Brief Answer: Not to worry / discussion below Detailed Answer: Dear friend, Welcome to Health Care Magic _________________________________________________________ Beta blockers have several effects – slowing of the rate and lowering of the pressure are expected effects of beta blockers. The dose has to be tailored to the individual. For example, the dose of metoprolol is 25 to 200 mg. Diuretics (water pills) eliminate/reduce the sodium. The effect depends on the dose. The dose for treating blood pressure is small – to keep other effects (like altering potassium) minimum. Hydrochlorothiazide, at usual doses of 12.5 does not lead one to pee much / but, by depleting the sodium, especially in the vessel wall, helps to control the pressure. _________________________________________________________ MVP is from excess of valve tissue. It is not always seen – for example, with less blood volume on standing, it may not be detectable / shows wide variation from beat to beat… Absence of proof is no proof of absence! _________________________________________________________ PVCs vary widely and are unpredictable. They may disappear for years and may return. It is very difficult to find out the cause in a given individual. Like many issues in Medicine, it may be easier to treat than to evaluate the cause! Anaemia / Anxiety / Alcohol / Tobacco (smoking) / Caffeine (too much tea, coffee, cola) / Fever / Infection / Pain / Stress / thyroid are a few of the reasons to cause abnormal beats / At times, abnormal nerve paths in the heart (bypass tracts) or disease of the conduction system may be responsible! ________________________________________________________ Blood Pressure and PVCs are usually different issues… _________________________________________________________ Hyperthyroidism can certainly cause arrhythmia / in some, especially elderly, it may be the only symptom… Iodine is not to be taken – it can interfere with investigations, can suppress and so on… _________________________________________________________ One needs the results of Holter or Event monitor to guide further treatment… Some may need Electro Physiological Studies (EPS) too The treating doctor may suggest them depending on need, based on his assessment of the situation. _________________________________________________________ YOU NEED NOT REDUCE YOUR WEIGHT! Your weight is OK / Your BMI is 21,6 (18.5 to 24.9 is normal range) However, here are some guidelines... Weight is like bank account / The amount in your account comes down when you withdraw more (physical work) and you deposit less (eat less). If the weight is picking up, it only means – the exercise is not enough / the food is more / or both.... You have to reduce the QUANTITY of your food and change the QUALITY too. It is not possible to explain or understand the nuances on a single occasion. To start with, reduce the amount to one third of what you are presently taking. Avoid all fats – they have double the energy of carbohydrates. You should see a good DIETICIAN - One generally needs SEVERAL sessions, to master concepts of calories, nutritional values, biological value, vitamins, minerals and so on. Exercise helps, but its role is however is limited. For example, in walking 1 kilometre, one spends 1 Calorie per kilogram of body weight! A cup of rice or an average bar of chocolate has approximately 200 calories. A treadmill may help. A supervised program in a gym may help. _________________________________________________________ Good luck Take care Wishing all well God bless

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Brief Answer: Some answers to solve your salvo of queries! Detailed Answer: Hi You have mentioned the dose, but not the name of the drug! There are several of them in each class Beta blocker is usually stopped when the rate or pressure is low Pressure and rate problems are not generally related. When the pressure rises quickly, the rate comes down! There are certain situations like Panic – when both the pressure and rate shoot up. If the event is episodic, sudden outpouring of adrenaline hormone from Pheochromocytoma, must be excluded. / Your doctor may order appropriate investigation. / Panic attacks also do this, but you will be aware You need not reduce your water intake, because of the pills. Yes, ‘water pills’ over the long term reduce pressure The arrhythmia is unpredictable / There are too many factors that precipitate or exaggerate and it is nearly impossible nor cost effective to investigate and pinpoint in a given individual… These ectopic beats are not always symptomatic. The feeling depends on individual sensitivity – some do not feel them at all / some may feel every beat. Specific treatment may not always be necessary. Many cases of palpitation are benign, especially when associated with normal ECHO and may not require treatment, If you also have symptoms like blurred vision, dizziness, loss of consciousness, shortness of breath, chest pain along with this, you need urgent work up These ectopic beats are not always symptomatic. The feeling depends on individual sensitivity – some do not feel them at all / some may feel every beat. Specific treatment may not always be necessary. Many cases of palpitation are benign, especially when associated with normal ECHO and may not require treatment, If you also have symptoms like blurred vision, dizziness, loss of consciousness, shortness of breath, chest pain along with this, you need urgent work up If there are no clues and if the problem is still bothering to the extent of interfering with life style, there are advanced techniques of investigations – ElectroPhysiological Studies (EPS) > it resembles angio – a catheter is put inside the heart / electrical activity recorded / stimulation and suppression tests are carried out / suitable medicine tested and so on. Though the test is the gold standard, it is INVASIVE and hence is not generally done unless there are compelling indications. This super-speciality expert is called ELECTRO-PHYSIOLOGIST. Your doctor may suggest, if necessary, based on his assessment…. There are other advanced treatment modalities - like ablation (thermal or radio-frequency), which could be done during EPS. Regards

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Brief Answer: You are well / You will be well Detailed Answer: Hi Let us not count the chickens before they are hatched! Don’t worry about scan, nodule and reports, until they come! Leave it to your care provider Be positive – why fear the heart beats faster, forcible or more? The problem is only if it could not beat! You are tolerating the rate well - means that you do not have any basic disease of the valve, muscle and so on. Be in touch with your doctor - it is a question of time and you will be well. Medicine is well advanced nowadays – management is possible for almost all situations... Ignore the beats and enjoy life Regards

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