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Suggest Treatment For Postprandial Hypotension
Question: hello,
I think I have a haital hernia or roemheld syndrome. my pvcs happen mostly when I'm sitting down. they
are happening everyday. this has been happening for about two months. I am 43. 228 lbs. I am 6.3 my BP this morning was 109/79. bpm was 67. I have been fasting all day. it seems I only get them when my stomach and chest are upright. I am starting to feel like someone punched me in the stomach and I'm losing air and becoming weak. I am in good health otherwise. I do have bad gerd and some anxiety. I am mentally and physically Burned out because of this. my vagus nerve is being stimulated and it's slowing down my heart, which causes other areas of the heart to fire prematurely. what is this please help!
I think I have a haital hernia or roemheld syndrome. my pvcs happen mostly when I'm sitting down. they
are happening everyday. this has been happening for about two months. I am 43. 228 lbs. I am 6.3 my BP this morning was 109/79. bpm was 67. I have been fasting all day. it seems I only get them when my stomach and chest are upright. I am starting to feel like someone punched me in the stomach and I'm losing air and becoming weak. I am in good health otherwise. I do have bad gerd and some anxiety. I am mentally and physically Burned out because of this. my vagus nerve is being stimulated and it's slowing down my heart, which causes other areas of the heart to fire prematurely. what is this please help!
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I carefully passed through your question and would explain that your heart rate is withing the normal levels, while your blood pressure is slightly below the normal ranges.
Before concluding that this is roemheld syndrome, further test are needed to investigate for other possible causes.
I would recommend consulting with your attending physician for a careful physical exam and some tests:
- a resting ECG
- a chest X ray study (to examine your lungs)
- some blood lab tests (complete blood count for anemia, blood electrolytes for possible electrolyte dysfunction, fasting glucose and HbA1C for diabetes)
- a fibrogastroscopy to exclude possible gastro-intestinal disorders like hiatal hernia, etc..
Post-prandial hypotension could be the reason of this clinical scenario. I would recommend performing a head up tilt test for this purpose.
Meanwhile, I would advise some tips to minimize your symptoms:
- eat small meals frequently during the day and avoid large hypercaloric meals which can trigger this symptomatology
- stay well hydrated, taking plenty of fluids (water)
- perform a lot of physical activity (walking, aerobics, etc.)
- try to lose some weight.
You should discuss with your doctor on the above issues.
Hope to have been helpful!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I carefully passed through your question and would explain that your heart rate is withing the normal levels, while your blood pressure is slightly below the normal ranges.
Before concluding that this is roemheld syndrome, further test are needed to investigate for other possible causes.
I would recommend consulting with your attending physician for a careful physical exam and some tests:
- a resting ECG
- a chest X ray study (to examine your lungs)
- some blood lab tests (complete blood count for anemia, blood electrolytes for possible electrolyte dysfunction, fasting glucose and HbA1C for diabetes)
- a fibrogastroscopy to exclude possible gastro-intestinal disorders like hiatal hernia, etc..
Post-prandial hypotension could be the reason of this clinical scenario. I would recommend performing a head up tilt test for this purpose.
Meanwhile, I would advise some tips to minimize your symptoms:
- eat small meals frequently during the day and avoid large hypercaloric meals which can trigger this symptomatology
- stay well hydrated, taking plenty of fluids (water)
- perform a lot of physical activity (walking, aerobics, etc.)
- try to lose some weight.
You should discuss with your doctor on the above issues.
Hope to have been helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
in regards to pph. my BP is usually 125/89. my BP has been low to beta blocker and hydroxine. I took the beta blocker for a day or two, but don't trust it. I have been trying to fast to see if there is a change in pvc. today I woke up after normal sleep and had baby food with no acids and a banana as well as 1000 mgs of magnesium. my last chest x-ray was less than a year and was normal. I have been settled with a conversion anxiety disorder which for me it is heart to believe that anxiety is causing 3 pvcs a minute for 3 day times and longer. they are not happening at night when I lay flat. my glucose was normal last time it was checked. in all other areas I am healthy. sleep well. appetite good. no sexual dysfunction. I have been diagnosed with severe sleep apnea, but have a cpap that I monitor. my bowel is normal. I have burning in my diaphragm with acidic foods and alcohol. I have to drink kefir a lot as it gets bad. feels like a hole being Burned in the center of my chest. my stomach area is large as I used to weigh 200, now 229. tired a lot. no vigor. I have attached my last blood serum.
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
I carefully reviewed your uploaded tests and would explain that all the tests are OK, besides your blood lipid profile. You have a high total cholesterol/HDL ration and high levels of triglycerides, which means that you have dyslipidemia and an increased risk for cardio-vascular risk.
I would recommend discussing with your doctor on the possibility of starting a statin like atorvastatin, simvastatin, etc..
Some lifestyle modifications would also help with your blood lipid profile and also your weight:
- a healthy diet, full of omega 3 fatty acids (fish, fish oil, wallnuts, olive oil) and avoid butter, sweats, etc.
- a lot of aerobics and walking
- try to reduce your weight. You should consult with a dietitian for this purpose.
Regarding your food related symptoms, I would recommend performing a fibrogastroscopy to exclude possible esophageal hernia or gastritis.
Anxiety seems to play an important role in your symptomatology too.
Hope you will find this answer helpful!
Greetings!
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
I carefully reviewed your uploaded tests and would explain that all the tests are OK, besides your blood lipid profile. You have a high total cholesterol/HDL ration and high levels of triglycerides, which means that you have dyslipidemia and an increased risk for cardio-vascular risk.
I would recommend discussing with your doctor on the possibility of starting a statin like atorvastatin, simvastatin, etc..
Some lifestyle modifications would also help with your blood lipid profile and also your weight:
- a healthy diet, full of omega 3 fatty acids (fish, fish oil, wallnuts, olive oil) and avoid butter, sweats, etc.
- a lot of aerobics and walking
- try to reduce your weight. You should consult with a dietitian for this purpose.
Regarding your food related symptoms, I would recommend performing a fibrogastroscopy to exclude possible esophageal hernia or gastritis.
Anxiety seems to play an important role in your symptomatology too.
Hope you will find this answer helpful!
Greetings!
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
why would you want to put me on a statin? my resting bP is normal. my overall is not that high. my triglycerides are high because of beer and ice cream. don't you think a stating would damage my heart in the long term not to mention side effects?
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
I understand your concern and would assure that statin have no such long term damage on your heart. Anyway, in this case they should be used for a short period, until your blood lipid profile is stabilized.
We often put in a balance the benefits and adverse effects of the drugs we prescribe and in this case the benefits are much more important than the adverse effects (which can be eliminated by stopping and restarting therapy).
Your total cholesterol levels are not too high, but your HDL cholesterol is low and the Total cholesterol/HDL ratio is high, which imposes you to a higher risk for cardiovascular disease (including stroke and coronary artery disease). That is why I recommended discussing with your doctor on the possibility of starting a statin for a short period of time (some months), until your blood lipid profile will be OK.
Regarding your triglycerides, I would agree with your that they could be related to beer and ice cream, but your should know that they are a risk factor for acute pancreatitis, which is a lifethreatening disease. Statins act on the tryglycerides too, by lowering their levels.
From the other hand, it is important modifying your lifestyle (diet and physical activity) because this is the best thing you can do to regulate your blood lipid profile naturally for a prolonged time, without any medications.
Hope you will find this answer helpful!
Best wishes,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
I understand your concern and would assure that statin have no such long term damage on your heart. Anyway, in this case they should be used for a short period, until your blood lipid profile is stabilized.
We often put in a balance the benefits and adverse effects of the drugs we prescribe and in this case the benefits are much more important than the adverse effects (which can be eliminated by stopping and restarting therapy).
Your total cholesterol levels are not too high, but your HDL cholesterol is low and the Total cholesterol/HDL ratio is high, which imposes you to a higher risk for cardiovascular disease (including stroke and coronary artery disease). That is why I recommended discussing with your doctor on the possibility of starting a statin for a short period of time (some months), until your blood lipid profile will be OK.
Regarding your triglycerides, I would agree with your that they could be related to beer and ice cream, but your should know that they are a risk factor for acute pancreatitis, which is a lifethreatening disease. Statins act on the tryglycerides too, by lowering their levels.
From the other hand, it is important modifying your lifestyle (diet and physical activity) because this is the best thing you can do to regulate your blood lipid profile naturally for a prolonged time, without any medications.
Hope you will find this answer helpful!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answers. I will look into the statins and make changes to my lifestyle.
Regarding the pvcs. This the last two days of my log
Palpitation LOG
Monday May 9, 2016 1:35 pm
BP-140/89 after some busy work. I laid down and listened to my heart. My first palpitation was at 1:30, My heart stopped palpitating after i listened to it. breakfast-walnuts,avocado,digestive enzyme,gatorade, took a hydroxine to test anxiety theory. no palpitations during sleep or a few hrs after waking up. It seems when i get busy or starting to get going the pvcs start in. I have to rest for a second and then they go away.
Sunday May 8 2016
Had pvcs intermittently all day. They stopped when i was focused on other things.As soon as i turned my attention back to me, they started immediately. Finally took hydroxine and laid down. They went away.
***end***
I will get a serum done asap to see my current stats. I am perfectly fit except for heart pvcs. How would you explain these benign heart hiccups that happen frequently? Also, i seem to a hard time raising my HDL. I eat avocado like crazy. My opinion is that i am too young for a statin.
what exercise do you suggest?
Regarding the pvcs. This the last two days of my log
Palpitation LOG
Monday May 9, 2016 1:35 pm
BP-140/89 after some busy work. I laid down and listened to my heart. My first palpitation was at 1:30, My heart stopped palpitating after i listened to it. breakfast-walnuts,avocado,digestive enzyme,gatorade, took a hydroxine to test anxiety theory. no palpitations during sleep or a few hrs after waking up. It seems when i get busy or starting to get going the pvcs start in. I have to rest for a second and then they go away.
Sunday May 8 2016
Had pvcs intermittently all day. They stopped when i was focused on other things.As soon as i turned my attention back to me, they started immediately. Finally took hydroxine and laid down. They went away.
***end***
I will get a serum done asap to see my current stats. I am perfectly fit except for heart pvcs. How would you explain these benign heart hiccups that happen frequently? Also, i seem to a hard time raising my HDL. I eat avocado like crazy. My opinion is that i am too young for a statin.
what exercise do you suggest?
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
All your symptoms seem to be related to anxiety or to physical activity. I would explain that this situation is quite normal and happens in every healthy individuals.
It is related to the activation of the sympathetic nervous system during physical or emotional stress, leading to a load of chatecholamines in the blood, thus leading to increased heart rate and even ectopic heart beats or PVCs.
If the problem persists, I would recommend performing further tests:
- an ambulatory 24-48 hours ECG monitoring to examine your heart rhythm trends for a prolonged time
- thyroid hormone levels for possible thyroid dysfunction.
Regarding your blood lipid profile, as I already explained you can modify your lifestyle (diet reach in omega 3 fatty acids and a lot of physical activity), which can help you regulate naturally your blood lipid profile, without the need of statins.
Walking and aerobics is recommendable for this purpose. You can try recreational sports and Yoga as well, as they are very helpful in the relief of anxiety too.
Hope you will find this answer helpful!
Greetings!
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
All your symptoms seem to be related to anxiety or to physical activity. I would explain that this situation is quite normal and happens in every healthy individuals.
It is related to the activation of the sympathetic nervous system during physical or emotional stress, leading to a load of chatecholamines in the blood, thus leading to increased heart rate and even ectopic heart beats or PVCs.
If the problem persists, I would recommend performing further tests:
- an ambulatory 24-48 hours ECG monitoring to examine your heart rhythm trends for a prolonged time
- thyroid hormone levels for possible thyroid dysfunction.
Regarding your blood lipid profile, as I already explained you can modify your lifestyle (diet reach in omega 3 fatty acids and a lot of physical activity), which can help you regulate naturally your blood lipid profile, without the need of statins.
Walking and aerobics is recommendable for this purpose. You can try recreational sports and Yoga as well, as they are very helpful in the relief of anxiety too.
Hope you will find this answer helpful!
Greetings!
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you for the info. last night and this morning I am extremely fatigued. i have body aches, but no fever. my BP this morning was 127/84. hr 59. It seems if I become active. I have to sit down and rest. pvcs start in when I need to sit. they go away after a few minutes rest. I'm really starting to worry.
Brief Answer:
I would recommend performing the above mentioned tests.
Detailed Answer:
Hello again!
Your symptoms are not indicative of any serious disorder.
I would recommend consulting with your attending physician and perform the above mentioned tests (Holter monitoring, thyroid hormone levels).
A cardiac ultrasound would also be helpful to examine better your cardiac function and structure.
Regarding your body aches and fatigue they could be related to possible inflammation or a viral infection. I would recommend performing muscular enzymes and inflammation tests (PCR, sedimentation rate).
Hope to have been helpful!
Best wishes,
Dr. Iliri
I would recommend performing the above mentioned tests.
Detailed Answer:
Hello again!
Your symptoms are not indicative of any serious disorder.
I would recommend consulting with your attending physician and perform the above mentioned tests (Holter monitoring, thyroid hormone levels).
A cardiac ultrasound would also be helpful to examine better your cardiac function and structure.
Regarding your body aches and fatigue they could be related to possible inflammation or a viral infection. I would recommend performing muscular enzymes and inflammation tests (PCR, sedimentation rate).
Hope to have been helpful!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much. you have been most helpful.
Brief Answer:
You are welcome!
Detailed Answer:
I am glad to have been helpful!
If you have any uncertainties in the future you can ask me directly at any time on the link below:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Kind regards,
Dr. Iliri
You are welcome!
Detailed Answer:
I am glad to have been helpful!
If you have any uncertainties in the future you can ask me directly at any time on the link below:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Kind regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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