Cardiologist Referral?

[starion]

Hi!  In 5/2000, I was diagnosed with idiopathic non-A1-AD moderate to severe emphysema, severe asthma, GERD and allergies.  I am otherwise in excellent health, good physical condition, walk regularly, and 46-years old, female and 5'5" and 130 pounds.  I have no other health conditions and always had low normal blood pressure and heart rates.  My daily  maintenance meds include Serevent, Atrovent, inhaled steroid, PPI, nasal steroid and antihistimine.  My conditions are well controlled and stable.

I purchased a Nonin 9500 Onyx personal pulse oximeter 4/2003 because I was concerned about my oxygen saturation and heart rates.  (It was accurate against all the National Jewish devices I tested it against 8/2003.)  I have noticed that my heart rate while just sitting is often in the 90s or 100s & it increases rapdily with activity.  When climbing stairs, the heart rate can climb to 170+ while the O2 SATs drop to 90.
  
My pulmonologists naturally are mainly concerned about my SATs, and tell me I can exercise as long as I keep my saturation rates at or above 90.  My annual EKGs (done by internist) are normal, as was the echocardiogram ordered 8/2002 at my request to check for 2ndary pulmonary hypertension.  The "Care Connection" nurse funded by insurer urged me to see a cardiologist now about working with my pulmos to have the best treatment of my heart & lungs.

At what point do you have your patients see a cardiologist?  What criteria do you use in making this decision?  We suspect my lung meds are increasing my heart rate & I need guidance.  THANKS!
Aloha,
Starion

[National Jewish]

I recommend that my patients with chronic obstructive pulmonary disease (COPD) see a cardiologist when they have heart rhythm problems.  Whenever there is congestive heart failure.  Anytime their exercise is limited more than would be expected based on their lung disease.  The rapid increase in your pulse could be a sign that your oxygen saturation during exercise may be even less than 90%.  Your doctor may have you exercise with oxygen to see if this happens.  Your saturation, exercise tolerance and heart response will be measured while you exercise.  Pulmonary hypertension along with COPD could be another cause of a fast pulse while sitting that increases rapidly with exercise.  I think you should see a cardiologist now.  This is the type of specialist that should watch you during the exercise test with oxygen.

[starion]

I've made an appointment for early January.  My pulmonologist referred me to the most patient cardiologist he knows.  I'll mention it to my internist when I see him for a check up this week as well.
Sometimes, it sure can get confusing, teasing out what our lungs are doing (or not doing) for and with our heart.  It will feel good to have more guidance.
Aloha,
Starion