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Suggest Treatment For Elevated Heart Rate

Posted on Sat, 13 Aug 2016

Question: Hi, I'm a 29 year old woman, who is has recently been having issues diagnosed as inappropriate tachycardia/ Pots syndrome. Additionally to my very elevated heart rate ( usually 130 to 170) when standing and light exertion, due to the condition, I've been having muscle weakness and breathing difficulty, for which I have seen a neurologist and a pulminologist for. I am still in the process of finding answers to what is causing such distressing symptoms. Today I was sent for a series of pulmonary function test done by a respitory therapist. One of the exams, which included a maximum expulsion pressure, I was told was a bit low at 70 percent. The therapist was not sure what that meant, and due to the fact my symptoms seem to be worsening at fast pace I was concerned. What could cause a 70% mep in someone my age? The other results seem normal as far as the therapist told me. I do have a history of slight asthma caused by reflux. Daily medications I'm taking include verapamil 20mg twice daily and klonopin .375 daily. I'm a bit worried as one can imagine, and would greatly appreciate any insight. Thank you.

Answered by Dr. Drkaushal85 (30 minutes later)

Brief Answer:
Can you show me the image of that report?

Detailed Answer:
Thanks for your question on Healthcare Magic.
I can understand your concern.
Honestly speaking, there is no term like maximum expulsion pressure in pulmonary function test.
You might be wrongly spell it.
So it would be of great help if you can send me the image of your pulmonary function test.
I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (42 minutes later)

Hi,

I'm sorry I believe thats just what the respiratory therapist told me. It was the test which measures the pulmonary muscle strength when you blow in and out. I was told that it showed the muscles were when blowing out were weak or was a 70%, which i'm not sure what that is. I didn't get a copy of the report. Would you be able to tell me what that test is and what a 70% as far as exhaling muscle strength means?

Answered by Dr. Drkaushal85 (11 minutes later)

Brief Answer:
It might be forced expiratory volume.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I am not sure but it might be forced expiratory volume.
Is it so?
Can't you ask for your report with respiratory therapist?
I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (5 minutes later)

I am unable to get the report at this time. I know it is called a Maximum Expired Pressure (MEP), and he said it was 70% which is low for someone my age, as he said normal was 80%. I was told that it mean the muscles for exhaling are weak.... I still don't know what that means or what could cause that. I additionally don't know is 70% is a very low pressure to have. I am worried.

Answered by Dr. Drkaushal85 (13 minutes later)

Brief Answer:
I don't think that 70% will cause these much symptoms.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Even if your value is 70%,i don't think it can cause these much symptoms because after all it is only 10% less as compare to normal values.
Please let me know
1. Have you checked for arrhythmia (rhythm disturbances in heart)?
Please reply me answer of above asked question, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (17 minutes later)

No the inappropriate sinus tachycardia and or post orthostatic tachycardia was what I was told as far a arrhythmia. I have had one episode of Supraventricular Tachycardia 3 weeks ago. The heart rate seems to only go up with standing or exertion and comes back down when sitting or lying down. Because of the muscle weakness I've been experiencing and shortness of breath I was concerned that the therapist said there was weakness at 70%. Could an mep at 70% be from asthma? Or are there other conditions which cause it to be lower than normal?

Answered by Dr. Drkaushal85 (6 hours later)

Brief Answer:
Have you checked for vitamin D3 and calcium levels?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Asthma basically affects FEV1 and FVC on the PFT report. So I don't think your this value is affected by your asthma.
Sometimes calcium and vitamin D3 deficiency can be the cause.
Other rare cause is connective tissue disease.
So please let me know
1. Have you ever undergone calcium and vitamin D3 levels?
2. Have you ever tested for connective tissue disease?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (12 hours later)

I have normal calcium levels, and I was checked for vitamin d3 a few weeks ago which I believe was only slightly low. Additionally I just underwent blood work with a rheumatologist to check a full auto immune panel including antibodies for myasthenia graves, myostits, and other similar diseases but the blood work is not back yet. I had been feel weakness in my chewing and swallowing muscles, breathing, and limbs as of last week. I saw a neurologist who performed a EMG on my arms and legs and said they were normal. However, EMG was done for the swallowing and breathing muscles. Should I have that done as well? I am worried due to the symptoms that have yet to be explained and normal mri findings that it could be something more serious such as the onset of ALS. Is it possible that early ALS symptoms would include such issues, or affect the lung muscles so quickly? or that my other pulmonary function tests were normal except for the Maximum expiratory pressure which seems to be reduced at only 70%?

Answered by Dr. Drkaushal85 (2 hours later)

Brief Answer:
I don't think you are having ALS.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Well, I don't think you are having ALS.
In my opinion, you are worrying too much about your symptoms.
You should wait till autoimmune diseases report come.
In my opinion, you should get done breathing test again.
You may have false negative value for maximum expiratory pressure which is falsely low by 10%.
So be relax and calm. Don't think too much about all these diseases. They are very rare in occurrence.
Wait for auto immune disease reports.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (7 minutes later)

I know it is rare, and I am waiting for the autoimmune test to come back. However, due to the fact I'm also having bizarre occurrences with my heart rhythm which is rare, and yet have still been able to gain an answer into what is the cause, I feel very concerned. The heart rate issue did not even worry me so much, I have become concerned after sudden onset of muscle weakness that has affected my eating/ more importantly breathing. The respiratory therapist performed the MEP twice and they were the same reading of 70%. He was unable to explain what was the cause. If I did not feel symptomatic I would be less concerned. Even if the reading is 70% could that still be within normal limits, or should that be cause for concern? Especially since I feel that since the exam my breathing feels more labored. I don't know if this makes a difference but I had been taking verapamil to help with the heart and noticed weakness about a weak after taking it. I stopped using the verapamil today so I have yet to see progress. Could such a medication also cause the decreased pressure? additionally I have been pretty much on bed rest for about a month since the heart issue started happening, which I don't know would affect my breathing muscles.

Answered by Dr. Drkaushal85 (10 minutes later)

Brief Answer:
Well, verapamil can cause asthenia.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Well, I searched on verapamil and found out that few patients have developed asthenia.
So if ak reports come back as normal then this can be verapamil induced asthenia.
How much dose of verapamil you are taking?
Please reply me answer of above asked question, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (5 minutes later)

I was only taking verapamil for 2 weeks at 40mg 3 times a day, and over the last two days decreased to 20 mg twice daily. I've noticed that it seems that my abdominal muscles that support me sitting up straight feel very weak. I have trouble staying seated upright and feel better when muscles are relaxed and I'm hunched over or lying down. I know the abdominal muscles are what affects the mep, is it possible long term bed rest as well or deconditining has weaked them and has caused these problems?

Answered by Dr. Drkaushal85 (5 minutes later)

Brief Answer:
Yes, long term bed rest can cause muscle weakness.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
You were taking higher dose of verapamil.
Who prescribed you this dose?
And what is your weight? Are you obese?
And yes, long term bed rest can cause muscle weakness. Actually long term bed rest can cause muscle atrophy.
But this needs prolonged bed rest.
So please let me know
1. Did you har Complete bed rest in near past?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (6 minutes later)

I was prescribed the verapamil by the electrophysiologist. My height is 5'8 and 135 lbs. I have been losing quite a bit of weight as well with very little feelings of hunger. I have been not been on complete bed rest. However, over the past month and a half I have been mainly sitting in a usually poor posture position, or lying down. I only really get up for short periods to go to the bathroom/ minor walking to car for doctors office appointments. I've never had great posture, and I've always had an issue with sitting in poor posture, due to the muscles feeling strained when sitting fully upright. However, they feel much more weak and strained now trying to sit up straight or up right since being inactive for about a month and since the verapamil.

Answered by Dr. Drkaushal85 (2 minutes later)

Brief Answer:
May I ask you some personal questions?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Well, I don't think this is the cause.
I am also thinking 1 more possibility.
But for this I have to ask some personal questions.
So may I ask you some personal questions?
It's OK if you don't want to answer.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (5 minutes later)

yes, please ask.

Answered by Dr. Drkaushal85 (2 minutes later)

Brief Answer:
Do you have normal menstrual cycle?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Do you have normal menstrual cycle?
Have you ever undergone hormone levels?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (4 minutes later)

no I have not checked my hormone levels. my periods seem to be regular, except they seem to be less heavy now and less in duration time.

Answered by Dr. Drkaushal85 (1 minute later)

Brief Answer:
Are you sexually active?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Please let me know
1. Are you sexually active?
2. Are you taking any contraceptive pills or depo injection?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (1 minute later)

No I haven't been sexually active since November 2015. I am not taking BC pills or deep injections. what is the other possibility that you may think?

Answered by Dr. Drkaushal85 (4 minutes later)

Brief Answer:
Hormonal imbalance is the other possibility.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
Well one possibility is hormonal imbalance. It can also cause similar symptoms.
Other possibility is contraceptive pills. These pills have side effects of muscle weakness, tenderness etc.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (2 hours later)

What type of hormone imbalance could cause these symptoms of breathing muscle weakness ect?
Also you mentioned botulism, but since I've had the weakness for 8 days wouldn't it have gotten sever by now or I would be very sick ie throwing up?

Answered by Dr. Drkaushal85 (2 hours later)

Brief Answer:
Low estrogen and progesterone can cause muscle weakness.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Well hormonal imbalance like low estrogen and progesterone can cause similar symptoms.
Again the chances are very rare.
But this is just to see for any causes.
Wait. You wrote botulism.
Did you take botulinum toxin or botox injection?
Please reply me answer of above asked question, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (14 minutes later)

I read that botulism has similar symptoms. so I was worried that could be the cause. No i have had no injections of any kind. it said symptoms could take a few days to develop or worsen. I first noticed the trouble chewing, swallowing and breathing difficulty 9 days ago. since then not much trouble with the chewing/ swallowing issue but muscle weakness particularly breathing weakness persists. If it were botulism, would it have gotten much more severe in a 9 day period? I have had no fever, no dilated pupils, no drooping eyes, and no vomiting. I've had on and off diarrhea but thats been a constant issue for me. also would the emg i had done picked up on that?

Answered by Dr. Drkaushal85 (15 minutes later)

Brief Answer:
Yes, you are right.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Yes, you are right if it is botulism then without treatment it would have worsening and it would have definitely picked up by EMG study.
So no need to worry for botulism.
Well after discussing all these, I think you should wait for auto immune disease report.
I don't think it will come positive.
Let me ask you some symptoms regarding this.
Please let me know
1. Do you have any skin rash or skin lesion on the body especially on face?
2. Do you have joint pains?
3. Is any of your family member is having auto immune disease?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (6 minutes later)

I had the EMG's done on two separate days. Tuesday for the legs, and Thursday for the arms, although the breathing didn't become really difficult until Thursday. At this point do you think the EMG's would have picked up on something serious such as that? or Do EMG's always pick up on such things as botulism? I don't have any skin lesions but sometimes get random rashes. I do occasionally have pain in my joints. No family members have any autoimmune issues.

Answered by Dr. Drkaushal85 (7 minutes later)

Brief Answer:
Well, this is tricky question.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Well, this is tricky question.
Botulism is generally an acute kind of disease.
So if you are having this after Thursday then your EMGs of Wednesday and Thursday will come normal.
EMGs will not directly comment Botulism but report will comment that muscles are having some problem.
But wait why we are discussing too much about Botulism?
It is caused by high doses of botox injections and by eating canned food (excessively).
Since you have not taken any injections, please let me know
1. Do you eat a lot of canned food?
Please reply me answer of above asked question, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (37 minutes later)

I was having some of the breathing difficulty on Tuesday through Thursday when I had the EMG's done, but they were normal. The breathing difficulties just still exist or feel worse. No I don't eat canned foods. I guess just trying to rule things out.

Answered by Dr. Drkaushal85 (41 minutes later)

Brief Answer:
Well, I don't think you are having Botulism.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Well I don't think you are having Botulism.
By our discussion, I don't think you are having major illness.
Don't feel bad but please let me know
1. Are you having stressful life?
Please reply me answer of above asked question, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar