u/buntingyyu

I am a 25 year old woman who was referred to a cardiologist last year by my PCP. After several tests at the cardiologist and explaining my symptoms to the NP in the office I was told that my results weren’t clinically worrisome and that along with my age, general health status, and family history means that they aren’t very concerned but to return if my symptoms get worse. I am at a point where I can’t tell if my symptoms are worse or if I am just noticing my symptoms more. I want to get an opinion here on if I should go back to the cardiologist or seek a second opinion.

Summary of tests completed:
- EKG
- Cardiac ultrasound
- stress test
- 48 hour halter monitor

Results noted in my chart:
- global longitudinal strain -12%
- mild tricuspid regurgitation with rvsp 19 mm Hg
- trace mitral regurgitation
- psap 19 mm Hg
- unspecified tachycardia (said 14%)
- resting heart rate 70, min heart rate 58, max heart rate 189
- BP 100/65
- Stress test peak says 169 BPM (86%) after 7 min with BP 142/82
- No diagnostic ST-T changes
- Normal hemodynamic response to stress (86% PMHR).
- Non-ischemic ECG response to stress.
- Normal exercise tolerance

Symptoms:
- unexpected dizziness/ black spots in vision during normal activities (walking, standing, and exercise). Very non specific, it is very random.
- Very high heart rate during normal exercise. HR will be sustained at 170-180 during a walk with the dog on flat surface, while lifting at the gym, rock climbing etc. Low and high intensity exercise produces the same result
- Elevation changes (hiking, airplane) cause clammy feeling like I have the flu, high heart rate, nausea. Usually end up dry heaving (occasional vomiting) and being drenched in sweat and then I am suddenly fine again. Only occurs on initial ascent.
- my husband says I sound like a 65 year old obese man when I am on a normal walk. Huffing and puffing and like gasping for breath but I feel completely fine. Like my body feels good but I just can’t catch my breath even on slow flat walks.
- I will feel completely fine while walking and then all of a sudden get like tunnel vision and be unable to take a full breath and then it’s like my limbs stop moving. Like I can’t control my legs anymore and can’t take another step until I lay on the ground for a few minutes.

Personal/ family background
- I workout 6 days a week, combination of weight lifting, mountain biking, walking the dog.
- normal weight (5 feet tall 110 pounds)
- medications are hormonal BC and Adderall 15 mg
I do not take any of my stimulant if I will be working out like at the gym or biking, but weirdly enough I notice fewer symptoms if I have taken my adderall that day (like before or around the time of a walk).
- normal cardiac labs
- paternal grandmother had a heart attack and quad bypass at age 80 still kicking!
- paternal uncle had a heart attack at age 45 and died (was a chronic abuser of cocaine though)
- high BP runs on paternal side of the family (mostly lifestyle though)

I have been traveling a bit more recently and have been experiencing my plane symptoms consistently now instead of only once in a while. Also, as the weather has been getting nicer I’ve been doing more outdoor exercise and I’m just getting pissed off because I am a very athletic person and then just randomly I feel like I’m about to drop dead and vomit everywhere on a simple hike. I can’t really tell if it’s getting worse or just inconveniencing me more? I’ve never had to end an activity early, just take way more breaks than necessary. But I am 25!! I feel like I shouldn’t have to be inconvenienced like this.

Any advice is appreciated!