Post 2ndary polycythemia & High heart rate

[WFB]

About 5 weeks ago my wife took me to emergency due to hypertension. My doctor had me on hormone replacment therapy (DHEA 25mg for 2 and 1/2 years and then 5mg per unit dose androgel for 1 and 1/2 years). My blood pressure this past year had been running on an average of 135/92 but at the emergency room that night it consistantly ran 160/106 lying down with a standing bp of 170/117. EKG, CT scan of the head,angiogram, mri of the head,  heart echo all came back normal which is good!  They sent me home with a script for Norvasc, but upon taking it I began urinating every hour to 1 1/2 hours. My RBC and hematocrit were slightly high at 18.3 and 55 when they sent me home and due to all of the urination I became dehydrated and returned to emergency 2 days later with a pressure of 154/122 in the ambulance and a rbc of 20 and hematocrit of 60 when I arrived at the hospital.  The doctor determined me to symptamatic from polycythemia (secondary thank god) due to the androgel and possibly the DHEA. They kept me over night and took blood 300ml day 1 and 250ml day2 and gave me a shot of lovenex to alleviate the polycythemia. When I stood up to go to the bathroom the morning of day 2 my heart rate shot up to 147 setting off the alarms and I was very shaky and settled back down to the 85 range when I laid  down. I quit androgel and dhea that day on the advice of the hematologist and they put me on 25 mg of Lopressor to keep my heart rate under control. 5 weeks later, my hematocrit is lower about 50, and my rbc is 17.3, but my heart begins to race if I don't have the lopressor up to 140 beats per minute. On the lopressor, it ranges from 85 beats to 105 beats standing up. Even though my blood pressure is now well withing an acceptable range, I feel light headed most of the time. I'm 48 years old and my question is, In your experience, have you seen this result in somebody who is post polycythemic and how long might it be to resolve itself.

[Michael J. McWilliams, M.D.]

I haven't seen this specifically associated with secondary polycythemia, but I have only seen a handful of polycythemia cases ever.  Some people do experience rebound fast heart rates if they forget to take your beta blockers.  If I saw a patient in clinic with similar concerns I would do a holter monitor for 24 hours to evaluate your heart rate range of a specified time period.  It might also be helpful to make sure your thyroid is working appropriately and that your blood pressure doesn't drop with standing.

I hope this helps.  Thanks for posting.