Brief Answer: Can be precipitated by stress related anxiety Detailed Answer: Hi, Thanks for writing in. I have read through your query in detail. Since you have mentioned possibility of stress and anxiety precipitating your increase heart rate, it is important that you recollect any events or thoughts which might have got your heart pounding. Stress induced palpitations are the commonest cause for such an occurrence. Since your heart investigations are normal except for LV impaired relaxation, it doesn't look to be due to any specific heart condition. Discussiing detail of your similar episode two months back would be useful. It might be possible that you were low on glucose, but that must have been ruled out earlier when our had a black out. Talking about the Lyme CDC being negative, there's not much to worry for that. The brain lesions may not be directly related but any person being investigated for brain lesions is surely under a lot of stress. Brain lesions are of many types and most are harmless. You may sendin details of your brain scan if you desire, so that I can help you understanding it. If you are feeling stressed out, please have a close friend or family around to help you should you have any further episodes of heart palpitation. You might consult a mental health professional for further guidance on stress management. Hope your query is answered. Do write back in case you have doubts. Regards, Dr.Vivek

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Brief Answer: Please find detailed answer below Detailed Answer: Hi, Thanks for writing in with an update. I read through your reports attached. 1. The MRI brain scan does reveal small areas where there is a suspicion of small areas of focal degeneration. These however remain the same from the previous scan. Three are no features showing any active areas. Your neurologist needs to examine you thoroughly before interpreting these results. 2. The test for Lyme's disease CDC shows negative. You need not worry for it. 3. The echocardiography and Holter monitoring results are not showing any cardiac abnormality. Your heart rhythm has been tested for 24 hours and all recordings are within normal ranges. I would have like to know your blood glucose test results and blood work up. Abnormal sugar levels can trigger black outs in some people. Hope your query is answered. Do write back in case you have doubts. Regards, Dr.Vivek

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Brief Answer: Please find detailed answer below Detailed Answer: Hi, You are welcome and thanks for writing back with an update. I have read through your blood reports and find that earlier you had slightly low hemoglobin levels and not it is just above lower limits for normal. Rest of the results is almost normal. The tests for autoimmune diseases like Anti dsDNA, Rheumatoid factor, C-reactive protein and ANA Are normal for you. Fasting glucose is normal and I assume you do not suffer from diabetes at present. Impaired LV relaxation is not a serious condition by itself but can complicate patients who are prone to heart failure and congestive heart failure. Since there is no indication of any such problem by your echocardiography or Holter monitoring, you need not worry about it. However, should you have any cardiology checkups in future, please don’t forget to mention about it to your doctor. The result if Lyme’s disease is interpreted by Western blot technique and inferred from the presence of particular bands in the test result. As bands 23-25 and 39 are indeterminate and 41 is +++, the result is appearing negative in CDC test criteria result. It is also mentioned that positive result in 83 may be due to old viral antibodies, probably the reason why your neurologist has said it could be due to viral infection with persisting antibodies. In your situation, it is unlikely to be due to any other causative bacteria. MS like lesions and MS are not the same. The diagnosis of MS requires elimination of more likely diagnoses and demonstration of dissemination of lesions in space and time as per McDonald’s criteria concerning MRI scan brain in suspected cases. MS lesions are to be followed closely with clinical symptoms of diseases. I would recommend you to consult a psychiatrist and get evaluated for symptoms of possible hyperventilation and anxiety. Hope your query is answered. Do write back in case you have doubts. Regards, Dr.Vivek

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