What is causing my occassional weak spells?

General responses to selected questions from Joel Braunstein, MD, of Johns Hopkins University and Joseph Toscano, MD.

Question:

I have had several "spells" over the past few months where I suddenly feel very bad, with fluttering of my heart, weakness, cold clammy skin, some shortness of breath - a general feeling of illness that lasts for several hours. Sometimes this feeling is accompanied by strong headache and I suffer partial loss of vision. Afterwards, I get sleepy. My family has a history of heart problems and strokes. The spells come over me fairly quickly and happen after I have been doing something slightly strenuous. I smoke 1 pack of cigarettes a day and drink at least two beers each night. I work hard in a physical job and have all my life, and I am not overweight. Do you think I am experiencing heart attack symptoms?

Answer:

The symptoms you describe are not very typical of a heart attack or a pre-heart attack condition like unstable angina. While there are many manifestations of an impending heart attack or unstable angina, the predominant one is chest pain, pressure or tightness (different patients describe this sensation in various ways) that may arise at any time, although it is certainly worsened by strenuous activity. Effected individuals may describe the pain of a heart attack as "an elephant sitting on their chest." Other associated symptoms are a suffocating feeling, shortness of breath, profuse sweatiness, nausea, and high anxiety. In the case of a heart attack, these symptoms will usually not resolve until the clogged artery causing the heart attack is unclogged or the dying heart tissue has fully died. In the case of unstable angina, these symptoms may relapse and remit, although they usually escalate in severity over time. Headaches and vision loss, per se, are not specific concerns of heart attack.

With that said, I certainly think your physician needs to carefully evaluate your symptoms and make sure they are not related to your heart. Smoking is a serious risk factor for heart disease, as is a family history of early heart disease. I would have additional concern as well if you informed me that you frequently experience chest pain/pressure/tightness when you exert yourself to a certain level or have additional cardiovascular risk factors.

You characterized your "spells" as a fluttering of the heart with clammy skin, some shortness of breath, and subsequent fatigue. These "spells" could represent an intermittent heart arrhythmia. A relapsing and remitting arrhythmia can easily manifest itself with "fluttering of the heart" and the other symptoms you describe. Unfortunately, without knowing the additional details of your medical history, it is impossible to provide you with a clear answer as to what you are experiencing. Other considerations with an appropriate history could include anxiety attacks, vasovagal episodes, or even migraines.

What is clear from your description, however, is that these symptoms are burdensome to your life and have you concerned. Seeing your physician in timely order should be the first step to identifying their cause.