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Q. Is it normal to get sharp shooting chest pain with increased heart rate in a patient with AR?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jun 14, 2020 and last reviewed on: Jul 07, 2020

Hi doctor,

My history: I am a patient of aortic regurgitation (moderate-severe) with a bicuspid valve. SB III (as per my last checkup).

My question is, many times I feel a sudden sharp shooting pain in the middle and slight left of the chest which shortens the breath and gets normal within a few seconds (drinking water helps in to be able to breathe at this time). Also, I wear a MI fit to track the heart rate while walking. Even when not walking too fast, my heart rate touches 165 bpm. Is this normal? I am suggested to take Amtas 2.5 but I have not too it so far. Please help.

#

Hello,

Welcome to icliniq.com.

Firstly it is a moderate to severe AR (aortic regurgitation) with normal heart function and normal LV dimension. So there is no significant damage to the heart. And also since you do not have symptoms of aortic regurgitation like palpitations or shortness of breath with exertion, serial monitoring with echo would be enough.

Now regarding chest pain, it is unlikely to be cardiac. It is likely related to acid reflux which is diluted by drinking water. So you may have some antacid medications like Rabeprazole, Domperidone or Pantoprazole and Domperidone combination before breakfast for few days. You should also avoid spicy, oily, and hot foods as much as possible. Have light meals and walk for sometime after meals rather than resting immediately. Avoid too much tea or avoid caffeinated drinks.

Now regarding heart rate, it is unusual for heart rate to go up this much with simple walking, however, with running it is expected. Also, one would certainly feel palpitations at this high heart rate. And arrhythmic tachycardia would have other associated symptoms like dizziness, shortness of breath, chest pain, etc. So it is probably an artefact, which is read as heartbeat by watch. It is better if you can wear a watch which also shows ECG tracings to confirm it or have 24-hour Holter monitoring to confirm it.

Amtas is for blood pressure, not to control heartbeat so if your blood pressure is elevated then you may have it. So in a nutshell, it is probably artefactual rather true tachycardia, as it is unlikely for the heart rate to go above 150 with just walking. However, if one is too breathless during walking or has severe low hemoglobin or hyperthyroidism with baseline elevated heart rate of more than 100 bpm then it may or otherwise not.

I hope this helps.

Thank you doctor,

I do feel breathless while walking. I just slow down to relax and then continue to walk. Dizziness is not a common thing but yes, it occurs rarely for a second or two and gets back to normal. From your answer, I believe that I do not need to worry about it.

#

Hello,

Welcome back to icliniq.com.

Whether to worry or not, this answer is not a straightforward one, that is why I explained it in detail.

You mentioned above, even not walking too fast heart rate touches 165. So as I mentioned above, it is unlikely to reach this much heart rate with walking alone and there is a possibility that this may be a false reading. So as I advised you above either an ECG watch or Holter monitoring to see the tracing and confirm that it is just a sinus tachycardia only. In order words, watch with heart rate monitor would not be enough to guide us further.

So if it is just an artifact and not true heart rate elevation, which is a likely possibility, then not worrisome. However, if the watch was right (after seeing ECG tracings or Holter confirms it) then we need to further investigate the matter as to why the heart rate is elevating this much by undergoing repeat echo to see if AR is progressing or seeing hemoglobin and thyroid levels. Anyways, yearly echo is recommended so you should go for it. So it is probably not worrisome, but need to confirm with further evaluation.


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