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Bigeminy

I have had Sarcoidosis (Pulmonary) for 19 years. I am a 51 year old healthcare worker.  I have also had other manifestations such as an Iritis and Uveitis for which I was treated in Boston.  Two years ago I developed Bigeminy and my description was shortness of breath with walking and a fish flopping in my chest.  I was hospitalized, the cardiac enzymes were negative, my cholesterol is normal, and my EKG showed Bigeminy.  I was started on a Beta Blocker (Metoprolol 12.5mg TID due to long acting dropping my rate into the 30's).  This converted me back into Sinus for two years.  I suddenly began having Bigeminy on this medication and my holtor confirmed it.  We tried different doses of Metoprolol with the same effect.  I have gone to see a EPS doc who did an echo, stress test and lipids.  We tried a Calcium channel blocker and I had severe leg cramps, hand cramps, nech spasm and bad headache.  We stopped that and put the beta blocker back on along with Mexitile 150mg BID.  I was still in Bigemeny so he increased the mexitile to 150mg TID.  Now he wants me to see the pulmonologist because he thinks my SOB is not cardiac but Sarcoid related.  I was not SOB before I went back in Bigeminy.  
My questions are:
1)  Shouldn't we do a gallium scan to prove definately if the sarcoidosis has inervated my heart???
2)  Is there any other test that can help us distinguish this?
3)  Where is a good place to get a second opinion as I live in a small rural area, in Pennsylvania near the New York state border, and I am not feeling confident with my care?
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Avatar universal
Thanks for the vote of confidence.  I am really not comfortable with the information I received and wanted confirmation.  I think the doctor gave me also answers I had found on my own but needed other professional input.  I was thinking of the Cleveland Clinic.  It would be a 5 hour drive but I know my family would take me.  I am happy for your success.  Robbylynn
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Avatar universal
Based on personal experience bigiminy CAN cause shortness of breath.  I was having over 25,000 pvcs a day, 15,000 in bigiminy and could always tell when I was in bigiminy due to the sob.  I second the referral to Cleveland Clinic if you can get there.  They took really good care of me and as of today, 3 weeks post ablation, my pvcs are gone.  
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230125 tn?1193365857
MEDICAL PROFESSIONAL
1)  Shouldn't we do a gallium scan to prove definately if the sarcoidosis has inervated my heart???

A gallium scan may show if there is cardiac involvement, but it might be present and the test is negative too.  I agree that it is possible that the sarcoid is in your heart.

2)  Is there any other test that can help us distinguish this?

A heart biopsy can be done, but I would not recommend it.  I think it is reasonable to suspect that there is sarcoid involvement of your heart even without a confirmatory test. The test only adds risk.

3)  Where is a good place to get a second opinion as I live in a small rural area, in Pennsylvania near the New York state border, and I am not feeling confident with my care?

If you are on the East side, I would recommend going to The Cleveland Clinic or the Univiersity of Pittsburgh.  Columbia in NY and the University of Rochester also have good EP programs.

Bigeminy can cause significant symptoms.  I hope you find the help the help that you need.  I trained at The Cleveland Clinic and have a great deal of admiration for their program -- but I am biased.

I hope this helps.
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