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

[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

[Tralfaz]

Thanks doc. Nothing beats free medical advice!

[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.

[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.

[Guenter]

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

[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").

[Momto3]

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

[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’s, and another Echo with no significant findings. After reviewing my Holter from my PCP I was ordered not drive and to file for disability. I was then referred to an electrophysiologist. In January 2003 I had an EPS study that showed 300 BPM but no ablation could be done because they couldn’t map the path because it would only last 8-10 seconds at a time. I also had a head up tilt test. It was positive at 6 minutes my BP down completely off the monitor, syncope and heart rate under 30. I was diagnosed as Neurocardiogenic disorder. I continued to have syncope 2-3 times a month. In April, 2003 I had another EPS Study, and still no ablation, and then a Medtronics Reveal monitor implanted, and my medication changed to Norpace 300 mg twice daily. I continued to have syncope, and the Reveal captured an episode of 225 BPM. On July 1, 2003 I had another EPS Study no ablation, and then a Medtronics AT501 pacemaker was implanted and the Reveal monitor removed. Since the pacemaker was implanted it recorded 3 episodes of AF on July 20, with no therapy since the therapy was not activated at that time. On August 6, my therapies of 3 rounds burst were programmed. I continue to have episodes of syncope and events that are recorded as VT and therefore no therapy has been given. The following is a list of the events recorded on my pacemaker:
7-20-03 15:01:10 150ms 3 seconds AF
7-20-03 15:04:10 110ms 5 seconds AF
7-20-03 15:05:22 150ms 32 seconds AF
7-7-03 18:48:50 290ms 15 seconds VT
7-7-03 8:53:09  290ms 16 seconds VT
7-7-04 19:29:14 300 ms 9 seconds VT
7-7-04 19:43:21 270 ms 25 seconds VT
7-9-04 15:31:33 300 ms 11 seconds VT
7-15-04 9:10:30  360 ms 29 seconds VT
7-15-04 19:11:10 360 ms 3.9 minutes VT
7-15-04 20:31:06 250 ms 1.3 minutes VT
7-20-04 20:15:23 250 ms 1.8 minutes VT
8-19-04 18:08:13 260 ms 1.1 minutes VT
8-19-04 19:12:25 250 ms 54 seconds VT
8-19-04 19:27:21 260 ms 15 seconds VT
8-19-04 20:34:17 300 ms 2.8 minutes VT
8-19-04 21:48:17 310 ms 23 seconds VT
9-25-04 12:51:34 250 ms l3 seconds VT
9-25-04 21:02:00 290 ms 3 seconds VT
10-4-04 12:46:39 290 ms 1.8 minutes VT
These are off of the latest reports that I have in my possession, although there are more episodes recorded that I don’t have copies of. Because I continue to have all of these VT attacks my doctor took me off the Norpace and ordered Propafenone 150 mg 3 times daily in October 2003. Since I have started this medicine I continue to have nausea almost every single day. Because of all the VT episodes recorded I was ordered to wear another event monitor during the middle of November to the middle of December 2003. I had one attack recorded on December 6, 2003, but don’t know the exact results although I was extremely light headed and near syncope. The nurse was very concerned that she called back 20 minutes later and wanted another recording. When I visited my electrophysiologist on December 12, 2003, he said that the event monitor revealed AF while the pacemaker didn’t record anything. All of my settings were changed on my pacemaker to include immediate therapy. I have since had 7 episodes while none where recorded by the pacemaker. I was told this was because the settings are set to record at 180 bpm and they must have been below 180 although I felt them and my key chain activator said that their was no AF present. I am very sensitive to the beats of my heart and can feel any abnormal beats no matter how fast the beats. I can’t take my pulse during my episodes because they happen so quickly. I have been able to tell my doctor every time that I had an episode and the approximate bpm. The last recording that my pacemaker showed was November 16, 2003. It was an episode that occurred at 4 am while I was asleep and it woke me up with my heart beating fast and shortness of breath. I was told to return in 6 months and that we may have to increase my Propafenone to a higher dosage if I continue to had episodes. I expressed how I get nauseated every single day from the medicine and he still keeps me on it. I am still awaiting approval for disability since I have been denied twice so far. The first was right after the Reveal monitor was implanted, and the second was after the pacemaker was implanted yet they made the decision without any of the current medical records. Their records didn’t include of my medical records since April 2003 and therefore didn’t know about the pacemaker or all of the recorded episodes. Disability requested the records from my electrophysiologist three times but his office never sent them. I am still unable to drive because I can’t go 90 days without an syncope episode. I now have to wait approximately 6 months to appear before the Judge and then possibly another 6 months for Disability’s Headquarters in Atlanta to approve the Judge’s decision. I continue to have episodes of fast heart rate, light-headedness, fatigue, shortness of breath, chest pain, syncope and nausea. Today I have experienced 6 episodes of black vision for just seconds, but no fast heart rate. I did feel beating in my jugular veins that were pronounced, yet not really fast. These were while I was sitting at the computer typing. Last week I experienced 1 episode of black vision. I am awaiting an appointment to go back to my cardiologist since I haven’t seen him since he referred me to the electrophysiologist over a year ago. I have requested this appointment so that I can get a referral to another electrophysiologist since I appear to have gotten worse instead of better even with the pacemaker. One of the Medtronics representative has expressed to me that possibly I have the wrong pacemaker implanted since I am recording VT and not AF. The Electrophysiologist states that the pacemaker is being fooled to record VT instead of AF per the event monitor. Either way I am still not receiving therapy during any of my episodes. I continually feel exhausted, fatigued, chest pain, shortness of breath, light-headedness, and nauseated. I am definitely worse than I was a year ago. I am told that I have a strong healthy heart but that I just have an electrical problem. What if anything can be done to help my condition to improve? I am a single mother and have a hard time taking care of myself, or my daughter and her needs. I can barely stand to even cook without getting light headed and having to take a break. I desperatley seek medical advice since I still haven’t received disability and have already depleted all of my savings, I need to be able to get back to work and driving. Thank you for your forum, and time.

[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.

[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.

[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

[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!!

[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

[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.