Question: Hi - I am copying my last question below as it has all the information about me in it. This new question is about irregular heartbeat. In XXXXXXX 2010 I had Wenckebach arrhythmia for the first time after starting Lyrica. Heart was missing every fourth beat at 4 am. In hospital, by midday it was missing each 8th beat then it went around 6 pm. I’ve been in hospital twice since then – the last time it was missing after 2, then 4, then 6, then 1 beats ie irregularly. This morning after taking more Tramadol than usual yesterday, it was missing irregularly 5 times each 15 seconds. I didn’t call an ambulance because I thought this has happened before and it’s been ok. What I need to know is… do I need to call an ambulance at times like this or if not, what should I do to help the heart? Thanks, Louise

Weight 92 kg Height 175 cm Age: 54
Diagnosed conditions: Fibromyalgia, C2/3 facet joint damage (MVA), C6/7 nerve root impingement (MVA), RSI right wrist (35 years), plantar fasciitis (comes and goes), sacro-iliac pain (comes and goes).
Recent blood test: bit low in Vitamin D.
Medications: Tramadol 100 mg/day, Codeine 30 mg day PRN, Citalopram 10 mg, Oxazepam 7.5 mg
Hi – I feel very breathless on little exertion and my heart rate increases a lot – for example just bending down to do up shoelaces. However, I can go for a 50 minute walk and not get too out of breath (except on hills). Having trouble sleeping for last two months as came off Stillnox after eight years on it. Sometimes used codeine, Temazepam and periactin to sleep. But last night took none of these and still feel very short of breath. Doctor has listened to chest – all ok. Might have a bit of reflux at night – not sure – but I think morning coughing could be due to that. Put on 10 kg in a six month period recently – it’s plateaued at 92 kg for about three months. Also feel pretty exhausted and tired and lacking motivation quite a bit of the time. Thanks

Dear Dr Iliri,

Many thanks for your responses! I have just had blood tests and the only things were Vit D was a bit low and thyroid a little bit low. Also trigylcerides up a bit and good cholesterol down a bit.

Actually I tried coming off Citalopram two years ago (been on it for 9 years now) but it was murder! Went on Mirtazapine at that time but it caused 12 kg weight gain in two months, water retention in ankles and a general feeling of being 'out of it' - apart from that - anxiety and depression and sleep wise, it was very good. But I found Citalopram better and went back on it. I would like to try to get off Citalopram very very slowly after getting off the Tramadol - the problem is I usually need more Oxazepam when I do it so it's all swings and roundabouts!

My rheumatologist suggested Cymbalta or Pristiq to help with the pain issues. What are they like for the heart side-effects?

Would it seem to you that because the Mobitz type I was even in it's irregularity to start with but is now uneven in its irregularity (ie losing beats after random numbers of beats, say 4 then 2 then 5 then 1) that it might have progressed to Mobitz type II? (been Dr Googling...) In this case, do you think I should be calling an ambulance when it happens or do you think it's ok to just ride it out at home until it stops? It usually only happens about once every six months when I take an unusual combination of medications.

So glad I'm talking with a cardiologist!

Many thanks for your help,
Louise