# Heart/cardiovascular problems at 21?

1. Oct 13, 2006

### leright

heart/cardiovascular problems at 21??

So last weekend I was having some chest pain and difficulty breathing so I went to the clinic. They did a chest x-ray, blood work and an EKG. Everything came back normal except for the EKG. It seems my t-wave is inverted and this is an indicator of possible ischemia which is a narrowing of the coronary arteries. They sent me to the hospital in an ambulance (I was kinda freaked out by this, since the doctors seems somewhat worried but were saying it was likely it was just stress or something) that night for stress testing early in the morning. The doctors at the clinic said that if the stress test came back normal then everything was fine.

Over night at the hospital more blood work and ekgs were done. In the morning I had my nuclear stress testing and everything came back normal. This eased my mind significantly. However, the doctors said my BP (~140/80) was a bit high, especially for my age, but it was nothing severe.

A week later I saw my cardiologist and my EKG still shows inverted t-waves and he said my BP is a problem. He claimed my ekg is one of a person with high BP and said it is possible my BP was even higher in the past. He said I will need an echocardiogram in a week (I will be going in for this on wednesday). He also said I will need to monitor my BP with a BP kit. I am supposed to see him in a month for a checkup. Also, he said he wouldn't want me to have a myocardial infarction or anything at my age, and I looked that up and it means heart attack. This kinda worried me.

Why am I having these problems at 21? The doctors seem kinda puzzled by it and seem tempted to dismiss it and claim it is caused by stress because I am so young. While the inverted T-wave is nonspecific and could be just the way my heartbeat is, the BP is kinda puzzling. I don't really eat THAT unhealthy (no more unhealthy than anyone else my age).

So far, nothing is wrong, besides my BP and the T-wave inversion (which so far turns out to be nothing), and hopefully it stays that way. I don't want to have a heart attack at my age (I didn't even know 21 year olds had heart attacks) and the fact that my BP is high worries me. If my BP is 140 at 21 what will it be in 10 years??? I'd at least like to live long enough to get my Ph.D. (well, of course I'd like to live a full life....)

I thought I'd get that out.

edit: also, no history of heart problems in my family....

Last edited: Oct 13, 2006
2. Oct 13, 2006

### Danger

Sorry to hear that, leright. I'm no expert in this by any means, but I do know that you can have a heart attack at any age. It could just be the way your body developed that is causing the problem, rather than any outside factor. There might be a problem with the way the nerves are connected to the muscle, or with the structure of the muscle itself, or the flow potential of the blood vessels (such as diameter, wall thickness, etc.), or a bunch of other stuff. On the bright side, it's a pretty well understood field. As long as you take good care of yourself, I'd expect that the doctors can find a solution.

3. Oct 13, 2006

### rhuthwaite

I hope you get better!! When I was 12 my friend had a heart attack it was the scarist thing I have ever seen and done (I had to do CPR until the ambo got there) I really do hope you get better!!

4. Oct 13, 2006

### Moonbear

Staff Emeritus
I think you need to ask your doctor all of these questions, as s/he's the only one who can best answer based on your specific case. I'm not sure it's useful to compare your diet to others your age, because a lot of young people eat horrendously. Though, I suspect if your doctor thought this was a diet-induced issue that you'd have already been advised to change it.

So, just ask your doctor outright if this is something that diet and exercise could help. I was diagnosed with high blood pressure about the same age you are, and stress was certainly a contributing factor, as was lack of exercise and a dining-hall diet, which meant way too much greasy food (even if you tried to eat healthy, it was just impossible given the selection most days). Within a few years, I was getting more exercise (I have little choice in my chosen field of research), cooking my own meals, and while I was still under a bit of stress, I had learned to cope with it better. I've been off medication for many years now and have had perfectly normal blood pressure again. So, it is very possible that the combination of diet, exercise and stress may be factoring in to your problem. And don't forget alcohol! All the excessive drinking at 21 can contribute to cardiovascular problems too.

But, you may also simply be "built" that way and haven't done anything to "cause" this to happen.

The good news is you caught it in time. I think a lot of young people are under the same assumption you were, that young people just don't have problems with blood pressure or their heart, and when it continues to go undiagnosed and uncontrolled, then they're the ones at risk for a heart attack in their 20s or 30s. If you get it all under control, either with medication or lifestyle changes or a combination of both, you'll have a full, normal life ahead of you.

5. Oct 13, 2006

### leright

oh, and btw, the chest pain and breathing difficulty is completely gone and has been for a week. I have asked the doctors these things and they tell me that it could be just the way I am built. I am 6'1" 215 lbs, so I am overweight I suppose, but not THAT overweight. However, the cardiologist never said anything about improving my diet, but it may be because the test are still inconclusive.

Also, I don't drink or smoke at all. Maybe like once a month I have a drink, if that.

I may just be under a lot of stress....in fact, I am under a lot of stress. I have three labs this semester, all a ton of work, and I am not meeting my target GPA which stresses me out everytime I think about it. I work my ass off in school and learn everything very deeply but my poor performance my first couple years brings my GPA down.

Last edited: Oct 13, 2006
6. Oct 13, 2006

### USAPatriot

Leright,

I'm a former cardiology technician. Former, as in 1993. You don't say anything about your lifestyle and as this is my first post here, I don't know you.

BP alone shouldn't cause ischemia. In it's simplest form hypertension is just your ventricles failing to fully relax. Blood pretty much circulates normally regardless unless the BP is really malignant in nature. It seems like the doctor should have separated that out and considered it a symptom not a cause. There's shortness of breath and then there's shortness of breath. It can be mild or very distressing. That can definitely cause both hypertension and ischemia. Or it can do nothing. It's a question of degree. I guess the first question is, what sort of physical shape are you in? Are you either very athletic or very sedate in your lifestyle? It might seem counterintuitive, all these athletes that drop dead of cardiac arrest, but the fact is pushing the body to it's limits, like any mechanism, will test it's tolerances and expose any weaknesses. The second question is, do you do any drugs? Lastly, I noted that you said, "A week later I saw my cardiologist". By "my cardiologist" can I assume this isn't the first time you've had the problem? Any rhythm disturbances or other info you'd like to share? Best. -Rod-

7. Oct 13, 2006

### leright

Thanks USAPatriot for your advice. To clarify, the BP wasn't really brought up as an issue until I saw the cardiologist a week later when the breathing difficulty and chest pain was gone completely. He didn't say it was a cause or a symptom. He just stated it was an issue. And I have never seen a cardiologist before and that was poor phrasing when I said "my cardiologist"...I should have said "the cardiologist". I went to the doctor that I was referred to by the hospital.

And I do not exercise that much. I'll go to the gym consistently for like a month and then stop going for a few months or more. I am quite busy with classes and such. I weight 215 lbs and I am 6'1". I suppose my weight and height do not tell THAT much about the shape I am in, but I am not in the greatest shape. In fact, I am not in good shape at all.

I do no drugs and take no prescription drugs.

Also, I have never seen a cardiologist before, but a few years back my heart had this "fluttering" type rhythm accompanied by some fatigue and this happened on and off (maybe twice a week) for about 2 weeks. I don't recall it ever happening again.

Last edited: Oct 13, 2006
8. Oct 13, 2006

### USAPatriot

Ok. My apologies. I thought there was a connection being made between the BP and the other. This fluttering. Did they put a name to it? Atrial Fibrillation or A-Fib or A-Flutter, anything like that? The heart basically has 3 of it's own pacemakers built right into it. One in the upper chambers of the heart (the atria) called the Sinus Node, one in between the upper and lower chambers (Ventricles) called the Junction or AV node and then the ventricles have their own pacer that they can use as a last-ditch to try and keep you alive. Each is identifiable by it's normal speed range, 60-100 for the Sinus, 30-50 for the Junction and around 20 for the ventricles. In A-Fib, the Sinus, for a variety of reasons, misfires and gets out of rhythm. Instead of the atria rhythmically contracting and relaxing, they fibrillate, or basically just sit there and shake. And because that pacemaker isn't working, the heart rate is also altered and usually becomes irregular. It can be quite slow or dangerously fast, while the rate of the atria themselves is probably equal to about 600bpm. Since the atria are no longer properly contracting and relaxing, the volume of blood is decreased, which in turn causes a decrease in oxygen availability which all equals ischemia. That ischemic T would have persisted for some time after the A-Fib resolved itself if we were to assume that when you were having chest pains and were SOB that you in fact were having a bout of A-Fib. I assume you weren't in A-Fib when they did the EKG in the ER. Did you happen to take your pulse before they shipped you off and was it irregular? Were you doing similar things this time compared to last time? Finals, lots of school work, flu, other illnesses, etc? Dehydration?

All the clues are there I think, it's a matter of putting them together. A-Fib itself probably wouldn't cause an MI - heart attack - though you couldn't rule it out. Oxygen deficiency in the heart is not a good thing, but it will cause all the symptoms you had. The caveat is that A-Fib is also one of the possible symptoms of MI. IOW, A-fib may not cause MI but MI can cause A-Fib. The other danger is stroke from A-Fib and you'll want to question your doc on all the particulars of what you just did and what you did before. Because the atria are sort of sitting there fluttering in A-Fib and the blood isn't properly circulating through the heart, it's possible for blood clots to form within the heart itself which can be dangerous if one should travel outside the heart and move somewhere else, either the brain or lungs. All of this stuff is just guesswork of course until it's proved by the docs. It's all treatable, usually easily so, even the problem of the clots. The echocardiogram is a great idea and will help answer multiple questions. -Rod-

9. Oct 13, 2006

### LiveFree

I may not be able to contribute any medical advice here; but I wish all the luck in the world and a speedy recovery from any lasting symptoms.

10. Oct 13, 2006

### marcusl

Hi leright,

I'm sorry to hear your travails but I think you are lucky that you've found out about your problem early. There's plenty you can do and probably all of it (lower your stress, improve your diet, exercise) will improve your overall enjoyment and quality of life at the same time it improves your health.

I'd say the first thing to do is to get accurate and comprehensive information, primarily from your internist and "your" cardiologist (you say you don't have one now, but I'd get one and see him/her regularly if I were in your shoes). This forum is not a good place for reliable information. For example "In it's simplest form hypertension is just your ventricles failing to fully relax. Blood pretty much circulates normally regardless" is, so far as I know, completely wrong. Your BP is high precisely because your blood isn't circulating normally. Your ventricles have to work extra hard to get the job done. There are lots of causes, and many may be in play at once. To give just one contributor: high sodium intake is a rampant US dietary problem that leads to high BP because your body retains extra water in your tissues to try to dilute the salt, and that gums up everything. But I'm a physicist not an MD, so you should distrust everything I say too!

If you want to get info from the web, stick strictly to reliable sources. I recommend the American Heart Association web site, WebMD and the NIH. Do your google searches like this
keyword site:nih.gov
to avoid getting flooded with useless garbage.

Best of Luck!

Last edited: Oct 13, 2006
11. Oct 13, 2006

### leright

Thanks again Rod. Regarding the fluttering at a younger age, I never asked a doctor about it at the time and forgot to mention it to the cardiologist but I will definitely bring it up on Wednesday during my echocardiogram. I don't recall being under much stress when I first had the fluttering at around age 15 or 16 (maybe it was later). Also, they checked my pulse at the clinic and it was high 70s or low 80s and I also checked it and it seemed normal...no irregularities and it didn't seem too fast. I don't think I had an A-fib or any type of fluttering or else the doctors sould have detected it in the EKG.

Also, they said my blood saturation was 100% at the time I was in the clinic, so I was breathing very well...in fact, better than normal which led him to believe I was hyperventilating and I was stressed.

12. Oct 13, 2006

### leright

Really, the only thing I can do is trust the competency of my doctors. However, sometimes I have trouble doing that since they have been checking my BP for the past 3 years or so and it always comes up as 140/80 or higher (sometimes lower) and they just dismiss it and say it is "whitecoat syndrome" or I am young and it's not a problem. What is the point in measuring BP if you're just going to dismiss it because of my age? My BP never came into the picture until I started having this chest pain and this t-wave inversion.

And also, the doctors at the clinic said the inverted t-wave is likely nothing and is just stress or the way my body works. They said that this stress test will reveal any problems and if it comes back ok then there's nothing wrong. According to the hospital the stress test came back negative. Is there really nothing wrong with the stress test or are they just saying that because I am young and there can't be any problems at my age??

Well, I went to the cadiologist and he said the stress test ISN'T the test that reveals all and an echo needs to be done. So, if I went to the GP instead of the cardiologist (the hospital recommended I see my GP about the BP and said nothing else was wrong...seeing the cardiologist was my choice) and told them the stress test came back ok and I just need to be worried about the BP this echo would never have been conducted and other problems would never be revealed!

Last edited: Oct 13, 2006
13. Oct 13, 2006

### USAPatriot

Well, I don't think a doc would simply say or think there can't be anything wrong just because you're young. They've seen enough kids keel over dead to know better. As a minor at the time one might possibly be tempted to tell your folks who then decided not to tell you. Such things do happen. It might be that your folks would remember more about the first incident and have a name for it, if there was anything there to name. You'll definitely want to bring up the subject when you go in for your echo. Can there be something wrong? Sure. We're all born to die and none of us is born perfect. Kids with leukemia, brain tumors, emotional problems...none of us are immune from the threat of having our lives cut short. The T wave, BTW, is a waveform that shows your ventricles repolarizing between beats. Just as they depolarize in a certain way (which cause the heart muscles to contract) they should repolarize in the same fashion. Often times it's not what your heart is doing that is important but when something changes...that's often significant. I actually lost a patient once because I missed a very subtle change in his EKG. Very subtle...but it wound up killing him. A T-wave inversion isn't something you'd feel. It's a simple change of direction of the flow of electrons. But it does bear investigating, especially since you've been symptomatic. If you don't like the answers you get from the docs, I'd ask other docs. You're always entitled to a second opinion. -Rod-

14. Oct 13, 2006

### marcusl

Yeah it's easy to get bad advice even from MD's. I've changed doctors for far less serious infractions. Sometimes you can get recommendations for a good doctor by chatting with other health-care professionals: the echo tech, nurses, etc. Explain your difficulty (I'm young and not well connected in town, I'm really scared about this problem, I got bad advice for 3 years from my GP, play it all up) and see. It doesn't always work, but soemtimes you get recommendations to the same expert from widely different sources and then there's some chance they are really good. I learned this technique from my wife, although she really connects with people and is better at it than I am.

There you go again, asking people who will only give you unreliable answers! Ask your new cardiologist. If you don't trust his/her answers, find another cardiologist and get a second opinion. Most insurers cover 2nd opinions these days, or pay out of pocket if you need to (we are talking about your life, after all...)

Hmm, I'm sounding bossy and preachy but really these are the things I'd do myself.

15. Oct 13, 2006

### marcusl

Forgot to say that 140 systolic sounds high in any context. My internist freaked when I edged towards 130 during a particularly stressful year a while back.

16. Oct 13, 2006

### leright

Well, it was many different doctors that told me my BP of 130 to 140 was likely due to whitecoat syndrome and it wasn't an issue.

Even the doctors at the hospital in the cardio ward said that the BP of 140 wasn't that bad and it probably wouldn't be treated. It's not like this was the same doctor every time......

Why is it these guys make so much money anyways? I thought they charged so much because they are meticulously careful. I figured that if I went to see four different doctors and all of they show my BP at 130-140 they would bring it up and say it is bad. When they say my BP is 130-140 or higher and they shrug it off I just trust their judgement.

17. Oct 13, 2006

### Danger

Blasphemer! This forum is self-checking. And don't for a second think that a field is open to barbarism. By your post count, you don't seem to have been here long. You might therefore be unaware that Moonbear is a biology professor, or that Fred Garvin designs jet engines professionally, or that Astronuc tests designs for nuclear reactors, or that Adrenaline and Doc Toxin are medical doctors, or that Zapper Z and Arildno are very well respected particle physicists at internationally famed laboratories, or that Brewnog is an engineer increasing the profits of an un-named company that makes large yellow construction machines. Evo designs and sells optical networks. Russ Watters could probably recondition your furnace without burning your house down. Yomamma is a (just barely) 14 year-old who knows more about more subjects, and has a quicker wit, than probably 95% of the professional people in your circle of acquaintances. (He's also quite a smart-ass with an attitude, which really endears him to most of us). SOS is an expert in politics and history. Some of us are 'generalists', in that we know a reasonable amount about a very wide range of subjects. That's where I fit in, and I think that Zoobie, DaveC#, and a few others are in the same category. Even we have our specialties, but for the sake of the forums we don't espouse expertise in anything.
One of the main ways that we get new people on board is that a Google search for something will lead someone here. Sometimes that person will so much appreciate what s/he sees that registration is mandated. In others, as I strongly suspect is Rod's situation, a casual reader feels such a need to respond to a thread that s/he will register just in order to post. That's how they got me, much to their regret, but some serious professionals have come on board that way. Anyone trying to pass him/her self off as an expert will be either vindicated or destroyed within a day or so. Again, I am certainly no expert in either physiology or cardiography, but my semi-educated opinion is that Rod is a legit professional. And you'll note one of the marks of a professional: he didn't propose to have the answers. He gave a very adept overview of the possibilities. That's because no real professional will offer a diagnosis without meeting and testing the subject.
While your suggestion to check out serious cardiology sites is correct, you have insulted almost everyone on this site by that statement. The rest are probably too polite to point that out, but that's not one of my weaknesses. :grumpy:
[/rant]

18. Oct 13, 2006

### USAPatriot

White Coat is a definite possibility. I actually have the opposite problem. My BP drops when I'm at the doc. I trust the guy, been with him for 20+ years. I guess I'm relaxed around him. 130/140 is too high. It's not dangerous today, no. But over the long haul it's not good. It takes it's toll on the heart, the eyes, the kidneys. Decades of 140's would not be a good thing. A simple and cheap drug like Lisinopril (just a for instance) would be a logical starting point for a newbie with hypertension. It's at the bottom rung as far as strength goes and shouldn't really have any side effects for most people though there's always some possibility in the early stages of treatment. It's better than the alternative...possible blindness and dead kidneys when you're 50. A home BP monitor might be a good idea. They aren't as accurate as a manual device and stethoscope in my opinion but would still allow you to check your BP on your own time, in your own home and rule out or confirm white coat. Two checks a day at random intervals will tell you a lot. -Rod-

19. Oct 14, 2006

### zoobyshoe

Depends on what's causing it, of course, but I think blood pressure is easy to keep under control with moderate, regular exercise. Mine used to be 140 over something. Back in April I started taking a mile walk every day: half mile out, half mile back. I don't amble, I really book when I walk, but not too far and not for all that long. Since I started this my bp has been 107/70 or so each of the three times it's been checked. This despite being 51 and having a heavy smoking habit.

20. Oct 14, 2006

### brewnog

Go with Moonbear's suggestion and take the advice your doctor gives you.

Defib on standby... Just joking.