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Suggest treatment and precautions to take for hypertension

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Cardiologist
Practicing since : 1998
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I'm 33 years old, I use smokeless tobacco, I have one to two drinks (beer) each evening usually watching TV. I work out five days a week, mostly cardio exercises, no weight lifting. I was recently diagnosed with high blood pressure, runs in the family. My father passed away from a heart attack at the age of 59. He was overweight and had low cholesterol but high BP. My recent diagnosis was 156/110. I've had an echocardiogram and stress test conducted this past January, I also wore the halter monitor for heart rate. I had a sudden onset of a muscle spasm over my left chest which I thought was something related to my heart on December 29th, 2014. That was last year, I've only been on a low dose of ramipril for around three weeks now and it has lowered my BP to acceptable levels. I sometimes have a shooting pain in my arm that lasts for seconds and sometimes sharp chest pains or strong heart beats, usually occurring after eating. I carry my 30 lb toddler on my left side, using my left arm mostly. Since the even in December I've had the test above, I also have had five EKG's, all normal from visits to my Doctor and Urgent Care. I woke up in the middle of the night on May 19th, before I was having a full CT scan and had a racing pulse, around 150 bpm that stabilized, haven't had an episode like that before or after. My cardiograph CT scan showed no plaque buildup in my heart, and it appeared to be functioning properly. Why can't I get this out of my head, I always feel like when I see my cardiologist I'm in and out, and he only ever wants to talk to me about my blood pressure. My echo did show a thickening of my upper ventricle or atrium, you probably know which one, he says it's typically common as a warning sign for people with hypertension or for people in very good shape. My resting pulse sometimes is below 60, I recently had a endoscopy and my pulse before going under was in the 50's. That scared me a bit, though my Uncle who is a cardiologist told me that's nothing to worry about since there is no other symptoms. I do take pantoprazole for acid reflux and I have mild gastritis. I often think about just dropping dead, I hate to say that, like there is something wrong with my ticker. Aside from the occasional mild chest discomfort and or shooting pain in my left arm that lasts but for a few seconds, my only other complaint or concern is my obsessions with my pulse, why it fluctuates so much, why it sometimes beats extra hard or feels like it to me. I've also noticed if I change sometimes from laying on my side to flat on my back, I can feel it really beat, usually slow and steady but strong. I don't want to die, I don't think I'm dying, I can pull myself from allowing it to me dominate my day, so I can still find time to enjoy work, family and fun but I do think about it everyday. Am I being too aware? Should I be concerned?

Thanks,
Sometimes I Just feel hopeless and that's just not me...PS, I've got a nasty little sore throat and cold, can I take Nyquil?
Posted Tue, 12 Aug 2014 in Hypertension and Heart Disease
 
 
Answered by Dr. Sukhvinder Singh 28 minutes later
Brief Answer:
please see below.

Detailed Answer:
Dear sir.
A thickening of left ventricle is a sign in people with high blood pressure or in athletes and not of atrium.
A pain which is sharp shooting and last for few seconds is unlikely to be cardiac in origin.
Sudden cardiac death is common due to a heart attack for which stress or anxiety is a risk factor. Avoid anxiety. Beside heart attack, which is not a predictable event, sudden cardiac death is unlikely in an individual with normal ECG and normal echo.
Our pulse rate varies with mental and physical activity or stress. A rate of 50 BPM is good enough in absence of symptomatic. Anxiety or panic can make it as fast as 180 BPM.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment and precautions to take for hypertension 11 hours later
Dr. Singh:

Thanks for getting in touch with me, my name is XXXXXXX by the way, no need to call me Sir. So what I gathered from your message was that I should "chill out, calm down and relax". Considering all of the tests that I've had done, the stress test, the echocardiogram, the multiple EKG's and the chest X-rays along with the full body CT scan, it highly unlikely that I'll have a cardiac event. I'm not really an anxious person by trade, I have no problems public speaking, I have no problems performing my work duties which puts me in difficult conversations with taxpayers. I'm also a recreational pilot so I feel that I don't allow myself to get to worked up in stressful situations. I think what I am searching for is reassurance from a medical professional that my heart isn't going to just fail. At least not in the interim. Thanks again Dr. XXXX I really appreciate you taking the time to address my concerns.
I wanted to mention what typically gets me thinking about the ticker. I have a cold, started last night, I took a half day, I didn't get to sleep until late last night and took Nyquil. I wasn't able to eat anything until later this afternoon, around 6PM. After 30 minutes of a semi larger meal, I could feel my heart beating harder and faster. I have device that measures pulse, standing it was 110, sitting it's in the 80's. I don't feel any worse off than before eating, but I can feel the pounding and the faster beat. Thanks.

XXXXXXX
 
 
Answered by Dr. Sukhvinder Singh 8 hours later
Brief Answer:
please see details.

Detailed Answer:
Dear Mr XXXXXXX
A pulse rate of 80 at rest and 110with activity is quite normal with common flu. At times drugs used for the flu also increase heart rate, although nyquil does not have any such component.
As I explained in last answer, remaining stress free is important to avoid acute cardiac events. Normal Ecg, normal echo and normal CT angiogram are definitely favorable. Do avoid smoking. Get your BP, sugar and cholesterol checked regularly. Keep optimal weight and do exercise as per prescribed limits.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
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