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Question:
Is it likely that my heart, having 4 things wrong, is going to function fine?
Heart Murmur + Bradycardia + Arrhythmia + High Blood Pressure. I have had a heart murmur since birth, and it only shows up when I have a fever. One test done when I was an infant (which my mom doesn't have the results for) and the doctors said don't worry about it, and I will probably grow out of it. Never did. . . . Within the last year, it has been brought to my attention that my heart beats between 38 and 45 beats a minute. I am not 'symptomatic'- I don't pass out or feel groggy. . . . My heart also skips beats, one beat about every 5. . . . The last thing . . . is that I now have high blood pressure: 156/110. I have never had high blood pressure in the past, and it runs on my dad's side, but not my mom's. I am 5'9", weigh 135, and am in relatively athletic shape. I eat a very healthy, low sodium diet, and rarely eat fast food, or eat out. I work out a couple times a week on a volleyball league. I am in law school,which is a LOT of high stress. . . . I am on oral contraceptives (ortho-tricyclen). Recently, the doctors have become concerned about these newly surfaced heart problems, and . . . I have done several tests, including an EKG, 24 hour urine collection, tested blood. Apparently all my tests come back looking completely normal. They have also tried taking me off the birth control, and that did not change anything. I started to get headaches, so one doctor put me on 12.5 mg of hydroclorothiazide. That has brought my blood pressure down to 144/100. The doctor has basically determined, because all my tests come back normal and I am not "symptomatic" - that maybe I just have all these conditions, and high blood pressure at this age/body type . . . is this something I should pursue further? Is it likely that my heart, having 4 things wrong with it that the normal person doesn't, is going to function fine? Please let me know! [Edited for brevity.]
submitted by Elizabeth from Cheyenne, Wyming on 10/20/09
Answer:
by Texas Heart Institute cardiologist, Roberta C. Bogaev, MD
Hi Elizabeth, Let's address one issue at a time. Heart murmurs can be functional, in that they come and go. Some people will develop a heart murmur when they increase the blood flow across their aortic valve. It is normal for a heart to increase the amount of blood pumped with exercise or a fever. Therefore it is common for some people to develop a heart murmur during exercise or with a fever. It is also common for women to develop a heart murmur with pregnancy, when they are pumping more blood. People can also develop a heart murmur in the setting of anemia, when the heart pumps more blood to deliver the same amount of oxygen to the tissues. Functional murmurs are benign and reflect normal cardiac physiology.
Bradycardia can simply be a slow rate with a normal heart rhythm, sinus rhythm. Sinus bradycardia often reflects a well conditioned heart and is common in atheletes. If a patient has sinus bradycardia without symptoms of dizziness or shortness of breath then the heart is pumping an adequate amount of blood to the body. The amount of blood pumped is equivalent to the volume of blood ejected with each beat times the number of beats each minute. Therefore, sinus bradycardia reflects a very healthy heart that ejects a lot of blood with each beat and does not have to beat as many times as a non-conditioned heart. When the heart rate is slow due to interruption in the electrical signaling to the heart, then patients often feel poorly with their slow heart rate.
The Electrocardiogram (ECG) is a tracing of the electrical signal in the heart and can determine if you have an abnormal rhythm. I suspect you have sinus bradycardia because you are in excellent physical condition from working out. Skipped beats often reflect premature ventricular contractions (PVCs). PVCs are normal and can increase in frequency if you consume a lot of caffeine, take stimulant drugs such as Adderall, or have a low potassium level from excessive sweating during exercise. PVCs are not concerning unless they occur in a patient with a structurally abnormal heart or they are many in a row, which is called non-sustained ventricular tachycardia. I would recommend decreasing your caffeine, avoiding all stimulant drugs, and eating a banana a day to see if the PVCs decrease in frequency.
Hypertension, or high blood pressure can develop as we all age. Stimulants can also increase blood pressure and are a drug of abuse among college and professional students. Lifestyle habits that can elicit hypertension include consumption of a high sodium diet (fast food, processed foods, and even food at most restaurants), lack of exercise, weight gain, and alcohol consumption. You are not currentlyoverweight and I would applaud you for maintaining a routine exercise regimen. The American Heart Association recommends that we exercise 6 days a week, 30 minutes a day. I would highly recommend decreasing or elminating alcohol and adhering to a diet of less than 2000 mg a day of sodium. These changes do take some effort on your part to read food labels and eat more fresh foods but will also decrease your risk of heart disase in the future. If your blood pressure remains elevated after all these lifestyle changes, you may require medical therapy. It is important that you follow your blood pressure and target a goal BP of 120/80 or less. This will dramatically reduce your risk of cardiovascular disease in the future. Thank you for contacting Ask a Heart Doctor.
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Updated October 2009
