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Change in Palpitation Frequency
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Change in Palpitation Frequency

I am a 40 year old female, generally healthy and have bicuspid aortic valve.  My last echo, 2 yrs ago noted stage 1 regurgitation.

For the last week, I have had an increase in palpitations.  I have them all day long and they are especially bad at night.  The exact minute I lay flat they start going crazy.  I don't think it's a case of noticing them more because it's quiet, etc.  They are really more frequent and stronger.  I have to sit up in order to slow them down and still then they keep on coming.  

I have noticed that I have a lot more heartburn lately.  I have been taking Nexium 40 mg twice daily for about 4 years and somedays I still have heartburn.  I am being very careful of what I eat. I haven't had caffeine in about 5 years.  I don't exercise because these palpitations scare the stuff out of me and I can't make myself go to the gym.  I was told to do cardio and only very light weights if I was going to do any weights at all.

I had a bad bout of palps around Christmas and went to the ER they ran an EKG and I had LOTS of PAC's and only about 4 PVC's.  The palpitations that week kind of settled down to a bearable amount and then last week, that was it.  It started all over again.  It's like a big vibration and then a thump.

I don't know what to do.

Is there something new going on?  Is there a special test I should get?  I don't want to go on a beta blocker because my BP is low and my heartrate during palps is around 64.

What do I do next?  I am so scared.
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Hello,

This is a very common concern.  There is some debate about the right thing to do.  Most physicians will reassure you that these are not life threatening and offer you a beta blocker if you want it.  The other option is to try an antiarrhythmic agent, usually a class Ic like flecainide or propafenone.  These medications may help suppress your pvc's, they make make them worse or make no difference.  The only way to know is to try.  

Why doesn't everyone do this?  There are studies showing that class IC medications in the setting of coronary artery disease increase mortality.  In the right setting, they are safe medications but many physicians do not feel comfortable using them for this reason.  If you take these medications,  you should be on a beta blocker or calcium channel blocker as well to because there is a risk of very rapid heart rates if you develop atrial flutter.

I hope this answers your question.  Thanks for posting.
26 Comments
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Until about a year ago, I ALWAYS had what I would call low BP (100/110 over 50/65).  I took BB's for many years and it did not seem to affect BP or HR in a negative way.  As I recall, Holter monitors indicated an average HR of 60-65 (on BB's and off).

About a year ago, my BP jumped a bit (no longer taking BB's on at regular intervals).  Reading were about 135-140ish/80ish.  Now, I'm taking an ace inhibitor and BP is lower than ever.  Took a little time to adjust to lower BP, but doctor says it is beneficial to keep it at an optimum.  In the summer, I noticed my systolic reading could dip into mid 80's while the diastolic reading could dip into mid-40's.  Felt a little tired, but after adjusting, it was OK.  Doctor was not concerned absent any symptoms.  I guess what I'm trying to say is that as long as your doctor is OK with BP, maybe you would find BB's (or antiarrythmics) helpful.

Hope you are feeling better and that you are having less frequent ectopics today.

connie
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"For the last week, I have had an increase in palpitations. I have them all day long and they are especially bad at night. The exact minute I lay flat they start going crazy. I don't think it's a case of noticing them more because it's quiet, etc. They are really more frequent and stronger. I have to sit up in order to slow them down and still then they keep on coming."

that paragraph exactly describes me too. i would have though i wrote that paragraph. i have both pacs and pvcs and mine tend to come and go in cycles every few weeks, some weeks ill have maybe 10 a day, and then ill have a period of a couple days or week or two where i have them constantly throughout the day and have up to 5-10 a minute during the night or when im laying down and my HR is slow. my bp is around 110/60. i was on a beta blocker for awhile and i never fainted or anything due to low bp, but it made me really drowsy and i dont like pumping myself up with meds anyway so i quit using it. aerobic excercise usually gets rid of my pvcs on the fairly rare occasions im getting a lot of them during the day, and ive noticed that regular excercise seems to greatly reduce the frequency of the "heavy" cycles. caffeine has little effect on my pvcs/pacs some people say excercise makes them worse though, so just try new things and see if you can figure things out that work for you. shedding your fear is probably the best thing you can do, because then they hardly bother you.
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"I have noticed that I have a lot more heartburn lately."

Just want to chime in with the G.I. connection.

I used to get PVCs/PACs them all the time, but since I started exercisely regularly and taking a magnesium supplement, I only have a few now and then and haven't been bothered by them for years.

The other night, though, I had a very serious IBS attack which left me bent over with cramping and vomiting for 24 hours. I'm better now but I'm still experiencing mild symptoms. In the last 2 days I have had more PACs then I've had in the last two years, and they are coming right after I eat something. I usually get about 20 in about 10 minutes. At times I can get about 10 in 10 seconds, which can lead me to panic (even after all these years I can still panic) which increases my heart rate, which leads me to think I'm going into a-fib, which causes me to panic more, and just makes the entire experience extremely unpleasant.

I'm hoping whatever happened to my stomach resolves very soon because I don't want to be held hostage to ectopic beats anymore. My advice for you is to not ignore the heartburn connection. It may help you find a solution. At the least it may help you relax. Even though I can panic when they're coming fast and furious, for the most part I've learned to ignore them, and I never let them keep me from going to the gym, which I really believe is one of the main reasons I don't usually get them anymore. Oh, and you may want to try magnesium supplements. Check with your doc.

Good luck!
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Sorry, I had to ammend that. I get 10 in about 60 seconds, not 10 in 10 seconds. They are all singletons.
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Hi, Whelan...
   I'm coming up on the big 5-0...and have had palps as long as I can remember. They wee so bad at one point but I hate medication, so I just toughed it out. I just assumed I would be bothered forever...but about five years ago they pretty much stopped. I still get them infrequently, but for the most part I am at peace. They still freak me out, it's a fact of PVC's...they are awful! I also have a bicuspid aortic valve...I exercise six days a week and have no problems. Hang in there...wish you the best...and that things can change for the better!
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Hello,

I am post surgery ASD repair of 12 years. I had the surgery when I was 30 years old. At that time I took Lanoxin (for about one year) and it increased the PVC's I was having so it was stopped. I had not taken any heart medications since then. Around nine months ago, I experienced an increase in palpitations and tachycardia. I also had more palpitations when laying flat. After 2 month of little abatement, I contacted my cardiologist. An echo found moderately severe tricuspid regurgitation. I was put on Atenolol 50 mg daily. I was concerned that it would lower my already good blood pressure (usually 100/70) but it has not affected it at all. The palpitations have decreased significantly as well as the tachycardia. If I were you, I would talk to your cardiologist about giving medications a try. Good luck.
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I had asd repair 1989 and am still to this day petrafied by pacs and one episode of a-flutter, palps seem to be getting worse. I am about to go crazy. can anyone help on toprol 50mg have about 4000-8000 pac 24hrs. can anyone relate ?I would love to seen how to not let these affect my life anymore!!!! Please help
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Hello Jazzy, just wanted to let you know that I have 20,000+pvcs/day, and I take toperol XL, infrequently, about 12.5mg once or twice a day, but not every day (it just seems to put me on my backside if I take it for more than three days in a row.

For me, the toperol doesn't seem to decrease the high frequency, but it does lessen the sensation of the pvcs. Although, if I took more, I might find a reduction in PVCs. It did stop a constant bigeminy and runs of nsvt that occurred in the summer. But it hasn't done anything for the constant trigeminy I'm now in (just the sensation).

Hope you find some relief with the toperol, but like other posters on here, you might have to (with your doctor) experiment on other beta-blockers to find which one works best for you. Atenolol and Inderol are two that are commonly mentioned here that seem to work for other folks.
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You seem so calm with all those extra beats. If you are not mortified why and how did you become not scared. I have had pac's and pvc's for years and am constantly in mental anguish. Having so many for how long of a time period? I really could use some help in overcoming my anxitey, I live life in a box because of them any help would really be very appresiated from you and anyone else who has managed to overcome these and still live with them. They impact my life very very much.
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It helps, jazzy, to concentrate and be aware of the fact that you can walk around, cook, shop, and so on--and you're not dead!  In other words, the skipped beats do not usually interfere with your ordinary life--until you start focussing on them.  However, I know from experience that being aware of that fact is not enough when you're feeling panicky or anxious.

If you have been extensively tested and told repeatedly that your heart is OK, then you are probably suffering from clinical anxiety, and that should be dealt with by a psychiatrist.  I do not mean to be insulting:  Anxiety and panic are illnesses as much as any sprained ankle or gut problem, and since that is the case, it's a good idea to go looking for a the proper doc, in this case, a good shrink.  I have found the right antidepressant to be a tremendous relief.
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jimmyb, you say you have BAV too.  You also said you exercise 6 days a week.  When starting your exercise routine, how did you start?  Did you do weights, were they light at first, how much cardio and for how long?  I am afraid to exercise because walking up hill or in the wind or wiping snow off my car causes my heart to race and I get tons of PAC's.  So, I am so scared to exercise.  I don't know where to start.

Thank you everyone for sharing your experiences.

Connie
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Hello, don't know exactly how to describe the path to a sense of calmness over the PVCs, I'm not on it all the time, I find it about as much as I lose it, it seems. Luckily I think I'm on the path for longer than I'm off.

First, I've had PVCs for at least 22 years, ever increasing. So it's been a fact of life for me for as long as I can remember. I guess you learn to live with it, because there is no other way. That should not cause you any despair, like the above poster said, you go about your life, you work, you shop, you celebrate another birthday!

I think a big turn-around came at age 30, I finally found an extremely compassionate doctor who ordered a holter and stress test and referred me to a cardiologist. It had been 12 years of pats on the head and diagnosis of depression and anxiety prior to that. Back then my PVCs were 10,000+/day but the cardio advised against beta-blockers because he felt BBs could make PVCs worse (that is a possibility but BBs do help some people), and he said I'd have to take them for the rest of my life. "WE" agreed to hold off on the BBs.

Now in my 40s PVCs have more than doubled, but the information on them is still the same. Benign in the presence of a structually normal heart. I read in your post you had a heart procedure in 1989. I don't know what that is, but if you've had the usual holter, stress or stress/echo since that time and have been told everything is ok, that's the best news.

As for the rest, on how to live with them, it's more a matter of overcoming your anxiety about them. That's been a big part of my life too. I think it's much harder to overcome anxiety/panic attacks. They heighten the sensation of PVCs exquisitely. Deal with the anxiety first and I hope you too will find the PVCs bother you less. Hang in there.
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DId everyone see the evening news about women and heart disease undetected?  The symptoms of sob, chest pain light headed.....all the symptoms alot of us get with pvc's/pac's?????Now who do you believe? I usually don't believe the news media anymore, but this has me agitated. Of course that was probobly the desired affect they wanted.  Just had to vent!!!!!!!!!!!!!!!!
:) SOrry
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I'm suffering tremendous anxiety over my PVCs which come and go, as well as a run or two every year of what the docs aren't sure is NSVT or SVT with aberrancy . . . anyway . . . I also have worked in the media before, and I know that the media DEFINITELY wants the hype. Also, rest assured, those of us who suffer from PVCs and visit our cardiologists in states of panic are NOT "UNDETECTED" cases! These are women who say, "Oh, hm...my heart feels weird, or I have shortness of breath, blah, blah, blah," and never do anything about it. WE HAVE BEEN DIAGNOSED, checked out, tested, etc. I read a post on here a few months back from someone who said "Those of us who suffer from PVCs, arrhythmias, etc. might actually be HEALTHIER than those who don't, simply because we're tested and checked out by our doctors more often." I agree. That doesn't make it any easier to live with, and as I type this, I, too, am feeling crazy PVCs and am nervous as heck over them (I pray one day that I will be like many on this forum and find my PVCs to be nothing more than a "nuisance," but I'm reassured knowing I've had the tests done.
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Hello, I hope you are having a better day today. I'm glad that you have some comfort in knowing that all the tests you've had point to a healthy heart. That can be the start of helping you to overcome the anxiety. But it takes practice thinking that way. It's like you have to "train your brain". Focus on that bit of positive news and the thought gets stronger, and then so do you.

I think anxiety is a more insidious villian than the PVCs. However, it's hard for me to realize in the middle of a full blown panic attack accompained by a pounding, flipping heart, which I feel worse about. But I just try to ride them out now. However, I have a good security blanket that I can fall back on if I have too--xanax (generic alprazolam). That is something you should talk to your doctor about. I've had panic attacks for many years, gee, seems like as long as I've had high frequency PVCS, so I don't know which came first. PVCs I suspect.

I currently take .12mg as needed, which luckily isn't often, but I used to have to take more until I became stronger in calming my mind and body myself. And that was just reading lots of books on the subject and "practicing"--And not listening to the media to get my medical information because they have no idea half the time what it is they are even reporting! For a profession that prides themselves on getting the facts, they sure leave a lot out to swing your opinion.
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I'm a 19 year old male, and for the last week now ive had the same thing, it started last Sunday and i woke up in the middle of the night with severe heart palpitations of 140+, it finally subsided after about 30 minutes, i could not sleep though, i would wake up every 2-3 hours with them, i could hear my heart beat in my ears, which was worse when i laid down.

Monday night i went to the hospital, turns out i was really low on potassium so they gave me 4 pills and later on i could sleep fine, now im taking potassium supplements everyday beause of a defiecency, but the thing is, i was givin anxiety medication to, i do have a history of panic attacks (often severe) and these palpitations still climb to 120+ sometimes.

All the tests came back normal (minus the low potassium), blood test, urine test, chest x-ray, ECG, all that was negative for anything serious. But they havnt stopped yet, i do feel very nervous quite often, I most likely may have panic disorder, as i am experiencing a combination of intense fear and depersonalizaiton throughout the day, with chills/flushes, chest pain, and these palpitations. Im waiting to see a shrink to have it evaluated though.
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Thanks for the great post.  You are absolutely right and I feel much better thinking it through.  With me its the dang symptoms I get from PVC's.........I get short of breath, chest pain and dizzy.......if it were not for that, the feeling in my chest would not bother me so much.  They keep changing my meds every few weeks so I am a little frustrated lately I suppose. Thanks again for a very thoughtful and intelligent post, I know your right. Good luck to you also.
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I just wanted to let everyone know that PVCs and PACs, in the absence of any heart disease are not dangerous...just very very annoying and scary. I have been suffering with sporadic PVCs almost daily for the past 2.5 years. I can't tell you the the number of ER trips, Holter Monitors, Event Monitors, Cardiologists, GP, etc..that I have been through.  I have had 1 echo, 2 regular stress tests, and 3 echo stress tests and all have been normal plus several dozen EKGs. All of been normal with very slight variation now and then.  

These things are scary I admit and I have been through the full regimen of anxiety drugs...Zoloft, Paxil, Effexor, Cymbalta, Xanax, Ativan, and now I am on Klonopin, .50mg twice daily. I have recently told my doctor that I wish to get off my anxiety pills completely and I am on a slow, taper program. I have mild hypertension and I take Avalide 150mg for it and it works fine.

Recently, my PVCs have increased after being more quiet for a few months so I may go back on a low dose of Toprol XL.  These palps occur whenever...during a workout, after a workout, during a conversation, after a meal, etc...they just come out of the blue and when they hit, they are very strong. I may get about 5-10 a day a the max and I have been told many, many times my heart is totally fine and that I coud run a marathon if I wanted to.

I just started running again on a regular basis to improve my heart and lung function, and reduce my stress level. I have been told that I do not suffer from depression but do some level of PSTD and Generalize Anxiety...mostly becuase of non-cardiac chest pain and these darn PVCs.  PLEASE, DO NOT LET THESE take over your life as they did to me.  I am now slowly trying to regain my life.  My PVCs started two months after my first panic attack which started one month after I got married to the woman of my dreams.  We have both suffered because of my anxiety and PVCs and  through a good diet, relaxation techniques, and some solid prayer, and I am hoping that I am on the road to final recovery.

PS...I recently flew to Vegas. And on the jetway, while I carried my luggage, I got really strong PVCs. But when I sat down, they stopped.  Each time I moved around the airport, my PVCs would trigger, then once I sat, I was fine. When I moved around the hotel, they would kick in, but in my room I was fine!  When I returned home a couple of days ago, I went running....and guess what..NO PVCs!  I went walking around town...no PVCs.  Now today I have had about 3-4 and each time, my internal alarms go off, but I try and divert my attention and tell myself what my docs and cardios have been telling me for almost 3 years...my heart is normal...live and enjoy your life.

Take care all!
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First let me say that this site has been a blessing for me.  I have had palps for a long time and didnt know what they where.My latest bought started back in sept. I felt lik i was going to die.  Went to dr many times and through lots of test ...ekg..stress echo.. holter moniter..blood test ect.. he bascily told me it was just somthing i had to get use too.He put me on med for blood pressure and after about a month i started feeling better.  I have very high anxiety and these episodes make it worse. I have as of yesterday started back with strong and frequent palps and even though i know i shouldnt worry they really scare me to death.  Does anyone know what brings them on after they have been gone for a couple of month and what should i do about them?   I really hate the thought of the dr visits again only to be told the same thing.
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That is the nature of the beast. There are so many different triggers, and not all of them are the same for each individual. Some people have PVCs that are greatly aggravated by caffiene, while some other people don't feel caffiene affects them at all.

Some people do very well with beta-blockers in reducing or eliminating their PVCs, others do not.

Some people have 5 to 10 PVCs a day and are in the ER, and others have multiple thousands and just try to tough it out.

Some people notice their PVCs others don't. Some get them in cycles, others get them constantly.

BUT if you've had all the tests and passed with flying colors, my only advice is to ENJOY the time you don't experience the PVCs and remember when you feel them again, well, you lived through it once, you'll do it again. What doesn't kill you, should make you stronger. With that analogy I should be superwoman!! I'm not, but I'm still here and trying my best to laugh through 20,000+PVCs/day.
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Finding this board is really eye-opening for me. I really appreciate reading your comments and advice...and seeing others feeling what I am is reassuring.

This past Xmas I drove myself over to emerg with thumps in the chest. They did and ECG blood tests etc. and said all was well except for high BP. (I'm a male 48 in fairly good shape).

I went on a BB and diuretic and my BP is okay with no side effects. I'm scheduled though for a Holter and physical to try and get to the bottom of my skipped beats (a shallow beat followed by a hard THUMP), maybe 30-50 a day. My Doc said he suspects PVC's and that likely they're not related to any heart disease.

The skips take my breath away and have been worrying me like crazy. I've also had a panic disorder that is pretty much under control. The advice I've seen here about managing stress and dealing with the anxiety is really on-target. I'm just hoping that the rhythm problems I'm dealing with are not serious and I can get some sleep.

Mostly what I've read here on the boards seem to indicate that most people here who go through the tests find out their hearts are sound. It's good to hear. I know compared to others the frequency of my palpitations is mild. I'll keep that in mind and wish you all good health and relief from your thumps...
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What a great forum.  It's like it was custom-made for me.

Guys, don't be so quick to say no to beta-blockers.  About 8 years ago I had a case of PVCs (mild, I'm tellin' ya, compared to what I'm going through now with them) but I promptly schlepped myself off to a cardiologist complaining about the strange flip-flop in my chest when I stopped walking or lay down in bed.  He ran the 10-minute EKG and of course everything was fine.  I did feel a little bit head-patted but I see how that he was just trying to reassure me that I am (was, at age 32 anyway) a healthy young woman with a strong heart and I don't remember if he explained my problem as being PVCs or if I had to look it up myself later.  I think I looked it up because despite my top-level intelligence, well, doctors oftentimes think that the lil' ole patient can't understand big words.

Anyway, he put me on a beta blocker (can't remember which one) and I only took it for a week or two.  I remember that it made me tired, that's all.  But guess what?  No more PVCs for 8 years.  That was worth it, to me!  Now I've had a bad run of more persistent PVCs (I guess) presenting themselves more often while I'm active or exerting myself in even the smallest manner, like pushing the vacuum around or putting my child in her carseat or carrying two bags of trash to the curb.  From reading around here I'm starting to understand that it's probably going on all the time, but I only feel it when my heart is beating more forcefully.  In fact, last night while calm, I checked my pulse (I'm not a constant checker, but I don't know how anyone can be expected to be totally unconcerned when this stuff is going on) and thought, "Good, nice and slow, not racing like it has been recently" but then noticed the pause, then another pause, and within one minute there had been a bunch and I didn't have the stomach to keep "checking."  I was feeling the mildest flutters at that point, but I figured it was my imagination.... nope, no such luck.

Saw a cardiologist last week and she felt two "skips" while I was lying down on her table - the only "good" think about that appointment being that I didn't have to defend myself against the common, "Are you sure you're not just anxious and feeling your normal heartbeat and flipping out about it?" since she documented it herself.  Wore the monitor for 24 hrs. and then they took their time sending that in for scanning.  Should hear today!  Wish me luck.  I can only HOPE that something simple like and Rx for beta blockers will cure me of this, until next time, which could be years from now.  I can say that a boatload of stress has converged upon me in the last few months (and quitting all caffeine for 4 weeks now has not helped one bit - it's only gotten worse) but my theory is that the heart gets "irritable" and needs some kind of intervention (even if it's only time, or so I've heard, it's not happening for me) to break the cycle and get things back to normal.
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This is just a question for everyone .  Does anyone else get these palps first thing every morning?? For about a week now i have gotten them about 5 am  evrymorning and they somtimes last for hours. somtimes all day.  I mostly feel it at the top of my chest kinda where your throat ends and you chest begins.. This is new for me although i have had palps for many years.  They are driving me crazy....
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Hello,
Since I'm in constant trigeminy, I get them ALL day long. And since I've had them for 22 years, I really can't remember if I got them at a particular time of day more than another time of day. Seems that I would notice them more when I was relaxing, watching TV or reading.

I suspect that your description of morning PVCs may be more associated with what is on your mind when you wake up? For example, thinking of a busy stressful day of work? I know that all PVCs are not anxiety induced, but it's always been a big trigger for me--I feel them much more. Do you normally wake at 5am or is that something new?
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By the way, please excuse my typos and anything else I mis-phrased; for example, I didn't mean to sound like a big-head with "top-notch  intelligence"; rather, I only meant to say I don't have a deficiency that makes me unable to understand basic concepts but sometimes Drs. treat a mom of two youngsters as if there is nothing upstairs but peanut-butter-and-jelly sandwich recipes.  There is a different climate in medicine lately, though... and I like it.  I was shocked to observe lately that drs. do apologize if you've been kept waiting and don't always treat you like they have 2 seconds to get you in and out of their personal space.  Sometimes there is actually a dialogue instead of a speech while being pushed out the door.

worriedat40, we're both 40 and both having the same thing.  When I noticed these first thing in the morning, that's when I started to think about seeing a doctor.  I wish I knew what caused the actual sensation in the throat but the only thing I've seen referencing that exactly is mitral valve prolapse.  No one has mentioned that in the reading I've done here today (granted I have not read the whole forum.)  18  yrs. ago I was diagnosed with mild-moderate MVP through a lengthy echocardiogram with details given that I've forgotten (regurgitation maybe??)

Then 8 yrs. ago while pregnant my OB ordered another echo which took far less time, was done by what seemed to be an 18 yr. old tech, and it showed no MVP.  I realize that criteria has changed drastically in recent years.  Also, though, I wonder if the MVP can "show up" sometimes but not others.  My OB chose to treat me as if still having the MVP (prophylactic antibiotics.)  Anyone else have an MVP diagnosed in conjunction with these arrhythmias?  I'm still waiting on my holter report but I figure since they are not calling me, it must not be anything they are worrid about (though I felt dozens of problems while wearing it so it probably picked up hundreds or more.)  I'm guessing I'll next be sent for another echo since the others were a long time ago.  I'm kind of afraid I'll find out something bad but then again, maybe it will be an "A-OK" result and that will be reassuring.
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