Should I seek immediate private consu... - British Heart Fou...

British Heart Foundation

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Should I seek immediate private consultation? UK - 25 y/o M, elevated LP-PLA2, low iso diastolic BP

funRunner219 profile image

Hello, first-time poster here, hope this is the right place.

I'm a 25-year-old male in the UK, 73kg, 23BMI, and I'm trying to ascertain whether it's sensible for me to wait for my NHS Doctor to get on to a Cardiologist, wait for a referral, or just blow my savings pots doing it privately for fear that whatever I've got wrong, gets worse while waiting.

2 years ago, roughly, I first went to the doctor experiencing dizziness, lightheadedness and heart palpitations. They checked my BP, general health markers and said that it was probably the stress of university causing this dizziness. I thought "OK! Great stuff" and continued with my life. I tried meditating, working my anxieties through in my head to sort them. But I realised, I wasn't inherently anxious, or stressed, so it didn't really make sense to me. Either way, I trusted the doctor's opinion. I've still been getting symptoms of dizziness, lightheadedness and heart palpitations to this day, despite taking steps to try to correct my mental state which, in my opinion, was the same stress as the majority of university students!

Last month I decided to start training for a marathon. I regularly run 10k's probably 3 times a week but wanted to double-check my blood levels etc. before starting a more intense training session. I went to Bluecrest and got their complete health check done, and was a bit shocked to see some of the readings come back.

- PLAC test revealed an LP-PLA2 level of 680U/L.. way into high risk.

- Sinus Arrhythmia - Known about this for a while anyway

- My cholesterol was 6.2, comprised of 4.4 LDL, 1.4 HDL and a ratio of 4.43.

- Triglycerides were normal, 0.9.

Cholesterol, to me, isn't surprising. I've not been the "best" at eating throughout the university, albeit not the worst. I still aim to get my fruit and veg, just one too many late-night pizzas perhaps. My mother's side is ALL on statins from young ages after having cholesterol's of 8+, so it could well be genetic given I'm relatively in shape, fit and healthy.

So I started to wonder what's going on here? And I'll be the first to admit, the idea of a heart issue so young terrified me, and even writing this now I'm really struggling to conceptualize the potential consequences although appreciate finding things like this early is key to preventing it from getting worse...

I started to check my BP regularly. It's always elevated at doctors as I'm a nervous wreck there but seems stable enough at home. It appears I have an isolated low diastolic BP, averaging out at 115/62, which as far as I understand is unusual for my age. Furthermore, my resting heart rate is between 45-55, but when I run at a moderate, 10k pace (roughly 50 minutes - 1-hour nonstop), my heart rate consistently sits at 185-190! Drastically higher than my resting HR.

I called my NHS doctor, who didn't seem bothered by the large gap in my blood pressure or that it was nearing 60 whilst not being high on the systolic side. She also said I may just have a high max heart rate, and that's why it gets so high when I run. However, she also had no information regarding what a PLAC test was or what it tested, so now she's taken my reading and gone to contact the cardiologist and I'm just left waiting to hear. From the journals and literature I've read, this high PLAC test suggests some form of Atherosclerosis that would be strengthened by the low isolated diastolic BP, so I'm keen to know whether I can afford to wait for the NHS to get back to me (Potentially months?) or if people here think that this warrants me just going to get an echocardiogram done next week privately. My stress levels are through the roof, with this hanging over me, I'm worried every time I go out for a run or walk I'll just randomly have a heart attack.

What does high risk even mean? That my life expectancy is X time? I'm really struggling to comprehend all this information and shock at once and just want an answer. For now, I've switched to a Mediterranean diet, dropped my running intensity for fear of overloading my heart and kicked the few cigarettes I did smoke a day down the drain (3-4 maybe - used to be heavier).

I am sorry for such a long post, and I really appreciate any advice or guidance. I'm feeling so alone, I know it's not healthy to cut myself off from the world but I can't face anyone with this constant worry about something being really, really wrong. It's making my heart palpitations 100 times worse, I can't stop feeling it now.

19 Replies
Kristin1812 profile image
Kristin1812Heart Star

Hi funRunner219. It sounds as if you have got very worried. We’re not able to give you expert advice, but just interested people with heart issues who have learned a bit and are keen to share it with each other.Two things occur to me. One. It might be very useful to chat your questions over with the BHF nurses on our hotline.

They are v helpful and knowledgable. You do sound anxious, and they will give you accurate information, which might help you decide whether to blow your savings on an early Cardio Appt.

Secondly it would be very sensible to stop smoking. You say it’s not a lot, but it is a major risk factor you can do something about.

I hope you find some way forward.

Kristin1812 profile image
Kristin1812Heart Star in reply to Kristin1812

Forgot this………Heart Helpline team on 0300 330 3311 Mon-Fri 9-5pm or email hearthelpline@bhf.org.uk

Hi Kristin,

Thanks for your message, yes I think I am a tad worried, lol! I was brought up having it hammered into me that runners randomly drop dead and you need to get an ECG done yearly etc etc. so think with the results of the tests it has all boiled over. I know it's comparatively nothing, but it's just concerning as I'm so young.

I have completely stopped smoking now for 10 days, which is a new record since I started at 17!

Thanks for your reply re the nurses, might give them a call next week if I can get a minute. Take care

Kristin1812 profile image
Kristin1812Heart Star in reply to funRunner219

Sounds like a plan. Stopping smoking completely is a great achievement. I’m sure just the idea of heart issues must be especially hard being so young. Even at my ripe old age I thought it was really unfair!Keep in touch. Let us know how you get on?

Not a doctor, but:

Apart from the cholesterol, which is likely to feed into the PLAC test result, none of those figures look worrying at all. The PLAC test measures enzymes that break down LDL cholesterol. With high LDL the PLAC result is almost certain to be elevated as well.

BP are both comfortably in the normal range and your pulse pressure (the difference between the two) at 53 is nearly smack in the middle of the expected 40-60 mmHg. Keep in mind that all the "norms" quoted for age are simply averages and there's a big individual spread around them.

45 to 50 resting pulse is more than likely simply a reflection of your fitness level. There's a lot of evidence that the "60 - 100" normal range for that should really be 50-80 but it's been what it is for so long that change is difficult. Certainly, if you don't get symptoms, then just be happy that your heart is strong enough to supply what you need at a slow rate.

You don't say what they mean by "sinus arrhythmia" but the fact it's a sinus rhythm means it's being generated appropriately (ie: each beat is starting in the sinus node as it should) and they may well just be referring to the lower than "normal" rate, which us classed as an arrhythmia in itself.

Similarly, for the max when running. In my 30s I used to maintain 180bpm in the gym for 30 minute sessions. Now, in my 50s, I can still hit mid 170s on a sprint (and that's after a too-many-kebabs induced heart attack) . It's just another of those things where "averages" are pretty meaningless when applied to individuals.

Generally, heart rate reserve (the difference between your testing and maximum) is one of those things where more is most definitely better, as long as the rhythm at each extreme is appropriate (ie: sinus rhythm and appropriate for the level of exertion). It's also been shown to be a good predictor of cardiovascular disease, especially in younger men (higher reserve = lower risk) At over 130bpm your reserve is excellent.

So, keep running, cut the pizzas (especially with a likely genetic leaning towards high cholesterol), wait for your GP to hear from cardiology, save the cost of a private consultation and spend it on some salad instead (OK, maybe not the salad bit because that stuff's poisonous...) ;)

I'm not sure about this Plaque test. I have read and been told it is a new test and not widely used or valued - I've never had one although I suppose it's a bit late for me.

Hi Thatwasunexpected,

I really appreciate you taking the time to post such a long and informative response. I understand that PLAC measures the LP-PLA2 enzyme which could be indicative of inflammation, however on the results for Bluecrest, it says even with a normal range of Cholesterol/BP/Trigs that I should further be mindful of it. I think the wording in their report has just freaked me out completely.

I understand that there are norms for certain ages, I just had assumed that (from what I've read) a low diastolic blood pressure indicates a general stiffening of the arteries, hence we see it more in older people. Sometimes mine goes as low as 55, but generally, it's 60-65. As stated, I also get really dizzy sometimes whilst out and about, as though my balance has suddenly disappeared! I hoped it was just the low diastolic BP causing it and nothing more serious, perhaps a dip in BP. I guess the worsening heart palpitations at night could be down to me stressing more and more over it, but then until I can speak to a cardiologist rather than a GP, I doubt that'll stop. The GP seems consistently of the opinion that I'm "too young" to have an issue. We all saw Christian Eriksen collapse with a cardiac arrest on the TV when Denmark was playing in the Euro's, 29 years old and fit as a fiddle, so it still concerns me that I do get symptoms of potential issues and have a family history of elevated levels.

In regard to Sinus Arrhythmia, I have never had his discussed with me but believe it is because my heart beats slower on either the in-breath or the out-breath. It wouldn't just be as the HR is low as it's never low when I'm at the docs (70) 🤣

That's great to hear about your running heart rate, I'm hoping mine is just a case of it also having the ability to go higher with no issue. I may invest in a running ECG just to ensure that everything is normal when I'm hitting 190+ at faster paces!

Again, thank you for your response, it is most appreciated as I've not anyone to discuss with in person! 😆

If you're thinking of paying for tests then a VO2max treadmill test would probably be a better investment than an appointment to talk to a cardiologist.

Putting your heart under real load will tend to show up most problems and part of the monitoring is to watch for any ECG changes in real time (for safety).

If you enjoy exercise it's also kinda cool to push yourself absolutely as hard as you can just to see ;) The report can always be given to your GP as part of your medical records for cardiology review if needed.

Keep in mind that a private cardiologist may well suggest testing anyway, in which case you'd end up paying twice!

Hmm, so you're essentially saying a VO2Max test will test for my max HR whilst ALSO monitoring with an ECG style test? Seems like that's a bargain given it's £300 for an exercise ECG at the nearest private institute 😜

I've been meaning to test my max HR for a while, but since I got this news I've been reluctant. Coupled with the dizziness, it just seems irresponsible of me just incase!

I'll look further into this and hopefully get back some news from the NHS cardiologist regarding my PLAC and BP gap and see 👍

Thanks again.

If you're reaching 180bpm anyway on runs then you should be fine with a max test. If anything untoward starts happening they should spot it well before that level.

Obviously there is some risk, but it's well managed and - if something did happen - better it happens in a lab with trained people in attendance than out on a run by yourself!

I was in the middle of arranging one with our local uni's sports science department when the whole Covid thing happened. It might be worth getting in touch with yours because they quite often want guinea pigs for the students :D

I haven't really pushed for a while but, pre-Covid, I used to give myself fairly regular "unofficial" max tests on the local gym's treadmills. No monitoring, no actual oxygen measurements, but a satisfying challenge to push to your limit.

Even after a heart attack, a stent, and known CVD it was always my legs that gave up before my heart or lungs. I now have real trouble getting close to MHR because my legs simply aren't strong enough (I don't have the patience for serious strength training)

By age my MHR even without the coronary disease should be 166, and my RHR is 45. I can happily run for half an hour + at around 155bpm which is over 90% of my heart rate reserve based on that and should be well into anaerobic territory which should be a few minutes at most. Oh, and I still smoke (yes, I know....)

Hearts tend to be a lot less fragile than you think! Things like Eriksen's cardiac arrest are essentially unpredictable and could happen to anyone at any time without warning, so really aren't worth worrying about.

Haha, I reach 190 fairly easily at the end of a fast 5k! I have wondered quite how high it'll go so it'll be a test for sure. I'll run it by the doctor/cardiologist and look into it. That's a good tip re. the university! I'll have to get in touch with them.

I was originally joining the navy when I was younger so used to do regular cooper runs (2.4k) to test myself but haven't done that for a while. It's much easier to get up to a high HR after already running for 20 minutes and THEN pushing yourself!

That's crazy, sounds like you're crushing it still 😁 Maybe you could try a spin class to really get it going 😅 And that you still smoke, that's testament to how fit you are, evidently!

I decided early on that I could let the heart attack define me, or treat it as just one of those "been there, done that" things.

It's always there in the background but becomes kind of irrelevant when you're in a circuits class with people 20 years younger than you and more than keeping up with them :)

The "still smoking" is the little bit of (stupid) rebel in me that refuses to die ;)

I would also add to TWU's great reply that you are far too young to suffer from the effects of atherosclerosis. As he says just cut out the junk and fags and stop worrying.

Thank you for your reply 😀 That's the plan, the latter will hopefully happen eventually 🤣

If I was your age, knowing what I do now, one of the things I would be doing was keeping an eye on my cholesterol levels. Now, nobody knows for sure if raised cholesterol leads to CHD, but it seems to be the mainstream thought. I use a company called Thriva, they will do you a blood and liver function test for £25 or so, and it is reliable, they use the same labs as some GP's, and very quick and easy. Your current level is too high!!

That’s the plan! As I said in my post I’ve started a Mediterranean diet and kicked the smoking so I’ll update in 6 months time! 😆

If anyone has any insight into the term "High risk" and what it actually means, I'd be all ears. It seems to be discussed everywhere but I have no idea what it translates to in real-life terms. Is there a guidance or % of chance of X which constitutes "high risk"? Thanks

Milkfairy profile image
MilkfairyHeart Star

' high risk' the definition depends who you ask and how risk averse they are.

Insurance companies employ actuaries to calibrate the chance or risk of an adverse event.

A risk isn't your destiny.

I suggest you have a look at this charity.

c-r-y.org.uk/screening/

I took my 3 children to be checked because my brother in law had an out of hospital Cardiac arrest (he's still with us).

Also my husband and I both have heart disease.

My children were all okay.

They are all in their 20s, never smoked, diet who knows now they are not at home. They all exercise.

Good luck.

Thanks Milkfairy, so maybe I should stop concerning myself so much with the word high risk! I went to CRY tests every year from the age of about 12-16 as per worry from my mother but didn't realise they're still going for under 35s! I'll have to register interest and hope they come to Wales sometime.

Thanks for your input.

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