Heart palpitations due to picc line?? Emergency?

[frozenborderline]

Hey all

I wanted an opinion before I waste taxpayer resources and my energy on going to an er and risk getting covid.

I'm just reposting below what I wrote on a doctors forum bc it's easierthan typing more and since leaving the hospital I haven't eben gotten out of bed, which is wild bc in there I was actually consistently out and doing pt. Maybe crashing after that.


"As stated in title, 26 year old male. New Jersey, USA. 165 pounds, 6'3". Many prior existing issues , too many to list. POTS, Hereditary alpha tryptasemia syndrome, low immunoglobulin (forget the technical term for that), peripheral neuropathy, MCAS, and then structural issues for which I had three surgeries recently, a craniocervical fusion, and a tethered cord surgery, which had to be revised due to infection, and wound debridement. So I got a picc line for that infection , and iv cephazolin??
Meds: methacarbamol, gabapentin, colase, ketotifen, cyproheptadine, guanfacine as needed, oxycodone, diazepam. Tylenol. Heparin. That's all I can remember off top of my head, I know there are some more that are as needed or less important. I know I'm gonna mayne get shit about the amount of meds but I had two major surgeries on top of having chronic pain plus a minor one, and I had long hospital stay the first time due to pneumonia.
Anyway down to the issues.

Can picc lines cause heart palpitations, flutters or skipped beats?

Also can u get chest discomfort from them? Had it in and I've had a lot of these symptoms since it was in, jm sure the heart palpitations aren't anxiety , fbe chest discomfort is more questionable or mild-moderate but the heart palps are actual skipped beats. Additionally, they did ultrasound and ekg with two leads when putting it in and nothing went wrong on those but I've heard x ray can be more accurate and that a small slip out of place can cause heart palpitations??

I dont want to rush to the ER all the time , I'm in pain and tired of travelling and hospital visits. But I cant put up with these symptoms and the fear about them much longer.

I need the picc for 6 weeks. I dont want to be running to the ER daily this six weeks. The home nurse who flushed the picc wouldnt even listen to my heart and breathing with a stethoscope. I know nurses are often overworked but come on. A nurse from my old agency, which is great but doesnt do iv antibiotics, listened to heart and lungs and spent more time examining me, I feel like with my level of debility I need a home doc and better triage help bc i can't just go waste the ERs time and my energy everytime theres some issues that could be benign.

Every doctor so far has said to go to the ER but I know people with anxiety based chest pains or racing heart that have been sent to the ER all the time bc doctors have to play it safe with heart stuff. To be clear. The heart palpitations are actual PVCs or skipped beats, not an anxiety thing or just fast heart beat. I've had enough to know the difference. And a few can be fine but they're persistent albeit in an intermittent way. Like I have a lot of them during a few parts of the day, then absent during the rest of the day, for a couple days.

Wondering if a quick ekg would even pick up anything due to them being intermittent. A holter monitor might be better but showering often is important for my surgical wound (a debridement and washout of a back surgery wound which got infected--hence the picc line for home antibiotics ). I've been in the hospital for so much of the last three months I just feel like I never want to stay overnight in one again but I dont know...

So if you can do a holter and still shower that seems like worth my time, whereas an ekg could miss something that happens multiple times a day but not multiple times a minute.
And we dont knowbwhether the local emergency room at a decent teaching hospital could admit me to somewhere that could adjust 5he picc line or evaluate that or if the people that put it in would want to be in charge of it.

At this point I've questioned my perceptions of the chest discomfort due to having some anxiety , but the symptoms continue to persist even when I'm relaxed, and the heart palpitations are interfering with my functioning and general sense of well being. I've put off going a lot but I dont know what tests to ask for, where to go, and how to push, or have my caregiver push, for the best treatment to resolve this quickly.

Also do people with piccs just have heart palpitations that are benign but annoying due to placement of the line in the heart, all the time? Is this just something I need to learn to put up with or no.
The heart palps are realx I'm s ur e they would show up on a holter monitor but what then, I mean how much does it correlate with a picc line. I csnt think of anything else that changed to have the heart palps emerge. No meds or. Anything. I have been feeling worse in general, like headache and stuff , and wondering if it's the antibiotics. And maybe hypotensive. "

 

[Learner1]

Based on a little googling, looks like you may have bumped the PICC line and it needs to be repositioned...

https://hadawayassociates.com/lynns-blog/piccs-and-cardiac-complaints-from-patient

Two other sources:

Heart palpitations: This is a fluttering feeling in the chest or a pounding heart. You can have these when you first have your PICC put in or later on and it may mean that it is not in the right position.


Irritation of the heart: If the line is too close to the heart, or in the heart, it can irritate the heart and cause a cardiac arrhythmia, an abnormal heart rhythm. If the problem is not diagnosed quickly, the PICC line rubbing against the beating heart can cause damage to the heart muscle or valves.


There are potentially some other reasons. But based on what I've read, this is not a time to put off getting medical care. It may not be that you need an emergency room, but whoever placed that should take a look, and investigate what the problem is and resolve it or you could end up in serious trouble.

 

[Crux]

OK,

Please at least get a copper and ceruloplasmin serum blood test. I've already brought up neutropenia, but elevated tryptase and even mcas can occur with its deficiency.

Heart arrhythmias can be a result of copper deficiency, even resulting in ventricular fibrillation, death.

Sorry, I can't help but feel a bit too much about this.
My sister and brother died from v. fib.

I recommend an ECG too. It may show something. prolonged qt interval or something

 

[5vforest]

I would go to the ER.

 

[Zebra]

Hi, @frozenborderline

I think @Learner1 provided you with a very informative and valuable response.

I'm going to assume you went to the ER. When you are feeling a bit etter, would you please let us know how you are doing?

I recently struggled with a "do I *really* have to go the ER?" medical situation, which was somewhat less serious than yours (botched IV/suspected blood clot) but I can relate to how much you want to avoid a trip to the ER, even though your instincts seem to be telling you to go in.

You are going through so much right now. I'm sorry there seems to be a problem with the PICC line as well.

Best wishes,
Z

 

[frozenborderline]

Didn't go yet. Just tired of hospital time. Er is a covid risk and I'm not vaxxed

 

[frozenborderline]

Still having palpitations

 

[Learner1]

Didn't go yet. Just tired of hospital time. Er is a covid risk and I'm not vaxxed

Still having palpitations

You don't need to go to the ER. Call up whoever placed the PICC line and ask them for help. Or your Primary care doctor/GP. You may risk serious heart damage (and death) by doing nothing.

And, after averting this crisis, it might be helpful to get vaccinated for COVID so you don't have to be in the situation of avoiding an ER because you haven't been vaxxed. The top ME/CFS specialists are all recommending doing so for almost all of their patients and recommending taking antihistamines to avoid side effects.

 

[Crux]

Low electrolytes can cause palpitations :

https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668

Electrolyte imbalance. Substances in the blood called electrolytes — such as potassium, sodium, calcium and magnesium — help trigger and send electrical impulses in the heart. An imbalance in electrolytes — for example, if they are too low or too high — can interfere with heart signaling and lead to irregular heartbeats

 

[Learner1]

Low electrolytes can cause palpitations :

https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668

Electrolyte imbalance. Substances in the blood called electrolytes — such as potassium, sodium, calcium and magnesium — help trigger and send electrical impulses in the heart. An imbalance in electrolytes — for example, if they are too low or too high — can interfere with heart signaling and lead to irregular heartbeats

That's a good point. If electrolytes are too low, this can kill you.

Another reason to seek medical attention.

 

[frozenborderline]

And, after averting this crisis, it might be helpful to get vaccinated for COVID so you don't have to be in the situation of avoiding an ER because you haven't been vaxxed. The top ME/CFS specialists are all recommending doing so for almost all of their patients and recommending taking antihistamines to avoid side effects.

It's a pickle. I've seen me/cfs docs downplay side effects of vaccines. Covid is worse, but I dont want to choose between long covid and the equivalent from a vaccine.

Many people's illness started with a vaccine.

Antihistamines dont help with suppressing all the cytokines or any mysterious immune effects of the spike protein, which the mrna is giving instructions to the cells to produce in quantities that are large and unpredictable

I'd rather take novavax , for safety sake.

 

[frozenborderline]

Low electrolytes can cause palpitations :

https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668

Electrolyte imbalance. Substances in the blood called electrolytes — such as potassium, sodium, calcium and magnesium — help trigger and send electrical impulses in the heart. An imbalance in electrolytes — for example, if they are too low or too high — can interfere with heart signaling and lead to irregular heartbeats

This is often first thing I look at but I've had mg electrolytes tested as normal and I always take daily electrolytes

 

[frozenborderline]

You don't need to go to the ER. Call up whoever placed the PICC line and ask them for help. Or your Primary care doctor/GP. You may risk serious heart damage (and death) by doing nothing.

Actually, I have called the PCP, and cant reach the people who put the picc in. The PCP advises to go to the ER, she doesnt know enough about piccs to help.

In this case, it's just about being close to reaching a point where i dont see an end to my illness and dont care much. Spiritually exhausted. I've fought hard to get through years of this and in particular months of hospitalizations, very unpleasant stuff for someone with me/cfs, and now I'm having to go back to a hospital after just breathing a sigh of relief upon being discharged ?
But yeah. I'll go. five days late or so.

 

[frozenborderline]

I mean at some point I have to have something to keep me going, some light at the end of the tunnel or hope of remission.

 

[5vforest]

I also think that if you wear a properly-fitted N95 while you're at the ER, your chances of COVID infection will be very very low.

You could also try to go at a time when you think it will be less crowded.

I mean at some point I have to have something to keep me going, some light at the end of the tunnel or hope of remission.

I fully understand where you're coming from on this. Ultimately though -- and I know I'm just a stranger commenting on the internet -- but I see this as part of your recovery from surgery, and you need to make it through this extremely difficult period before you can take stock of any changes / improvements. Maybe that perspective helps, I know it is hard.

 

[Learner1]

Covid is worse, but I dont want to choose between long covid and the equivalent from a vaccine.

The ME/CFS docs are recommending the vaccine because we are at risk for more serious and deadly cases of COVID. People with MS and autoimmune diseases are having worse bouts with COVID and some are dying. This is what the purpose of the vaccine is - to keep us from dying. I've heard of three people between age 40 and 48 and the last two weeks who have died of COVID. And, the problem with not being vaccinated is there is even greater reason to worry when being in unavoidable public contact situations. As @5vforest wisely suggested, wearing an N95 mask into a risky situation is helpful.

I'm glad you're planning to go to get help for your PICC line. It's something you should definitely be persistent about.

Best wishes

 

[frozenborderline]

The ME/CFS docs are recommending the vaccine because we are at risk for more serious and deadly cases of COVID. People with MS and autoimmune diseases are having worse bouts with COVID and some are dying. This is what the purpose of the vaccine is - to keep us from dying. I've heard of three people between age 40 and 48 and the last two weeks who have died of COVID. And, the problem with not being vaccinated is there is even greater reason to worry when being in unavoidable public contact situations. As @5vforest wisely suggested, wearing an N95 mask into a risky situation is helpful.

I have kn94s which may be about as good as n95s but not need a tight seal which is good for me as I cant shave often.

As for the rest, I dont deny the severity of covid. My concern is not mortality, in the least. It is long covid. I've already had covid once and the long term effects were severe. Two things can be true, it's possibleffor the vaccines and the virus to both cause long term negative effects.

I dont really "trust the experts" on this. But I do see a lot of promise in novavax , which is an older tech , similar to the hep b and pertussis vaccines my generation has had as kids.

I am not anti vax in general, but I also have experienced me/cfs docs downplaying the negative side effects vaccines have on our cohort. I dont think even they necessarily know how bad it can be.

So in summary covid is worse than the existing vaccines probably. But thats low bar, the vaccines could still be quite bad. and novavax is coming in probably a month or two? If waiting that out is possible I have full confidence in it

 

[frozenborderline]

I've been to the ER and back and wore my mask. Maybe i got covid. Mayne I didnt. Will have more confidence when I get my ivig treatments as well

 

[SNT Gatchaman]

(Also pro-vaccination, but this situation is complex - I'm Pfizer'd x2)

Agree that both the virus and the vaccine could cause bad long term effects. Entirely possible that the effects from the virus are worse than the vaccine. This is difficult to establish, particularly if the deterioration of some ME patients post vaccination is severe, but fewer are being exposed to the virus due in part to their illness-determined "lock-down" to demonstrate what "even-more-severe" looks like. Even more severe in this case could be the duration of and recovery from the severe deterioration.

As I understand it, Novavax is a protein-subunit vaccine. The spike protein is grown (in moth cells), purified and formulated for delivery with an adjuvant. Similar to HPV and HBV vaccines. mRNA vaccines use our own cell machinery to manufacture the spike protein. The end result is the same: spike protein to train our immune system against.

If it's the spike protein causing all the trouble (for some normal people and some ME patients) then there may not be that much difference between the two vaccine types.

However, the protein-subunit vaccine delivers a bolus of pre-formed spike protein. I don't know, but this may be a bigger load compared with what I presume is a slower prolonged manufacture of spike proteins (mRNA vaccines). In which case, it may be that the older technology is worse for the at-risk patient.

 

[Strawberry]

@frozenborderline Please let us know what they say. Or don’t say….