Dear XXXXXXX

Good evening

I am writing the following mostly in the form of answers to your queries. I have added additional information at places.

The venous return increases when we lie down. When upright, it has to climb against gravity. The right heart pumps it to the lungs and on to the left. If the left heart has problem pumping out, it stays back in the lungs – pulmonary oedema. It causes breathlessness – orthopnoea. Once upright, the return is reduced; the backlog is cleared; breathlessness disappears. "The fluid is shifted out of lungs – not out of the body". That is how diuretics (like furosemide) help. Turning to sides obviously will not help.

Other conditions that cause this are few and uncommon – abdominal distension from any cause, paralysed diaphragm, huge hiatus hernia, bronchial asthma at times, morbid obesity... and they are easy to diagnose.

Chronic Heart Failure (CHF) can cause hypoxia; Hypoxia can cause CHF – it is a vicious cycle.

The seriousness of arrhythmia depends on the nature – a majority of them may not harm. Ventricular fibrillation (VF) is often fatal; Ventricular tachycardia (VT) is the next most XXXXXXX one. If they are documented by Holter, an implantable defibrillator (with or without pace maker) affords relief.

Atrial arrhythmias do not generally cause heart failure. Ventricular arrhythmias like VT need immediate attention. Prolonged arrhythmias can lead to failure and failure can lead to arrhythmia – both can be the result of a common cause

24 to 48 hours ambulatory monitoring (Holter) should have documented the arrhythmia.
Approved sleep laboratory can document ECG, EEG, saturation and so on

At last your low SpO2 has been documented – long known to the patient, but not believed by the physician! The dictum in Medicine is this - Absence of proof is no proof of absence.
Patient knows himself - not his physician; not always...

I am afraid it is rather long!

I shall sum up thus -
1. We need a diagnostic plan - admission to a multi-specialty tertiary care hospital and investigation will clear the issue. Heart and lung specialists can join hands for proper assessment with a view for future assistance. Emergency departments cannot provide a comprehensive answer. They are trained to only to deal with emergency.

2. We need a treatment plan – why suffer because diagnosis is delayed?
*Non-invasive breathing assistance from BiPAP machine at home may give dramatic relief.
* A trial of failure treatment – like diuretics like furosemide and Angiotension Converting Enzyme (ACE) inhibitor or Angiotension Receptor blockers (ARB) is an option...

I hope I have been of some use! Do write back for further assistance.

God bless you and Good luck...

---

Dear XXXXXXX

Fluctuations in heart rate are common and often are normal. They are of concern, at certain levels...

I have not seen anxiety alone causing such a fall in SpO2. Hyperventilation causing CO2 wash out leading to alkalosis and tetany is the common presentation.
[If you won’t mistake, shall I say (off the mark) humorous view? to lighten the situation – Such uncommon situations stimulate the treating doctor to work out hard on the problem and that is how a new entity is often found; they name it after the patient or his doctor!]

That the monitor documented a normal sinus rhythm is good news and reassuring. No cause for concern.

Glad to hear that sleep studies are planned. The doctor has seen the problem – seeing is believing.
Things are moving in the right direction; soon your problems will find a solution.

Hope this is reassuring.
If you have no further follow up, please close this discussion.

If you wish to contact me again for future concerns, I will be available on WWW.WWWW.WW You can leave your queries there....

God bless you...

Good luck

---