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Hypokalemia, Tachycardia/arrhythmia and Digitalis
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Hypokalemia, Tachycardia/arrhythmia and Digitalis

My mom, 63, had Rheumatic Fever in her mid 30's. Later diagnosed with Mitral Valve Prolapse. In her 50's began having sporadic bouts of hypertension. Finally about 12 years ago went a week without sleeping due to hypertension and tachycardia (bp200+/100+  hr160+). Her MD prescribed Digitalis, Verapamil and Alprazolam (not all at once), still had sporadic bouts of hypertension and tachycardia (SVT). About 3 years ago, she had another very bad bp/hr occurence (bp200+/120+  hr160+). Cardiologist increased Digitalis and added Clonidine. She began having PVCs regularly, had a morning bp of 90/40 and hr of 40. Cardiologist removed Clonidine after observing sub 40 hr on overnight monitor. Her labs, when she visits the ER due to bout of hypertension and tachycardia, report hypokalemia (2.0-3.0) all other labs normal. Sodium never seems to go up or down. She takes 6gm.+ a day of potassium bicarbonate plus bananas, mangos and other high K foods and still cannot retain potassium. Yesterday she had 8.5 gm KHCO3 and still landed in the ER with BP180/100 HR160+ and K at 2.5-2.7. Been tested for kidney disease, Addisons, Aldosteronism, the works. The EP cut her digitalis in half and recommends RFCA (WPW?) The only problem is that the hypertension/SVT problem only occurs when her K level is low and PVCs only occur when BP and HR are normal or low. No one seems to be able to target the source of her potassium wasting or the hypertension/SVTs. She doesn't want to assume the risks of an EP study, RFCA or other invasive procedures if the problem is something other than EP. Anyone have any similar experience.
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251395_tn?1395961265
Hello...

I don't know what could be causing her depletion of Potassium. In regard to the HTN and SVT's, have they ruled out a Pheochromocytoma?

I can understand her fear of risks about the ablation...Did you put WPW? becuase you don't know what that is....or did the Dr put that as a possibility? Just trying to figure out which direction to point you in.
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Avatar_m_tn
Hey,

Thanks for the reply. I think they ruled out Pheochromocytoma during her Clonidine therapy considering her BP/HR was way below normal.

I put WPW because I assumed that is what he was thinking. Seems a lot of EPs around here are pushing RFCA and attributing much of the rhythm problems to WPW and a few other EP dysfunction. Here EKGs never show any strong EP problems. Even when her HR is way up (140-160) her waves are perfect, just very close together. Never any Torsades, LQTS, etc. Just mild atrial flutter during an episode and PVCs when calming or at rest.

Anyway, I think it is just a shot in the dark. Sometimes I think maybe its not cardiac. And in the midst of all these scary episodes, her cardiac calcium score is better than mine...go figure.
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