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Dr. Andrew Rynne

Family Physician

Exp 18 years

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Does fatigue, foggy vision, racing heartbeat indicate of cardiac problem?

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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 1412 Questions

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Posted on Mon, 1 Sep 2014 in Medicines and Side Effects
Question: Hi! Recently I have experienced fatigue, foggy vision, racing heartbeat, shortness of breath, dizziness, weakness and sometimes neck stiffness. I have noticed that is exacerbated with alcohol. My dad's side of the family has a lot of heart issues and my dad even has diabetes. My lymph nodes aren't swollen or anything but I can tell that something is a little off. I have anxiety but I know what an anxiety attack feels like. I'm also on adderall so I wasn't sure if that could exacerbate the issue as well. Could it be a cardiovascular disorder and if it doesn't sound like it could be, what could it possibly be?
doctor
Answered by Dr. Dariush Saghafi 1 hour later
Brief Answer:
Unlikely to be cardiac induced problems

Detailed Answer:
Good afternoon ma'am. My name is Dr. Saghafi. It'll be my pleasure to give you some direction on your question.

I understand that you experience the following symptoms:

Fatigue, foggy vision, increased heartrate, shortness of breath, dizziness, weakness, occasional neck stiffness.

The above seem to be made worse by alcohol ingestion.

Your dad's side of the family has important medical antecedents of heart issues and your father has diabetes.

You deny feeling any glandular swellings and it seems as if you're leaning away from anxiety spells as you suffer from that and feel this is something different. You are currently on Adderall.

You'd like to know if this were cardiac related. If not, what are the other likely possibilities.

First off it would be helpful to know whether this is the very first time you're having these symptoms or not. If this is the first time then, can you point to anything such as medication (prescription or otherwise, Gingko biloba, St. John's Wort, etc.) that you may be ingesting on your own that would just precede these symptoms? Do you use any illicit substances such as marijuana, street drugs of any sort, ecstasy, etc.? How long have you been on the Adderall and have you had a dose increase/decrease recently?

I certainly DO NOT get a flavor from your story of this being cardiac ischemia or anything similar. In my mind your symptoms are entirely consistent with what Adderall can produce as side effects including neck stiffness. Having said that, the taking of Adderall could also potentially affect a system such as your endocrine system which includes your adrenal glands and your thyroid gland. Therefore, I would also tend to think of your symptoms are possibly related to some hyperactivity there.

You say the symptoms are exacerbated by alcohol which is interesting since I wouldn't've guessed that. Generally, alcohol tends to slow things down and make the Adderall a bit less effective. In that way of thinking though it could mean as well that the alcohol could be DEACTIVATING the actions of Adderall which would be to IMPROVE symptoms of ADD....and that might just look like all the symptoms you have (worsening attention and concentration).....right?

Even though you're fairly sure that anxiety is not the primary problem I would still allow that to stay in my short list of possibilities as I worked you up and got to know you a bit more.

Having said all the above, I must add the following DISCLAIMER. Since this is the first time we are getting to know each other AND you brought the point up of your father's side of the family having a clear cut cardiac history of problems and you haven't really been tested for that sort of thing then, I believe it would be prudent for you to get a good examination done by a cardiologist along with some blood work and perhaps, even a stress test just to be sure that you're not really showing any signs or symptoms of heart disease....but as I said, I really don't have that sort of suspicion.

Therefore, in conclusion I believe I would consider your symptoms as being due to the following possibilities:

1. Symptoms of Adderall side effects
2. Symptoms associated with ADHD which may not be well controlled due to ingestion of alcohol, inadequate dosing of the Adderall, or other substances if used. BTW, please understand that my saying that Adderall may be at an inadequate dose is not a suggestion or carte blanche opportunity for you to increase your Adderall dose without first talking to your doctor.
3. Contribution to the above symptoms by a baseline state of anxiety worsened when alcohol is used since Adderall may be inactivated.
4. Hyperactivity of endorcinological functions by either thyroid, adrenal, or other glandular systems.
5. Last on my list would be cardiac involvement but if there is a serious history of heart disease in the family I would recommend that you use this opportunity to have yourself examined and thoroughly checked out with either an EKG, Stress test, Holter, or echocardiogram....or of course, an appropriate combination of these tests depending upon what else is going on clinically.

If you feel this information has been helpful can you do me the favor of sending some written feedback regarding my response along with a STAR RATING?
This will help me know how close I hit the mark for answering your questions.

Also, it would be greatly appreciated if you'd CLOSE THE QUERY on your end assuming no further questions. This will show the network that I've adequately addressed your concerns and that we can file and store the transaction for future reference.

I wish you all the best and hope you start feeling better very soon.

This query required 32 minutes of physician specific time to review, research, and document final draft information for patient envoy.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi 1 hour later
Thank you for getting back with me. This isn't the first time I've experienced these symptoms however, they havent been occurring for an extremely long period of time. I noticed that I started to get some of the symptoms when I began taking adderall however, I noticed that the week after I excessively used adderall and excessively consumed alcohol is when the symptoms began to worsen. They occur off and on. I don't consistently take adderall, only as needed. The dosage hasn't been decerased or increased however, there are times I have taken more than I should. I haven't been on the adderall for even a year yet. As I said, I am taking a mood stabilizer so could that possibly be affecting the adrenal or thyroid gland? I do occasionally smoke marijuana but not anywhere near often. As I mentioned earlier, there was a point in time when my adderall intake would most likely be considered excessive as well as my alcohol consumption.

When I say by symptoms are "exacerbated by alcohol" I am referring to the day after or, "the hangover." It's almost as if I can't bounce back from the effects of the alcohol and this has gotten worse over time. I fear that the alcohol consumption has made me anemic. Could excessive use of alcohol and adderall be a cause for the possible effects it has had on my glands?
doctor
Answered by Dr. Dariush Saghafi 32 minutes later
Brief Answer:
Combination of adderall & alcohol needs must stop

Detailed Answer:
Thanks for the additional information.

I am very sure that a good many of your problematic symptoms are coming not only from the Adderall itself but from the combination of alcohol and Adderall. I do not want to seem harsh or chastising, however, you absolutely cannot combine these 2 medications going forward. Take a look down below.

The following is the DRUG INTERACTION warning which is published through MEDSCAPE's DRUG INTERACTION DATABASE for Alcohol combined with Adderall:


Significant - Monitor Closely

ethanol + dextroamphetamine

ethanol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Potential for interaction, monitor.


This is very similar to what I was saying in terms of one drug interacting in a counterproductive way with the other. Except, it's not exactly a perfect positive/negative relationship if you understand what I mean. You may be feeling the residual side effects more on one instance of the alcohol (as you said the HANGOVER EFFECT) while on other days you may be feeling more of the STIMULANT effect or even the ADD/ADHD effects if the alcohol is not particularly causing the depressing effects. It also depends on how much of each is being used at any given time.

In short, I believe you are really making it difficult for your doctors to know exactly what's going on with your ADD/ADHD by adding alcohol to the mix. Please consider what I'm saying as a stern warning that you could be headed for big trouble if you're not able to right the ship now.

If your doctors are unaware of your combining these two medications then, please let them know. They can help you in different ways from recommending treatment programs to give up alcohol or alternative non-pharmacological methods to treat your ADD/ADHD if it's the case that you will likely continue using alcohol despite best efforts to stop.

In conclusion, I believe that it is altogether possible that part of your symptoms are just straight up side effects of the Adderall itself in which case a change to a different drug may be appropriate and beneficial whereas the majority of you're going through seems to be related to the combination of alcohol with Adderall and this is clearly a bad idea. BTW (and I'm sure you guessed it anyways), combining Alcohol with any substitute drug for ADDERALL is just as potentially bad. But you already knew that, right?

I wish you the best of luck as you confront this challenge. I'm sure you want to get well so I hope you find the path to that goal.

Again, if I've provided you with useful information I'd appreciate your written feedback with a STAR RATING. That's how they make sure we're "doing a good job!" HA!

And also as importantly, if there are no further comments or questions, CLOSING THE QUERY on your end would be the equivalent of turning off the lights in the room when you leave.....again, much appreciated!

Cheers!


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 30 minutes later
Thank you so much for all of your help! I now realize the damage I have most likely done due to the prolonged mixing of excessive alcohol/amphetamine consumption. I don't think I considered all of the possible effects that prolonged use/mixture of the two has had on many aspects of my body. I now see that I can absolutely not consume alcohol anymore or mix the medications with it and it took a professional to help me see that. I completely understand all you said and it was extremely helpful. Thank you for all your help and I will now close the discussion and review you.
doctor
Answered by Dr. Dariush Saghafi 4 minutes later
Brief Answer:
I wish you only the best

Detailed Answer:
Peace out brother.....Look me up if there's anything else I can help you with...hey...listen....it's a tough road to give up alcohol, even when you're not combining with anything else.....keep focused in front and move forward. Steps backward don't matter as much as steps forward.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 18 minutes later
Thank you so much. I'm sort of a hypochondriac and I'm always worried that I have the worst thing possible so.. I have been obsessing over my symptoms and the obsession turned into me thinking I have a brain tumor or something worse. I have always known that mixing any of my medication with alcohol (but especially the adderall) is really bad news.. especially when being diagnosed with depression and anxiety (which I have both)..It was never that I was in denial that drinking excessively couldn't cause all of these issues.. I knew it could... but I was just hoping that the drinking hadn't gotten to a point where it COULD caue all of these issues. I guess I havent really stopped to think how long the mixing of the two has been going on... and now that I think about it, it has been going on much longer than I thought and there is absolutely no telling how severe its effects can become after a "more than extended" period of time. Alcohol definitely hasn't done anything good for me and now I definitely know that.. more so than ever, actually. I've never really tried to stop drinking on my own so I will try on my own and if I can't do that then I wil most definitely seek help. But yes, giving it up most definitely will suck... and I'm glad you can admit that too.
doctor
Answered by Dr. Dariush Saghafi 15 minutes later
Brief Answer:
Sorry I can't say you've got a brain tumor! HA!

Detailed Answer:
I bet that's a disappointment.

Glad you agree and as I said before, even though I'm not a psychiatrist, psychologist, or addiction specialist, I'm happy to be there as a sounding board with some "pearly" advice and maybe a cheer or 2 if you need it....you can direct further queries directly to myself at DR. XXXXXXX SAGHAFI.

Or you can pick up and travel about 20 hrs. North x NorthEast till you get to the Rock 'n Roll Hall of Fame in beautiful XXXXXXX OH and visit that way! They're renovating the place. We may even have a sports team to brag about again with the Cavaliers and Sir XXXXXXX ..if you follow basketball at all....HA!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 15 minutes later
Haha oh gosh, definitely NOT a disappointment (but no worries I caught on to your sarcasm there HA!)... I think the obsession with that came from me having occasional vision weirdness/optical migraines (which I know are also possible side effects of what we already talked about).. but ugh, so frustrating.

But yes, my psychiatrist and my dad (who likes to think he's a doctor/psych/therapist haha) have told me time and time again about the dangers of alcohol by itself, let alone its effects when put with other substances.. I think you could say I'm pretty hard headed.. clearly... OH GOSH! XXXXXXX OH huh? Well from Kansas City, MO absolutely yes, BUT I'll be making a move to New York this coming Monday so the drive to OH would be much closer, haha!! And I have to admit, I give you credit for those Cavaliers..... i may be a girl but I do indeed follow basketball!!!
doctor
Answered by Dr. Dariush Saghafi 20 minutes later
Brief Answer:
Going to NYC?

Detailed Answer:
Wow....KC to NYC? Very cool.....is that like night and day or am I making too much of difference between those 2 towns? You've FOR SURE got to stay clear of that night life in the Big Apple because over there it's a 24/7 party.....I mean, XXXXXXX ..there's a renaissance going on here for sure....I'm mean....this is a happening place and it's liable to become very sweet in the next few years....but still they roll up the streets at 10p...sometimes earlier. Other day? Starbuck's? They're not supposed to close till 10p out where we live? We walked in like 9:10p...and all the chairs are up on the table, guy is mopping up under all the tables...everybody's lifting their legs....I'm thinking, are you serious? It's still light out even...you're not supposed to be closing for like 50 minutes? Hellooo?? What kind of crappy way is that to treat a customer.....then, the guy looks at me because he must've known exactly what I was thinking....like maybe I was going to report him to HQ or something....and he says, "Oh, I'm going all the chairs back after I get done mopping!" ROFLMAO! I told him...dude....when I was a kid like you working at Mr. Hero's, if the managers caught us closing the place down like that 50 min. before closing time....chairs back down on the floor or not....people would've been fired. That's why WE used to actually stay LATE in stores to clean up? Sometimes, like 2 hrs. after the place was closed...kitchen crew still cleaning, mats out, hose 'em down...etc. Nowadays, are you kidding? I see places all the time where the last employee walks out of the place right behind the last customer...and doesn't even have the key the lock...it's automatic? Really? So....that's XXXXXXX ...NYC....totally different.....they just frickin' never ever close man.....you gotta stay away from those places at least when you first get there.

Seriously, we need you to kick this alcohol if you're going to stay on Adderall or anything for that matter. Alcohol just doesn't mix....If you think you can use someone out there in NYC to talk with like a therapist/psychologist I have some contacts out there who I can hook you up with....but...whatever....

Have a safe trip...take it slow if you're driving out there and be good!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 9 minutes later
Thank god nothing is ever closed in NYC because I NEVER sleep... haha renaissance in XXXXXXX .. that was good.. Sorry but I think I still have to go with NYC over XXXXXXX . And yes!! NYC! I'm a performer so I'm gonna go pound that pavement and pray that something comes of it!! This conersation has been much more than getting help with my symptoms... definitely a good cherr-up conversation.. that'sf for sure..

Definitely need to kick the drinking..It's not an option and really I should've done that a long time ago. I could DEFINITELY use a hookup with a therapist.. That really would help me a lot because I have NO idea what to do when in regards to finding someone new and someone that's good..

A contact of yours would help tremendously.
doctor
Answered by Dr. Dariush Saghafi 12 minutes later
Brief Answer:
A performer? Now you're talking my language

Detailed Answer:
Really? So, look me up on FB and you'll see me standing there with a violin in my hand....guess what I could've done as an alternative profession when I was back in my youth? HA! But, I still do it quite avidly....it's just that being a doctor helps keep 3 kids in college and the dreams of a still HS'er who wants to be a Disney Animator alive! But I still gig, play parties, work with rock bands, do classical gigs....just came up 1 month ago from the XXXXXXX Music Festival....debuted with our new piano/French Horn/violin trio the Brahms E-flat Horn trio....Geez XXXXXXX is HOT!

So, let's do this....I will not only pass you on a name or 2 of a good therapist that I want you to look up in NYC....but I'm going to talk with a very good female vocalist friend of mine who I went to college with who is doing very well in NYC right now. Her name is XXXXXXX Rosene....you can Google her...she does Big Band era types of music...but she is strong man....lemme talk to her first though but I'm sure she would be happy to talk to you if you wanted someone in the "Biz" up there who may be able to give you at least some hints or pointers.

I don't know how many more times you can keep writing back and forth here before they stop you for however much you've paid. If you can't write back on this network...look me up on FB and we'll continue to communicate through that connection. That way we can close this transaction down and get it filed. I don't what the management thinks about people yappin' about making it like XXXXXXX Sinatra says...."I'll make it anyway!" HAHA! Or you can use my email: YYYY@YYYY . I'll have more info. for you on a therapiest etc. later today or tomorrow plus I'll talk with XXXXXXX ......you gotta promise though that you'll make an A-1 effort to have uncorked that last bottle of Schnapps! LOL!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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