their own risks and side effects, and you're right-on considering a second opinion. Ultimately you need to find a long-term cardiologist, and probably more-specifically a cardiologist who specializes in electrophysiology, who understands where you're coming from and is willing to come up with a plan that you're comfortable with. There are definitely a bunch of different ways to reasonably skin this cat.

Hope that's at least mildly useful, and you're welcome to hit me up if I can answer any questions.

This sounds like what happens to me every few years. I am 45 now, but it first happened when I was about 23-24. I always thought it was low blood sugar, and it still could be. I get sparkly vision and light headed, but after eating and taking it easy for 20 min or more, I am good to go. I have never been aware of any heart beat issues.

[Snowmiser]

I had a pretty significant case of SVT from the time I was in my early 20's until I finally was able to get an episode caught on an EKG in 2001. My episodes lasted from 2 minutes to 5 hours. I used to refer to them as my easy aroebics! I would go to the ER and get adenosine (sp?) to stop it (literally). Pretty scary stuff! After the last one which i had during a stay on the orthopedic floor, they finally convinced me to get it fixed. I had the catheter ablation and they needed to cauterize 3 different extra electrical pathways. It was a pretty scary proceedure because my I.V. sucked so bad that I was fully awake for the whole procedure. In the end though, everything worked out and it's been 11 years and I haven't had another episode. Once in a while, I feel my heart trying to go in to the crazy rythm, but it gets cut off and i'm ok after a matter of seconds. I would go with the ablation. It's way less stressful than going under the paddles or taking the adenosine!

Good Luck!

~Anne~

[Snowmiser]

AGREED!

That adenosine is pretty scary though! The last time I had to have it, the doc wanted to give me two shots of it! I told him "No Way"! Do one and see what happens. It wound up being enough thank God! When you get that shot, everything goes quiet and you feel a really warm sensation thoughtout your body. It seems like forever until you feel your heart begin to beat again even though it's only a matter of seconds. Definitly not something you want to ever repeat!!!!