How to get doctor to listen??

[Detours211]

A couple questions:

All of a sudden I developed a rapid (at rest) heart rate (2 weeks ago).  It does not go away.  In other words, it's not palpitations, it's a constant increased heart rate.  Anywhere from 90 to 120s.  

1.  What sorts of things should I have tested in my blood?  I had a CBC, cholesterol, fasting lipids, fasting glucose, and thyroid.  All were  normal except cholesterol  was slightly elevated.

Is there anything else (blood) that I should DEMAND be tested?

2.  I had EKG done (abnormal).  Echo - "normal"  and holter (24 hour) "normal."  

Is there anything else heart-test related that i should request be done?

3.  Could this be NEUROLOGICAL?  I do have tingling in my ankles and my feet, as well as the elevated heart rate.

Additionally in the last 2 weeks I have lost about 7-8 lbs.  Doctor doesnt seem to think this is too much to worry about.  My appetite is much less than it was before.

My main problem is that my doctor just doesn't seem to be too interested in my case.  When I told him I'm not able to work or concentrate he says "there is no medical explanation for that.  We did the blood tests.  We did the echo and the holter."  I'm like "THEN WHAT IS WRONG WITH ME?"

The kicker - the cardiologist says its anxiety - the internal doctor says it's not anxiety.  he just wants to try the beta blocker (which i had a bad reaction to) and the calcium channel blocker (which i also had a bad reaction to).

What should I do?  See another cardiologist?  See another internal doctor?  See a neurologist?  

Please share your answers and expereiences.  This has completely sidelined me from life and I'm 29.

[LivingInHope]

I am thankful to God to be able to try to help!   About the heart rate- you might mention the times it's over 100, as 100 is considered the upward limit of normal for a resting heart rate.  

That is definitely a quick appt. for a psychiatrist!   Please do keep me posted!

[Detours211]

Hi!
Thank you so  much for your detailed info!  I cannot tell you how much I appreciate this.  I go back to my cardiologist tomorrow.  I will be printing this out and running your points along with some others I have found by him.  
Ever since my echo and holter were "normal" he doesn't seem too worried about anything but he needs to explain to me why I have a high  heart rate (100 bpm) for 16 days.

I had some more blood work done today (don't have teh complete list of all things tested in front of me right now) but we tested for a crap load of things and will get those results this week.
I also was able to get an appointment with a psychiatrist in just 8 days from now - believe me that was NO small miracle.  Most of the psychiatrists are booking people 2 months out.  Anyhow, I know I'm experiencing anxiety as a result of all this going on so I am looking forward to talking to him next week.

Thanks again - I will keep in touch with you and again cannot tell you how much I appreciate what you have shared with me. These forums are getting me through this even more than friends and fam b/c you all are people who GET IT b/c you have similar experiences.  

Talk soon!!

[LivingInHope]

  You might ask the doctor to have his nurse do orthostatic blood pressures and pulses there in the office.  What I have had happen with my P.O.T.S. is that there is an exaggerated response of my blood pressure compensating for when I stand up.  So, my standing blood pressures (or a blood pressure taken shortly after I have been standing when at the doctor office) can be spiked, where-as a sitting blood pressure at home usually is not.  I believe I have what is known as the "hyperadrenergic" form of P.O.T.S..  

Before you even go to the doctor, you might try laying for 10 minutes and taking your pulse, if you know how, than standing for at least a minute, but possibly even a couple of minutes (my doctor wanted me to wait at least a two minutes) and taking it again.  If your pulse has an increase of over 30 beats a minute, definitely ask for the orthostatic blood pressures and pulses in the office.  

Also, you want to make sure you are properly hydrated with fluids because inadequate fluid intake can lead to things like an orthostatic drop in blood pressure and increase in pulse when you stand up.  If your body demonstrates an orthostatic intolerance in the doctor's office you might ask to see a cardiologist or even more specifically, an electrophysiologist to have a tilt table test conducted.

Dizziness can be another sign of iron deficiency- please let me know how the ferritin and iron come out?  If you have dysautonomia, feeling light headed is a common occurance with those of who suffer from it & please join the community I gave a link for above and you might be surprised how much support and info you may glean from there.

If your blood pressure is high whether sitting or standing, you might ask your doctor about trying Zestril (lisinopril) at only 5 mg.  This is what an immediate relative of mine is taking at present to start with and it seemed to start working right away at lowering blood pressure.  So now, I have two relatives I know of on lisinopril & one of them told of two more people who had trouble tolerating other BP meds who seemed to do better with this one.  It does have common side effects listed, but it might be worth asking about.  It doesn't lower pulse like a beta blocker though, according to listed side effects.

Also, if it doesn't matter which position you are in and your pulse races and your blood pressure spikes at times much higher than 140/90 and maybe you even get bad headaches and sweating, ask your doctor if they will order plasma free metanephrines, a fasting blood test that is supposed to be one of the best out there for ruling out pheochromocytoma, a rare tumor, usually (but not always) on an adrenal gland that emits catacholamines in high volumes- this can be sporadic, with "silent" periods, where catecholamines can be normal.  The high catecholamines can translate into high pulse rates and very high blood pressure readings.  The test I mentioned, which measures the inactive metabolites of the catecholamines is one of the best for ruling this rare but potentially deadly tumor out.  Also, you might want to get it done after a particularly bad period of racing pulse and spiking blood pressure.  And you don't want to have any tylenol at least 48 hours (might be 72) prior to this fasting blood test, as that can interfere with assaying the levels.

Have the done any kidney function blood testing on you and if so, did that come out normal?

[Detours211]

Hi,
Thank you so much.  

I need to get the answer to your question about what my EKG demonstrated.  I will have to ask my doctor and cardiologist.  I've had 3 or 4 of them (EKG) in the last 2 weeks but they never told me what it showed.

I do have high blood pressure (average reading about 140/90) and have had this, untreated, since I was 19.  I'm 29 now.  So, the doctor does believe that I should be on HBP medications.  The beta blocker (metoprolol) had bad side effects and I was only  on 12.5 mg!  Now I'm on Diltiazem (120 mg) and I am not tolerating that one too well either.

Just like you with the beta and the calcium drug, I can't say that I feel  MORE light headed (I was already light headed with the high heart rate) but I definitely don't feel better and I feel just "off."  As mentioned, I havent been working or concentrating and walking for any distance makes me dizzy. And I certainly can't walk as fast as I could before the drug.

I really appreciate your response and will be running your points by my doctor tomorrow.  

Let's please keep in touch!!  

[LivingInHope]

Oops- typo:
Also, you say your EKG was abnormal- was it abnormal in that it demonstrated sinus tachycardia, supraventricular tachycardia or ?

If you have dysautonomia, the blood pressure medications just might make you feel worse- your doctor doesn't feel you have high blood pressure, does he?  I know I was given a beta blocker in the hopes it would lower my heart rate, but it made me feel more light headed.  Have you tried doing any orthostatic pulses and blood pressure measurements?  If so, with what results (lying down & standing)

[LivingInHope]

Did anyone check your iron and ferritin (iron stores)?  I see your profile lists you as a male, but it is possible if you have some GI bleeding you may not even know about (occult/hidden blood in stools) or an absorption problem for males to become iron deficient.  A person can experience symptoms from this iron deficiency, even if their CBC is not yet affected- it happened to me.  One of the symptoms of iron deficiency can be rapid heart rate.  Another is poor concentration.  So, if you haven't gotten at least your ferritin checked, you might ask the doctor for that test.

Also, you say your EKG was abnormal- was it abnormal in that it demostrated sinus tachycardia, supraventricular tachycardia or ?

Tingling can come from peripheral neuropathy, poor circulation, and even as a result of a panic attack.  You might ask for doppler testing to see if you might have peripheral vascular disease, which can be hereditary and can strike even as early as teenage years.

  Poor concentration I believe is common with anxiety.  Also, some people eat less, while others eat more with anxiety.  Weight loss could be from anxiety, but I believe it could also come from a rapid heart rate itself- like you are getting a work-out of sorts without having to exercise.  

I was diagnosed with inappropriate sinus tachycardia before having a tilt table test, where an electrophysiologist diagnosed me with postural orthostatic tachycardia syndrome.   Both are forms of dysautonomia (see community forum on medhelp), dysfunctions of the autonomic nervous system.
http://www.medhelp.org/forums/Dysautonomia-Autonomic-Dysfunction/show/266

In case you are having anxiety, you might try something like vitamin B 50 time release to see if it helps any, deep breathing exercises, listening to enjoyable music, getting out and enjoying nature, doing relaxing hobbies or serving others in volunteer work, and if you are a Christian, prayer.

You might want to work on lowering your cholesterol naturally, by diet and excercise and get re-tested to see if your cholesterol has gone into normal range. Steps like:
Exercise to increase your HDL, which fights the LDL.

Things like butter spread with plant sterols for lowering cholesterol, pistachios, which can help lower your bad cholesterol, getting enough omega 3 fatty acids (which can be found in things like many nuts such as macadamias, pumpkin seeds and freshwater fish).  

And lowering sugar intake to help with triglycerides.