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Rapid heartbeat. On amlodepine and revelol. ECG showed Trachcardia. Did lipid, thyroid profile.Treatment required?

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Sir, I am 51 yrs male. i was on amlodepine 5 and revelol 50 (REVELOL AM 50/5)for last 3 years.suddenly a few few months back after i came fro toilet ,i feel a problem of increase heart beat 115 to 120 . but at that time i check my bp which was 145/86. I immediately went to hospital where they did ECG ECG result was Trachcardia ,other is normal. Emergency doctor immediately gave me Cardiron 100 and Zapiz 0.5 . With in one hour the beat come to normal. That day Doctor prescribe for some tests I did all the tests.
I did Tread Meal Test ie ECG in Walker machine- results normal
I did Echo Cardiography for structural view of heart- result normal only left ventricular hypertrophy.
I did Holter ECG ie ECG for 24 hours result- Normal
I did blood tests
Lipid profile- all well with in range including Cholostoral and triglyseride.
Thyroid - wel with in range
Sugar- normal range
Sodium and potassium- Normal range
LFT- All normal range
Doctor change my medicin to TEZLOC BETA 40/50 (telmisatron 40 and revelol 50) for twice daily. i continued for 1 month but my in the morning and evening my bp remains in the range 136/85 to 145/90
shaall i continue the medicine?
Doctor still now some times without any reason I experienced this type of high heaet beat
Doctor prescribed Inderal 10 and Zapiz 0.5 if the fast beat starts.In subsequent period when i feel fast heart beat , I took Inderal10( Propanolol) and Zapiz 0.5. Within half an hour , it comes down to normal
But Doctor, is it proper solution, As a cardiologist pl suggest any treatment or test. I am vey tensed.
Doctor my echo, ecg, holter ecg trade meal and all blood test are normal. then why heart beat suddenly raised.
i m confused. is any test is require? At present I am in Assam, Guwahati. Shall I go some where else?
Suggest me about my blood pressure medicin.
Posted Tue, 23 Apr 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 1 hour later
Hi friend,
Welcome to Health Care Magic

In most of the conditions, it is easier to treat than find the cause!
Some investigations are cumbersome and not cost effective; very often have a poor yield.

Anxiety / Alcohol / Tobacco (smoking, chewing) / Caffeine (too much coffee, cola) are common causes.
Medicines may be responsible – like Phenylephrine, Pseudo-ephedrine used for ‘cold’ / Salbutamol, Salmeterol used for asthma and so on.
Illicit ‘drugs’ like Amphetamine are notorious to cause abnormal beats

At times, abnormal nerve paths in the heart (bypass tracts) are responsible!

If there are no clues and if the problem is still bothering to the extent of interfering with life style, there is the advanced technique of investigations – Electro Physiological 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. The test is the gold standard... and is not generally done unless there are compelling indications, because it is invasive. This super-speciality expert is called ELECTRO-PHYSIOLOGIST. The treating doctor may suggest them depending on need, based on his assessment of the situation. Advanced treatment modality like ablation could be done during EPS.

     It is good that nearly all your investigations are normal except mild Left Ventricular hypertrophy – which could be from Hypertension

     Telmisartan is Angiotensin Receptor Blocker – good to treat Blood Pressure.
     Revelol is Metoprolol, a Beta Blocker – same class as Inderal and more selective / better / Don’t take both...
     For better control of blood pressure, you can add a diuretic – like Hydro ChloroThia Zide (HCTZ - 12.5 mg).

     But the combination of high pressure and fast rate calls for investigation of PHEOCHROMOCYTOMA (adrenal hormone). Discuss with your doctor.
Probably, you had thyroid tests done already...?

     Zapiz is clonazepam – given for anxiety...

Take care
Wishing speedy recovery
God bless
Good luck
Above answer was peer-reviewed by
Follow-up: Rapid heartbeat. On amlodepine and revelol. ECG showed Trachcardia. Did lipid, thyroid profile.Treatment required? 2 hours later
what is the brand name of diuretic – like Hydro ChloroThia Zide (HCTZ - 12.5 mg and its dose. should i take this with Tezloc Beta 40/50 twice daily.
Sir what is the name of the test for investigation of PHEOCHROMOCYTOMA (adrenal hormone)
Sir Should go for the test EPS. Is it expensive and painful.
Sir What is your expert opinion in my case. Is it curable. Is there any risk of fatal incident or my problem will lead to any major problem.
Sir Is it permanent solution that taking Inderal 10 at the time of sudden rise of heart beat.How long I will take it. If Inderal 10 fails to react after some days than what should i do. Please advise
Answered by Dr. Anantharamakrishnan 7 hours later
You seem to be rather anxious. Relax. Your doctor is doing the right thing. You need follow up.

There are several brand names for thiazide - alone or in combination with other drugs. You should not take it by yourself. Discuss with your doctor and get proper prescription.

24- hour urine VMA; blood levels of adrenaline, nor-adrenaline; CT scan abdomen are the usual tests done for Pheochromocytoma...

If the problem is very troublesome and interfering with your life style, you plan for EPS. It is expensive and invasive - cardiac catheterisation

It is not 'curable' - it can be controlled / managed very well.

As already said, Inderal is the same class of Metoprolol. Metoprolol is better and selective. If it does not work, change to another drug - there are several classes of drugs and there are several drugs in each class. They can even evaluate the drug during EPS...

All the best

Above answer was peer-reviewed by
Follow-up: Rapid heartbeat. On amlodepine and revelol. ECG showed Trachcardia. Did lipid, thyroid profile.Treatment required? 8 hours later
for last 6 to 7 years, I was very much comfortable with Revelol AM 50/5 ONCE DAILY. Whether amlodepine cause fast heart beat? here in guwahati, doctor's view is like this. But my bp was quite normal hole the day with normal heart beat. pl give a expert comments.
Answered by Dr. Anantharamakrishnan 16 minutes later

Amlodipine can increase the heart rate in some people. But this effect is likely to be offset by the Metoprolol (which can decrease the rate). Since you are taking the combination, there may not be any net change. Don't worry.

The dosing schedule is generally decided by the duration of action of the drug / the indication for which it is given / the timing of other drugs and so on. Many drugs are given twice for heart / once for pressure....

Above answer was peer-reviewed by
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