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detecting/measuring PVCs
My friend's problem is the opposite of most people's: he does NOT feel when PVCs are happening. What instrument can he get to detect and measure them at home? The ordinary home blood pressure/pulse cuff digital devices were not recognizing his PVCs.
His doctor used a stethoscope (under a blood pressure cuff iirc) to tell him when he was having an episode of multiple PVCs. She told him when this happens, to eat a snack high in potassium, or take a potassium pill. He is concerned not to take the potassium when he is not having PVCs, as the doctor already has him on potass supplements.
My friend is a computer tech and could probably repair any used cardio monitor, if he knew the right kind to get. But it seems to me there should be some instrument less complicated.
His doctor used a stethoscope (under a blood pressure cuff iirc) to tell him when he was having an episode of multiple PVCs. She told him when this happens, to eat a snack high in potassium, or take a potassium pill. He is concerned not to take the potassium when he is not having PVCs, as the doctor already has him on potass supplements.
My friend is a computer tech and could probably repair any used cardio monitor, if he knew the right kind to get. But it seems to me there should be some instrument less complicated.
Whoops, I didn't mean milligrams, I meant millequivalents! Meq, not mg. It is quite different, and I take 120 meq/day now, where the usual dose for replacement from Lasix 80 mg, would be about 20 meq. Sorry!
Those numbers seem a little odd. A quick Google shows around 2000mg potassium as a minimum daily requirement. 120-160 mg/day seems a drop in the bucket if someone actually had a deficiency. When my friend's deficiency was discovered, the doctor started him on about 500mg per day, which she has kept increasing (and he feels better and shows better heart numbers with each increase). He's now up to the equivalent of 4 bananas a day (at 500mg each banana). :-)
His doctor talked about diuretics and some of his other heart meds causing potassium deficiency, so requiring a greater intake of potassium than normal. Also, if I understood her correctly, his heart (and brain?) function may be unusually sensitive to lowered potassium levels; apparently his heart function (PVCs etc) varies with fluctuations of potassium level within a single day, as half a banana's worth does seem to relieve his PVCs (or at least the discomfort they cause him) immediately.
His doctor talked about diuretics and some of his other heart meds causing potassium deficiency, so requiring a greater intake of potassium than normal. Also, if I understood her correctly, his heart (and brain?) function may be unusually sensitive to lowered potassium levels; apparently his heart function (PVCs etc) varies with fluctuations of potassium level within a single day, as half a banana's worth does seem to relieve his PVCs (or at least the discomfort they cause him) immediately.
I disagree about the low sodium V-8. The 5.5 oz. cans only have 80 mg. in them and that is easy enough to fit in the daily sodium allotment and I think it is really good! I have never seen the salt free stuff, and would not even try it. Gross!
And skinny, don't even go there about my potassium levels! I used to take a normal dose of 20 mg/day and after my severe hyperthyroidism, my requirements escalated for some unknown reason and am now taking 120/day and was on 160 for a long while. And NO ONE can tell me why I now need so much! :-( Arrgggghh. And my thyroid levels are normal now. So, yes, I have been checked!
And skinny, don't even go there about my potassium levels! I used to take a normal dose of 20 mg/day and after my severe hyperthyroidism, my requirements escalated for some unknown reason and am now taking 120/day and was on 160 for a long while. And NO ONE can tell me why I now need so much! :-( Arrgggghh. And my thyroid levels are normal now. So, yes, I have been checked!
You said you have "non-ischemic DCM ... with CHF." So does he, though obviously your condition and his differ somewhat (yours sounds more serious, and he is nowhere near "end-stage".) He has had two recorded SVTs: one that resulted in syncope (unconscious on the floor); the other was caught by a new pacemaker/defibrillator.
IN 2002 his EF per Echo was very low, well under 35% iirc. They gave standard meds and installed a pacemaker in Sept 2002, and in a 2006 Echo the EF had improved, though I don't think it's up to 40%.
His former doctors had him taking much Lasix: in fall of 2006 he changed doctors and the new doctor has improved his condition very much! She is part of a large reputable hospital with very conservative standards that all the doctors are held to. Many tests are done frequently, and all his heart numbers are much better.
She is familiar with both diabetes (he was dx Type II in 2002) and the interactions of diab and heart treatments. She discovered a potassium deficiency, put him on potass supplements, told him he was "over-medicated" and should miniimize the Lasix, changed other meds, changed him from Tolbutamide to Glipizide (which relieved some 'rebound issues' with 'hypoglycemic-like symptoms" or "some kind of hypo"). Sfaik it is all well within the accepted "standard of care."
As to the current subject, the PVC problem. The new doctor is very emphatic that when he has these symptoms which make him want to take deep breaths, those symptoms are caused by PVCs and he should immediately do something for the PVCs, such as eating a banana. :-) (And when these symptoms happen in her office [PVCs verified by EKG on the spot] a potass pill relieves them.)
Now I may have been wrong in talking about actual lack of oxygen to the brain and lowered EF during these episodes; that's less clear to me. My impression was that she meant there was plenty of oxygen in the lungs but less was getting pumped up to the brain during those episodes because of the PVCs.
If you and he are getting different treatment, it is probably because your conditions are different. Have you been checked for potassium deficiency?
IN 2002 his EF per Echo was very low, well under 35% iirc. They gave standard meds and installed a pacemaker in Sept 2002, and in a 2006 Echo the EF had improved, though I don't think it's up to 40%.
His former doctors had him taking much Lasix: in fall of 2006 he changed doctors and the new doctor has improved his condition very much! She is part of a large reputable hospital with very conservative standards that all the doctors are held to. Many tests are done frequently, and all his heart numbers are much better.
She is familiar with both diabetes (he was dx Type II in 2002) and the interactions of diab and heart treatments. She discovered a potassium deficiency, put him on potass supplements, told him he was "over-medicated" and should miniimize the Lasix, changed other meds, changed him from Tolbutamide to Glipizide (which relieved some 'rebound issues' with 'hypoglycemic-like symptoms" or "some kind of hypo"). Sfaik it is all well within the accepted "standard of care."
As to the current subject, the PVC problem. The new doctor is very emphatic that when he has these symptoms which make him want to take deep breaths, those symptoms are caused by PVCs and he should immediately do something for the PVCs, such as eating a banana. :-) (And when these symptoms happen in her office [PVCs verified by EKG on the spot] a potass pill relieves them.)
Now I may have been wrong in talking about actual lack of oxygen to the brain and lowered EF during these episodes; that's less clear to me. My impression was that she meant there was plenty of oxygen in the lungs but less was getting pumped up to the brain during those episodes because of the PVCs.
If you and he are getting different treatment, it is probably because your conditions are different. Have you been checked for potassium deficiency?
I know what NSVT is, as I have several episodes a day myself plus SVT, and multiple groupings of PVC's from DCM. If s/he has a reduced blood supply to the brain from a very low EF, then they may be end-stage and it is common to put those on O2. I am on O2 at night myself, and it made a huge difference in how I feel. And yes, I have a prescription for it, and have to re-qualify every year. How low is their EF? I started at 15% myself and am now at 40%! I no longer need a transplant eval which they ordered twice, and for other reasons put off. So I have been there and really am still having trouble grasping what their doctor is doing, as it isn't following the standard of care. I am not trying to upset you, you are being a good friend to them.
From http://www.uspharmacist.com/index.asp?show=article&page=8_1802.htm
"Nonsustained Ventricular Tachycardia: VT is defined as three or more PVCs at a rate greater than 100 bpm and can be further classified as nonsustained VT (NSVT) or sustained VT depending on the duration of the dysrhythmia. NSVT usually spontaneously terminates within 30 seconds and is not associated with hemodynamic instability. The severity of symptoms seen with VT depends on the duration of the arrhythmia, the ventricular rate, and the degree of the patient's heart disease. Patients who have NSVT, especially those without heart disease, are often asymptomatic or have mild symptoms, such as palpitations, dizziness, and syncope.1"
We're talking about groupings of multiple PVCs within a minute or less; and repeated groupings within a few minutes, over and over within the space of an evening -- in a dilated cardiomyopathy congestive heart failure patient with very low EF to begin with. Enough of these PVC groupings close enough, and the result (if I understand the doctor) is an episode of erratically reduced blood supply to the brain over a period from minutes to hours.
The reason that during these episodes his brain feels a need of oxygen is that the heart isn't pumping enough blood up there. As for 'giving oxygen' ... there's a reason why oxygen requires a prescription and bananas (or otc potassium pills each equal to 1/6 of a banana) do not.
"Nonsustained Ventricular Tachycardia: VT is defined as three or more PVCs at a rate greater than 100 bpm and can be further classified as nonsustained VT (NSVT) or sustained VT depending on the duration of the dysrhythmia. NSVT usually spontaneously terminates within 30 seconds and is not associated with hemodynamic instability. The severity of symptoms seen with VT depends on the duration of the arrhythmia, the ventricular rate, and the degree of the patient's heart disease. Patients who have NSVT, especially those without heart disease, are often asymptomatic or have mild symptoms, such as palpitations, dizziness, and syncope.1"
We're talking about groupings of multiple PVCs within a minute or less; and repeated groupings within a few minutes, over and over within the space of an evening -- in a dilated cardiomyopathy congestive heart failure patient with very low EF to begin with. Enough of these PVC groupings close enough, and the result (if I understand the doctor) is an episode of erratically reduced blood supply to the brain over a period from minutes to hours.
The reason that during these episodes his brain feels a need of oxygen is that the heart isn't pumping enough blood up there. As for 'giving oxygen' ... there's a reason why oxygen requires a prescription and bananas (or otc potassium pills each equal to 1/6 of a banana) do not.
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