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Hi, One Of My Friend Is Sufferring From Frequent Complaints
Question: Hi, One of my friend is sufferring from frequent complaints of palpitaion since last 4 years. Occassionaly he has chest pain, breathlessness like symptoms. He is also quite tensed about it. Four years before, he joined a gym to gain weight and body building. He gained around 13 kg of weight and after stpping it, it came down to 46 kg again within 6 months. After this, he started having this problems. He has done ECG,2D Echo multiple times but found to be normal. All blood tests were normal. He found to have Hypothyroid and Thyroxin 12.5mcg started but no improvement in his symptoms. He underwent EP Study during Feb 2019 and found to be normal. Please advise on following
1. What medicine he should take?
2. Any other investigations required?
3. What is his problem?
I have attached his EP study report
1. What medicine he should take?
2. Any other investigations required?
3. What is his problem?
I have attached his EP study report
Brief Answer:
Needs ecg during palpitations or repeat EP studies
Detailed Answer:
Hello,
EP studies report is not attached here. Please retry attaching.
Firstly, regarding possibilities, it may be simply related to anxiety or psychological causes of palpitations as his EP studies was normal, however we should make all efforts to rule out possibility of cardiac arrhythmia. Now, even if this turned out to be arrhythmias, it's not life threatening and nothing to worry about it.
Now, is he still experiencing symptoms being on Ciplar? Does he have any documentation of high heart rate like Ecg or atleast on smart watches?
Now if he is still having symptoms of palpitations on Ciplar then should discuss with local doctor regarding starting diltiazem instead of Ciplar.
Now, coming to diagnosing it, either we need to have EP evidence of arrhythmia or alternatively Ecg should show arrhythmia. So, either he may go repeat EP studies or he should immediately rush to hospital for ecg whenever he feels palpitation. If ecg is normal during palpitations then it reliably rules out arrhythmia and no subsequent worries.
Also, he may wear smart watches which records ecg which may be helpful in coming to some conclusions. Also, if palpitations are occurring daily or once in two days then holter monitoring may give an answer. Alternatively, if palpitations are less frequent then ILR may be beneficial which is small device inserted under the skin to continuously records ecg to diagnose the rhythm.
So, we should firstly prove it to be arrhythmia then only we can treat it. So, you may choose the way from above options according to your feasibility.
Not gaining weight is related to high basal metabolic rate, and very little can be done about it.
Hope this helps you and get back if you have any doubts.
Needs ecg during palpitations or repeat EP studies
Detailed Answer:
Hello,
EP studies report is not attached here. Please retry attaching.
Firstly, regarding possibilities, it may be simply related to anxiety or psychological causes of palpitations as his EP studies was normal, however we should make all efforts to rule out possibility of cardiac arrhythmia. Now, even if this turned out to be arrhythmias, it's not life threatening and nothing to worry about it.
Now, is he still experiencing symptoms being on Ciplar? Does he have any documentation of high heart rate like Ecg or atleast on smart watches?
Now if he is still having symptoms of palpitations on Ciplar then should discuss with local doctor regarding starting diltiazem instead of Ciplar.
Now, coming to diagnosing it, either we need to have EP evidence of arrhythmia or alternatively Ecg should show arrhythmia. So, either he may go repeat EP studies or he should immediately rush to hospital for ecg whenever he feels palpitation. If ecg is normal during palpitations then it reliably rules out arrhythmia and no subsequent worries.
Also, he may wear smart watches which records ecg which may be helpful in coming to some conclusions. Also, if palpitations are occurring daily or once in two days then holter monitoring may give an answer. Alternatively, if palpitations are less frequent then ILR may be beneficial which is small device inserted under the skin to continuously records ecg to diagnose the rhythm.
So, we should firstly prove it to be arrhythmia then only we can treat it. So, you may choose the way from above options according to your feasibility.
Not gaining weight is related to high basal metabolic rate, and very little can be done about it.
Hope this helps you and get back if you have any doubts.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
1. I have attached reports
2. He wears a smart watch and it shows rate around 90 when he has palpitations. Only one, rate showed 110.
3. He has done ECG multiple times during episode of palpitation and was always found to be normal.
Can you please extend your advise?
2. He wears a smart watch and it shows rate around 90 when he has palpitations. Only one, rate showed 110.
3. He has done ECG multiple times during episode of palpitation and was always found to be normal.
Can you please extend your advise?
Brief Answer:
It's not cardiac, it's psychological
Detailed Answer:
So, considering EP is normal and ecgs during episodes are normal and heart rate rarely goes above 100, it's not cardiac. So, he may continue Ciplar which is also anti-anxiety. He should visit psychologist and internal medicine doctor if something can be done regarding weight gain. He may continue doing gym and exercise. Get his TSH checked as thyroxine supplements may cause palpitations. Also, restrict stimulants like coffee tea and caffeinated beverages. Try to engage in yoga, meditation etc.
Many a times, individuals feel their own heart beat normally which is not abnormal. He may be feeling it more due to weight loss and loss of fat in and around the chest.
All the best.
It's not cardiac, it's psychological
Detailed Answer:
So, considering EP is normal and ecgs during episodes are normal and heart rate rarely goes above 100, it's not cardiac. So, he may continue Ciplar which is also anti-anxiety. He should visit psychologist and internal medicine doctor if something can be done regarding weight gain. He may continue doing gym and exercise. Get his TSH checked as thyroxine supplements may cause palpitations. Also, restrict stimulants like coffee tea and caffeinated beverages. Try to engage in yoga, meditation etc.
Many a times, individuals feel their own heart beat normally which is not abnormal. He may be feeling it more due to weight loss and loss of fat in and around the chest.
All the best.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Answered by
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