Questions for the doc

[Tralfaz]

I'm a 33 year old male that's been experiencing periodic spells of tachycardia, but they've been getting better and less frequent. Just a few questions concerning this:
1. Is it normal for the heart rate to be higher when standing than when sitting or lying down? When I stand up my pulse will shoot to about 110-120, but as I stand there a few minutes it gets down to about 80. Would being tall (6'4") make any difference?
2. The same goes for my blood pressure. Supine BP is optimal, but when I stand it gets to about 145/95, but goes down after I've been standing awhile. Anything to be concerned about?
3. I've asked my EP about autonomic dysfunction and possible chronic viral infections, and he dismisses them both. I'd still like to at least check for these. What kind of doctor should I go to to see about this?
4. I've noticed that the day after drinking alcohol (about 6 beers or so), my pulse will be higher than usual. Does this mean I have to give up alcohol all together?
5. Is it normal for pulse and BP to be higher first thing in the morning, and lower at night?
6. Exercise or food doesn't trigger spells, my heart rate varies throughout the day, often it's higher when I wake in the middle of the night or in the morning, sometimes when I'm relaxing on the couch, and the EP and endocrinologist haven't found any specific cause after a battery of tests (chest x-ray, echo, blood work, event and holter monitors, ekg, etc.) Any ideas?

I appreciate any advice you might have. Thanks

[Yukon]

Dr. I just had a Heart catherization done on Friday the 2oth of Feb., How long is the recovery period after this is done.  It is Tuesday and I am running a low grade fever.  I also have a bruse on the left side of my stomach that came out after surgery.  Could you tell me what that is from.  The Dr. found Minor and Major arteries that were clogged.  I had a by pass in March of 2000.

[jrice]

I want to thank everyone that has responded to me and offered me such great and caring advice.  I saw my cardiologist yesterday and he has referred me to another electrophysiologist in Memphis.  I have an appointment this Friday so I will see what happens.  My insurance limits me to who I can actually see.  Since I am not working and have depleted my savings trying to survive my mortgage and support my daughter for the last year, and since I can't drive due to all of these problems I am unable to travel very far.  Yesterday I had an pre syncope episode in the check out at the grocery store, and today while I about to walk out the front door.  I don't know what is bringing on all the episodes.  Sometimes my heart races with the pre syncope and sometimes I can barely feel my heart beat.  I am at the point where I am scared to barely do any activity for fear of bringing on the symptoms.  All I want to do is sleep all the time, and when I do try to get up then I have a weird sensation in my elbows and knees.  There is no tingling but just a weird feeling kind of numb or weightless or something like that.  Has anyone heard of the Arrymthymia Consultants in Memphis, TN with Dr. John Porterfield?  I just found out that he accepts my insurance and will try him since he is into research.  I am scheduled to Dr. Szabo in Memphis, but I can't find anything about him.  I will keep you informed as to what they finally figure out about me. Again Thank you all and God Bless you.
Joyce

[NBCT]

Take the advice of the above posts. You need to find an expert in your area to pinpoint the problem and provide you with the best medical treatment available today to alleviate your symptoms and improve your quality of life...SOON...I know there are answers for you out there and accessing this site, getting helpful, caring advice from total strangers is the catalyst you needed. Best Wishes...Feel better soon!!

[LynnSB]

You are not that far from Emory in Atlanta. There is a brand new Center for Atrial Fibrillation at Emory University Hospital plus a state of the art EP lab there. I am sure they could help you. I suggest you call John Beshai, MD at Emory Hospital, or Angel Leon, MD at Emory Crawford Long Hospital . I can post their numbers for you if you want.

Lynn

[Guenter]

I forgot to mention too that there are a variety of new approaches being used for atrial fibrillation.  They involve pulmonary vein isolation.  I really think if you could get to a place where they are doing research in this area and have the expertise, you would get help for this.  This sounds to me like it is fixable.

[Guenter]

You need to go to a center where there are lots of electrophysiology experts like Cleveland Clinic Mayo Clinic etc.  In Milwaukee, there is an electrophysiologist by the name of Dr. Achtar who was really one of the very first in the area.  He is nationally known for his expertise in this area.  Also, there is one whose name is Dr. Sanjay Deshpande in the Milwaukee Area.  He has extensive experience with all the medtronic devices and actually works with Medtronic R & D people.  His expertise is actually in the area of devices and VT etc. and he would be very helpful for you.  His phone number is 414 219-7820.  I am not sure your insurance company would let you see these people but I would highly recommend them.

[Momto3]

Well said....I sure hope this is finally over.....zzzzzzz

[Momto3]

To clarify:

The issue that some people (not me) are concerned with is not how many questions are asked within a post. Rather, with how many TIMES an individual person posts. There is a limit of two "posts" per day (not questions, but "posts").

[Guenter]

There were six questions asked and answered in this one posting.  Isn't that a violation of how many questions each can ask?

[Tralfaz]

I'm unclear as to what I may have done to offend you or anyone else, but I certainly don't apologize for using my opportunity to get a post in to the fullest. There is a minimum of letters allowed in each post, and I stayed under that minimum. Whether I filled that space with questions, or whining about others getting their questions answered, should really be of no concern to you. I'm extremely grateful to the Dr. for the service he offers in this forum, and if he chose not to answer all of my questions, I would have understood and gladly taken what he offered. Fortunately, he was kind enough to address them all. If you have questions that need answered, try posting yourself, and maybe you'll get as lucky as I was. Good day.

Thanks once again to the rest of you for all of your replies. They're very encouraging, and have allowed me to put my mind more to ease. I hope you all progress towards good health yourselves.

[jrice]

I am sorry for posting my questions this way and pray that i don't offendanyone, but I have been trying to post since 1-6-04 numerous times through outthe day and am finally frustrated since I need help. I am a 33 year old female. I am of average size. I am normally an Small Office Manager in my profession. I live in Jackson, TN, between Memphis and Nashville. In 1988-1989 I experienced several black out spells, usually during long periods of prolonged standing while in formations while I was in the Army. No real testing was done but was accounted to me locking my knees, which I know I wasn't since I was moving my toes. I continued to experience unexplained spells of black outs or fast beating of my heart during periods of activity that usually produced me sweating a lot. In 1995 I experienced several spells of dizziness and then later that day while driving I experienced a black out spell for just a few seconds. Since I was about a mile from the hospital I drove straight there. After several hours and results I was released and told to follow up with my primary care physician. I went to my PCP the next day and was given a holter test. The test results showed SVT with episodes of 250 bpm and 30 bpm all during the night while I was sleeping. I was started on Atenolol 25 mg a day and stayed on that until 1998. I had occasional attacks but no black outs. In 1998 I experienced black outs again and fast heart rates. I finally got a referral for a cardiologist and had a Holter test, event monitor, EKG's, Echo, Sinus CAT Scan, and Chest X-ray. The echo showed 2 valves regurgitating but was still diagnosed as SVT. My medication was changed to Metoprolol 100 mg 3 times daily, and Digoxin 25-mg daily. After about 2 months my Metoprolol was reduced to 50 mg 3 times daily. I continued with this until October 2002. I would again have occasional attacks where I would feel my symptoms of sweating and fast heart rate and I would stop and lower my head between my knees by bending at my waist. In October 2003 I again had more severe symptoms and had episodes of actual fainting, waking up on the floor. My PCP ordered an EKG and Holter test. It showed 184 BPM 10 minutes after being put on and 194 BPM 20 minutes before it was took off all while driving. While wearing the Holter all that I did was basically sleep and lay in bed since I was still so exhausted from the previous days syncope. My PCP referred me to a cardiologist, different from the one I saw in 1998. He ordered an event monitor where I had no episodes recorded. I had EKG

[jan]

This is so weird!  I posted a response and it didn't show.  So, I thought I went back and copied it and reposted, but...

Here it is (if it goes the right way this time):

Hi,

BTW, why are you seeing an EP?

By "normal" I mean it is an expected response for a healthy person.

You say you feel healthy and comfortable, so I would say try and relax when you have the tachycardia.  Instead of focusing on it try to distract yourself.  I know it is easier said then done.  I didn't know I had tachy. I just wasn't feel'g well, tired and often dizzy. If you develop symptoms then discuss it with your dr.

Good luck.

[jan]

From all my research on this subject (because I have auto. dysfunction - IST and NCS) the things you have mentioned are all normal physical responses.

As far as the morning thing I have that, too. I am on atenolol and verapamil for inappropriate sinus tachy, you would think that treatment would prevent it, but it doesn't.  I have break through tachy other times during the day, too.

If you hadn't said you were seeing an EP in your post, that is the  dr. I would have recommended you seeing for any such problems.  

If you're still uncomfortable get a 2nd opinion, but I think you should stick with an EP.

[Tralfaz]

Thank you as well Jan. By "normal" responses, do you mean that they're nothing I should seek further treatment for? Overall I feel rather healthy and comfortable throughout the day, I just get a bit nervous when the pulse starts to quicken, or I read the high blood pressure when I'm standing. I'm not uncomfortable when standing though, and stand for long periods at work with no problems. I imagine I should just deal with the occassionaL tachycardia and be grateful it's not any worse, huh?

[jan]

From all my research on this subject (because I have auto. dysfunction - IST and NCS) the things you have mentioned are all normal physical responses.

As far as the morning thing I have that, too. I am on atenolol and verapamil for inappropriate sinus tachy, you would think that treatment would prevent it, but it doesn't.  I have break through tachy other times during the day, too.

If you hadn't said you were seeing an EP in your post, that is the  dr. I would have recommended you seeing for any such problems.  

If you're still uncomfortable get a 2nd opinion, but I think you should stick with an EP.

[Tralfaz]

Thanks doc. Nothing beats free medical advice!

[Cleveland Clinic]

tral, thanks for the post.

1) As you stand, the blood in your body redistributes. It is normal for the heart rate to speed up a little bit to accomodate for this. Being tall would have no effect.

2) Blood pressure can sometimes fall from the reason mentioned above. No change or mild elevation is normal.

3) There are autonomic dysfucntion specialist and syncope clinics. You might try there. Dr. Fuad at the Cleveland clinic specializes in this.

4) 6 beers is an excessive amount of alcohol. You should at least cut back. Changes in your body volume from diuresis and enhanced sympathetic tone probably are responsible.  

5) There are daily variations in HR and blood pressure. While everyone is different, early morning there are surges in some of the body hormones that are probably responisble for your heart rate.

6) Some people have autonomic hypersensitivity and are more prone to more extreme variations in heart rate and blood pressure. These can be so severe they limit activities. if you are having no symptoms, my suggestion would be to continue close followup with your docs. If you develop more severe symptoms, I would seek a second opinion at a center that specializes in autonomic dysfuction.

good luck