I have sinus arrythmia and bradycardia. What should I do?

I am 20 years old engineering student. My pulse rate has dropped to around 53. Sometimes it even goes as low as 46. It has been like this for a month now. After doing ECG , they said that I have sick sinus syndrome. I even did holter monitoring. According to the report , there were pauses in my heartbeat. . The exact statement was "Frequent short sinus pauses are noticed. Sometimes sinus pauses are followed by junctional escape beats." Average heart rate was 57 bpm.

I even did tmt test and cardiac MRI. In tmt test, everything was normal. My maximum heart rate during the test was 190. At high heart rates, the sinus pauses disappeared. In the MRI something was found that even the doctor who made the report was not sure about . He told that there may be a scar on the wall of the heart , which could be the leftover of some inflammation or infection. The exact statement he made in the report was "A small focal mesocardial  hyperenhancement  noted in the septum and inferior wall at the basal/mid region." Another statement from the report  is "Focal enhancing lesion in mesocardium of left ventricle - ? Inflammation -??Dystrophy/cardiomyopathy." ( I think the question marks indicate that he himself is not sure about the cause). 

He was a radiologist. When I went to the cardiologist  who suggested the test, he himself asked me to get a second opinion of the report. The doctor from whom I took the second opinion thought there was nothing too serious. I got the MRI done on 28th Jan. ( I am typing this on 17th Feb, 2020).

Regarding symptoms , I currently have almost  none. However , I did have slight symptoms in the past. I sometimes experienced slight chest pain , but it would stop later. Also , it was not in any particular region of the chest. There were 3 or 4 areas where the pain could occur. Often when the pain was about to cease ,the area of the chest would become warm. Sometimes I also experienced pain in muscles of my back. Sometimes , for very short duration of a few seconds, there was pain in my neck or behind my ears. I also sometimes had slight breathing trouble. It felt like the air I was breathing was not enough for me. But this feeling would always disappear later.

These symptoms lasted for more than a week.It was during the time I was visiting doctors and they were doing those tests on me. I have almost none of these symptoms now. But my pulse rate is still the same and those pauses are still there.

Regarding family background , I have a strong one. My father died recently on 9th Dec 2019 (at age 56). The day before he had no symptoms. Neither was he sick. Even at 1:30 am ( before falling asleep) he was talking fine. On waking up the next day, we found that he was no more. It was a sudden death. The doctor said it was either cerebral stroke or cardiac arrest. Earlier in 2018 he once experienced sudden blackout. In his holter monitoring report, there was something but not much serious. 

Two of my uncles (paternal) and one of my aunts have pacemakers. One of them got the pacemaker at age 55 and the others in their 60s. My paternal grandmother also had pacemaker, although she got  it  in her 70s. She also experienced sudden death like my father. So did two other aunts of mine.

It would be nice if I can get an opinion here (based on what I have written above) from some doctor , although opinions from others are also welcome.

5 Comments

Electrophysiologist?

by arent80 - 2020-02-17 12:12:01

Hello there!

I had a very similar situation at 39 years of age. I had sinus arrest (pauses) and sinus bradycardia only when I slept. I would pause up to 8 seconds during the night and my HR would drop very low as well. The lowest recordings were in the 20's. I had sick sinus syndrome and I had a pacemaker implanted on 12/30/2019. 

I see you mention a cardiologist. But have you seen an Electrophysiologist? They are the docs who specialize in arrhythmia's and sick sinus syndrome overall. I would make an appointment to see one right away. I was like you. All my "other" heart related tests were normal. My ejection fraction was 60-65%, I have a normal size heart with no enlargement in my atrium or ventricle. I have a calcium score of zero, no plaque build up and no stenosis. I passed a stress/echocardiogram as well. 
 

The only fix for a slow heart rate and pausing is a pacemaker. I was reluctant to get one at first because of my age but I was symptomatic. This all started one Sunday night at home brushing my teeth I felt dizzy. Went to the ER and all was normal. They gave me a two week ZIO PATCH and that's when it showed the slow HR and pausing. From there I noticed I was tired, had shortness of breath, just felt pretty bad. Since the PM I sleep much better. I'm still a little tired and have SOB but not as bad as before. 
 

If I were you I would see an Electrophysiologist ASAP who can shed some more light. Cardiologist are the plumbers, Electrophysiologist are the electricians. Your problem is an electrical one. I wish you nothing but the best and please keep us updated. Take care!

Alejandro 

Find an expert in inherited cardiac rhythm and cardiomyopathy conditions

by crustyg - 2020-02-17 12:57:23

Pardon me for being blunt.  You ask 'What should I do?', and suggest it would be nice to get an opinion from a doctor here in this forum.

I don't practice any more and I was never a specialist in this area, although I did have an interest in inherited metabolic disorders.

You need to beat a path to a Clinical Genetics team at the same time as finding yourself a really expert EP doc.  You've got a family history that would worry many folk (so sorry to read about your father's recent demise), and you have important symptoms.

A real expert (clearly not me) wouldn't risk a remote diagnosis on the basis of what you've kindly provided.  And if they knew the answer with near certainty, an open forum like this isn't the place for a proper diagnosis - at least not at first.  By all means when *you* wish to share the diagnosis, please do, but this is really sensitive and important stuff with *huge* implications for you and the rest of your life.

We will do what we can to help you with tips and tricks, adjustments (mental and PM settings), useful things we've learned from PMs and ICDs, to the best of our ability.  But this isn't a diagnostic consultation!

Best wishes.

 

Sinus pauses and Bradycardia

by AgentX86 - 2020-02-17 13:12:24

I second what others have said. You need to see an electrophysiologist ASAP. You don't say how long the pauses were but the fact that you had a junctional rhythm is actually good. It'll get you through the pauses,  if necessary. Your Bradycardia isn't severe, so it's of secondary concern,  if that. My _guess_ is that you aren't ready for a pacemaker yet but you're on that path.  You need the opinion of an electrophysiologist. Keep you cardiologist to keep an eye on the scarring.

advice

by Tracey_E - 2020-02-17 13:13:59

I am so very very sorry for the loss of your dad.

We are patients here, not medical professionals, so our advice is simply patient to patient based on our experiences.

A heart rate of 60 is normal, they don't usually take it too seriously if it's in the 50's and you're asymptomatic. Under that is when it's time to talk pacer to bring up a slow rate. Pauses are different than a slow rate. If pauses are more than 5-6 seconds, a pacer is a good idea because it can stop and not start up again.

Can you have genetic testing? Your symptoms alone don't sound to me like much to worry about, just monitor for now. However, family history says you are right to take it very seriously. It only has to kick in once to save your life.  Electrical problems can be more tricky than structural problems. Structural defects show up in the tests, electrical problems can come and go and be sneaky and hard to pin down.

edited to add, listen to Crusty. (we were typing at the same time)

 

See a new cardiologist

by Pinkit94 - 2020-02-17 15:54:29

Hello 

I worked in electrophysiology for many years and  you definitely need to be seen by both an electrophysiologist and ideally a pediatric cardiologist. Because while sinus arrhythmia is very common occurrence in most young adults, the fact that you have significant family history of sudden cardiac death and some mri findings that is concerning. You need to be screened for genetic heart conditions. When making appointment be very direct and express your concerns and make sure they write in your family history the death of your father this is very important fact that cannot be missed (I'm sorry for your loss). Hope this helps!

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