I changed from a family practitioner to a female internist two weeks ago, for an unrelated problem. My husband, who has A-fib, had been on me to get a physical. It had been several years since I had had more than my yearly "well woman" checkup. I was starting to feel like my family practitioner (a male) did not take my health concerns as seriously as my husband's. He had brushed aside my rapid pulse rate at several appointments in the past year. I decided it was time for a change.
Although I have a B.S. in Medical Technology and a Master's in Health Informatics, I see that I am not really well educated in problems relating to heart problems. This is my first time posting in a discussion forum. I apologize that I do not know many of the abbreviations that have been used in other postings. My specialty is microbiology so I hope if someone responds to my posting, they will use the full name of the test or condition so I can look it up later.
When I went in for my physical, my BP was 134/89 with pulse of 108. I hadn't really been monitoring it for the last two years, until two months ago when my husband went into the hospital with A-fib. He started reading all kinds of books on heart disease and high blood pressure. He asked me what my cholesterol and triglycerides were, along with LDL and HDL. I told him that I didn't know but that the last time they were done 3 years ago, they were all in the normal range. I started tracking my BP and pulse with his home monitor, for about 2 weeks prior to my physical. The BP was usually between 120/80 and 140/90, but the pulse was usually around 102 - 105.
I really liked the new female internist. She ordered a lipid panel, CBC, and thyroid panel. She also ordered a EKG in her office. I had done EKG's 20 years ago, when I still worked as a Med Tech. Glancing at the print out, I didn't see any glaring problems but I am certainly not trained to read them; I just picked up some idea of normal and abnormal from doing hundreds of them. She said that it was normal but did show the rapid rate. She said that if there was anything abnormal on the blood tests, she would have me come back to discuss the findings.
I had a cholesterol of 225; LDL of 159; HDL of 49 and everything else was in the normal range. I didn't think I had any thyroid elevation because I didn't have the characteristic bulging eyes. I was very surprised that my cholesterol was out of the normal range because we have been eating a low fat diet for 2 months since my husbands episode. Turkey, wheat pasta, low fat cheese and milk, Kashi cereal, almonds, and lots of apples. The heart rate at the followup appointment was up to 105. She said she wanted me to start on Beta Blockers (Atenolol) to slow the heart rate and she said that it would also bring my BP out of the prehypertensive range.
I know that the high side of the normal range is 100. I had an episode of high pulse rate (115) about 4 years ago when I was put on a very strong decongestant due to repeated sinus infections. When I went off them, it went down into the 90's and I didn't think much more about it.
Atenolol 50 mg made me feel horrible. I had asthma up into my early 30's, but it has been 20 years since I had an episode (I'm 53 now). I had told her about the asthma at the appointment. Less 12 hrs. after taking one tab, my BP was down to 110/69 and pulse of 65. I was having tightness in my chest and feeling like I wasn't getting enough oxygen. I didn't get more than 4 hrs. of sleep each night, even after she reduced it to 25 mg when I called the office to complain. After the 4th day when I called the office and said that I was NOT going to take this any longer, she switched me to a calcium channel blocker (Diltiazem 120 mg). After 2 days on it, I am sleeping again, BP of 115/79 and pulse of 88. I feel pretty normal again.
My question is whether my elevated pulse rate is really bad enough to be on any medication? I wonder what is causing the elevation. Do doctors just put you on medicine and hope it is controlled? I have gained weight since moving to Iowa; now weigh 185lbs. at 5'9" which I know if at least 16 lbs. too much. I am very motivated to do this with exercise, stricter diet, and weight lost. I walk at least a mile twice a day with my dog. I work out with our Bow Flex once a week, but would do more. I have signed up to take water aerobics twice a week. Although the Diltiazem is much more tolerated, I still feel a little off and get dizzy when getting up from lying down. I am stuck on this kind of medication for life? Has this doctor went to the other extreme of over medicating me?
As you probably know the heart beats faster to compensate for an underlying cause that can be systemic and/or emotional. A fast sustained beating heart (over 100 at rest) can pathologically stress the heart and cause an enlarged left ventricle. A dilated LV, when over stretched loses elasticity that will reduce contractility and lower cardiac output, and now the heart beats faster to meet system's demand for blood/oxygen. At this time inteventional treatment would be required. Worst case scenario. That is what happened to me. My pulse was consistently around 115 and weak contractions caused blood to backup into the lungs developing into pumonary edema. For several years everything is normal except for a valve problem that is not symptomatic.
Medication trial and error for optimal results usually begins with a minimum dose and go from there...or another med if unfavorable results. I believe doctors use computer technology and enter symptoms and other data and the computer software outputs a list of medications. Also, doctors rely heavily on salesperson's representations...they don't have time to research!
Feeling little dizzy when arising indicates the medication is working albeit very low blood pressure. That may only be temporary. Exercise should be beneficial. I have good tolerance now and that has certainly helped me and from what I read other posters' experience similar effects.
About the high cholesterol: Its NOT always from eating the wrong foods. Lots of times its genetic, it can also come from stress. In my case its genetic. I always eat healthy for decades, have been exercising for decades, and my cholesterol shut over 300 eventually, it stayed between 220-240 for several years. I refused statins and ended up having to take them anyway since the "natural stuff" didn't work.
Your LDL is to high, it should not be over 130 for people with NO heart disease. Your HDL is almost normal, it should be 50 or more. How were your Tryglicerides?
Sometimes an elevated heart rate could be caused by a side effect of a medication, being out of shape, thyroid problems among other things. I'd ask my doctor to get to the bottom of it. She is an Internist, they are usually on top of things. Our doctor is an Internist and if we only slightly mention something which is not very often he immediately goes into high gear of ordering all kinds of tests. These types are very interested to find out the "causes" of symptoms and always rule out the worst, at least that is the case with our Internist. He is so throughly that he scares me sometimes. Scared that he will find something.
Thank you for your quick reply to my posting. I know my problems are minor compared to some of the postings I have read, but as you mention, hopefully this was a blessing in disguise and it won't progress to something worse.
I am trained as a medical librarian although I work as an academic librarian at a college. Researching questions is my area of interest but unfortunately, our college is a liberal arts college and does not have a lot of the health related databases that I had access to when I lived in Houston, TX. I have used Medline Plus to gain information but it is more on a consumer level. Our access to PubMed is mainly abstracts and indexing. I will see the title of an article that looks interesting but the full text article is seldom available, or if they are, they are several years old. Have you found any free databases online that you feel offer authorative information on heart disease? Thank you.
My internist mentioned the genetic component of high cholesterol. I have my doubts that it is a problem for me because of the wonderful gene pool I have in my family! I knew two of my great grandparents who lived to be 97 & 98. I knew all four of my grandparents and all four lived to be in the 90's with 3 out of 4 living to be over 95 yrs. old age. My parents recently died of emphysema (Dad) and Parkinson's ( Mom). I was their medical power of attorney and met with their doctors. They were in the high normal range for cholesterol.
My trigylcerides were in the normal range. I recently read a book on women's heart health. The author of the book, who has a PhD. in nutrition, said that so many of the cholesterol studies have been done on men and not women. Her view was that trigylcerides and HDL were better indicators in women of potential lipid problems. As a Med Tech, I can remember spinning down a woman's blood for a lipid panel. When I took it out of the centrifuge, I was startled to see that her serum looked like whole milk rather than the clear, pale yellow color that is seen in normal serum. Her cholesterol was elevated but her trigylcerides were the highest I had ever seen. They called in her 18 yr. old daughter and 20 yr. old son, to see if it was genetic. Their serum was not as bad as hers but much worse than normal.
What you relate about the internist did seem to be true. She was much more interested in doing something than the family practioner. As a former researcher in infectious diseases, it was fairly easy to find the WHY in that area of medicine. What I don't understand yet is how I found out the WHY for the rapid heart rate. What tests do they do in cardiology, other than an EKG, which I have already had? Thank you.
A Cardiologist usually also orders an echocardiogram.
As for finding information, The American Heart Association also gives out great info, you can find it online.
Like I said the fast heart rate could have many causes. I would insist to find the cause. How is your exercise? Do you exercise? Are you in shape? I've exercised every day since the age of 14, and my heart rate never went over 60 (usually in the low 50's, high 40's) unless I was nervous, had a fever, after a meal, or severe pain.
Since you have a B.S. and a Masters in Health I'm surprised you don't know who to log on to for info as in the American Heart Association. Not meaning to be critical just surprised.
As I related in my reply to Kenkeith, I am some what frustrated that I no longer have access to peer reviewed medical journals as I did prior to our relocation and a new job. I have already been on the American Heart Association web site but didn't find their information to be much better than what is available on Medline Plus. I can read and understand medical information at a level above consumer information but certainly not at the level of a cardiologist. I had hoped that by posting a question on a discussion board, I would be able to find something in between that is available free. I related my degrees so others would have some level of understanding of my knowledge level. Rather than clicking through the hundreds of sites that come up, I hoped other people who have been having these problems much longer than I have, could give me a short cut to some good sites that could quickly increase my knowledge. Several people who have posted on this discussion board seem very educated about heart related disease and well versed in the terminology so wanted to find out how they had increased their knowledge base.
I was a competitive swimmer from age 8 to 18yrs. of age. Then I was in the drill team in college along with being on the intramural swim team. When I got out of college, I have always had a dog and have walked them twice daily for a minimum of one mile each time. Along with that I have taken stretching classes and weight training. Then, when I got a little older, I have had homes with swimming pools while living in Texas and could swim at least 6 month out of the year. I didn't start to gain any weight until moving to Iowa 2 1/2 yrs. ago. I still walk the dog twice a day but not as far on days when it is hovering around zero like today. We have a BowFlex that I had been using until I developed a locked hip joint a couple of months ago. I have just signed up to take water aerobics twice a week. I live on a half acre and push mow it in the summer. So, I would say that I get more exercise than any of my neighbors who are in my age group and more than any of my friends. My doctor was actually quite encouraged by my level of physical activity. Although I only work part time, my job as a librarian in a college is not sitting behind a desk shussing people as often portrayed. I am on my feet at least 4 hrs. a day because you have to be a jack of all trades in our small library. That is why I am wondering about the WHY because according to the three books I have read so far, I am doing so many things right.
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