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Heart Disease (Expert Forum)
Do we need a 2nd opinion?
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Do we need a 2nd opinion?
by Sandie Riddle, Nov 12, 1999 12:00AM
My friend is 36 years old, normally in good health with a heart rate of 75-80 bpm all of his adult life. He normally works long hours and sleeps 8-9 hours per night. 4 days ago he began to experience an occasional "flip flop" feeling over his heart, excessive fatigue, and occasional clawlike cramping in his left hand. Yesterday, he complained of pain in his left arm, a pressure around his heart that he described as someone with his hand in his chest pushing vertically down on his heart.
I took him to the emergency room where his EKG showed Braycardia in normal sinus rhythm. His heart rate was 48 bpm, BP normal. 1 PAC was noted. His CXR was normal along with his lab work.
He was admitted to PCU, and a stress test was ordered for yesterday AM. His sats dropped to 89% 1 hour after admission so he was put on 02 until his discharge. His HR remained 44-54 throughout his 24 hour stay.
The stress test was WNL with a top HR of 100 after prolonged exercise. His resting HR was 52, BP remained WNL. During his overnight stay, the nurse noted a rate of 21 on the monitor with PVC's but becasue of the delay in the recording, the rhythm was not captured on paper and the doctor discounted it as monitor error.
The cardiologist stated that it is not abnormal for a man of 36 to have a low heart rate, discharged him with an event monitor and told us to make an appointment in 2 weeks in his office. He did not give us any answers as to why his rate has gone from 76 to 48 or the the reason for his fatigue, and other symptoms.
We do not have a primary physician to discuss this with and are not comfortable with the cardiologist's lack of concern. The admitting doctor mentioned a possible malfunction in the SA node and a possible pacemaker which makes sense to both of us. His HR this afternoon is 50 and he is very tired.
Should we seek a 2nd opinion? We sincerely appreciate any advice you can offer.
I took him to the emergency room where his EKG showed Braycardia in normal sinus rhythm. His heart rate was 48 bpm, BP normal. 1 PAC was noted. His CXR was normal along with his lab work.
He was admitted to PCU, and a stress test was ordered for yesterday AM. His sats dropped to 89% 1 hour after admission so he was put on 02 until his discharge. His HR remained 44-54 throughout his 24 hour stay.
The stress test was WNL with a top HR of 100 after prolonged exercise. His resting HR was 52, BP remained WNL. During his overnight stay, the nurse noted a rate of 21 on the monitor with PVC's but becasue of the delay in the recording, the rhythm was not captured on paper and the doctor discounted it as monitor error.
The cardiologist stated that it is not abnormal for a man of 36 to have a low heart rate, discharged him with an event monitor and told us to make an appointment in 2 weeks in his office. He did not give us any answers as to why his rate has gone from 76 to 48 or the the reason for his fatigue, and other symptoms.
We do not have a primary physician to discuss this with and are not comfortable with the cardiologist's lack of concern. The admitting doctor mentioned a possible malfunction in the SA node and a possible pacemaker which makes sense to both of us. His HR this afternoon is 50 and he is very tired.
Should we seek a 2nd opinion? We sincerely appreciate any advice you can offer.
Doctor's Answer
by CCF CARIDO MD JMF, Nov 15, 1999 12:00AM
It is true that many people may have a low heart rate. I would suggest a work up of fatigue, including thyroid function tests. A low thyroid hormone may cause fatigue and a slow heart rate.
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You say that his normal heart rate is 75-80 bpm, when was the last time he had his rate checked and for what reason? Also, was he recently sick?
The symptom that really concerns me is the "pain in his left arm, a pressure around his heart that he described as someone with his hand in his chest pushing vertically down on his heart". I would expect them to do extensive tests to figure that one out.
Good Luck and hope all goes well.
Thank you so much for taking the time to review and address my concerns. He has had several episodes of palpatations over the weekend and sent these through the event monitor.
We will most certainly ask about thyroid tests at his followup appt, and are working with the insurance company to authorize an appointment with another cardiologist.
Sincerely,
Sandie Riddle
Thank you so much for taking the time to review and address my concerns. He has had several episodes of palpatations over the weekend and sent these through the event monitor.
We will most certainly ask about thyroid tests at his followup appt, and are working with the insurance company to authorize an appointment with another cardiologist.
Sincerely,
Sandie Riddle
Please?
Hypothyroidism may make diabetes worse and cause increase weight gain and fluid retention if not treated.