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Suggest treatment for severe sleep apnea and spikes of tachycardia after eating

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Posted on Tue, 19 May 2015
Question: Hello,
This site is great. I will brief in background since its long. Just came back from XXXXXXX Clinic. I have severe sleep apnea and spikes of tachycardia after eating. I was on Lopressor 100mg a day (i spread out 25mg in 4 doses and it worked well). I saw a top cardiologist who stated I had a hiatal hernia causing pressure on my atrium due to the esophagus running behind heart atrium and was irritating. H felt this was causing rhythm disturbance. I have been on nexium for 1 month and it has basically eliminated the tachycardia after eating. I also eat smaller portions. I did lose 20 pounds the last 6 weeks, still 297lbs and 6'4. Im 48 male. The doctor didnt like lopressor half life and put me on nadalol 20mg twice a day. I just started this morning.

An odd event happened this morning (never had), I always take my pulse in bed when I wake. My Afib I had that was cardioverted in 2013 was in morning when I woke only and was due to sleep apnea or pressure of gut on heart I found out. So when I checked this morning I had a few normal beats then 5 fast beats then a few slow beats and then fast. I got up nervous and my heart beated faster but in sinus rythmn as far as I could tell. I took my nexium and the new pill nadalol and after 10 minutes my pulse is 59 normal. I was a bit nervous thinking I was in afib (no afib since 2013 cardioversion). I dont think I was so what do you think happened? I feel fine.Actually pulse seems lower. Can I resume normal activity?

1-what caused the brief rapid beats then slow beats (2) then 5 fast when I woke ?
2-whats your thoughts on Nadalol vs Lopressor

Thanks
doctor
Answered by Dr. Prof. Kunal Saha (2 hours later)
Brief Answer:
Nadolol is a better drug (in terms of half life) for similar mode of action

Detailed Answer:
Thanks for asking on HealthcareMagic. I am really glad that you liked the site.

I have gone carefully through the details. Let me mention that at your weight, you can perhaps expect much more health hazards that you might really be presently experiencing. So, cutting down on your weight would be a key to a healthy life. Now, let me come to your questions:
* It seems to me that you were having atrial ectopic beats. They are pretty common and may manifest with heart rate irregularities like this. Other types of arrhythmias are possible but I doubt if it is atrial fibrillation (afib). In any case, i is really hard to comment without getting an ECG. In any case, the medicines like nadolol or lopressor would bring it in control.
* Maximum serum concentrations of Nadolol is reached in 2 to 4 hours after oral administration, while steady state serum concentrations are reached after 6 to 9 days. The serum half-life is 20 to 24 hours at therapeutic doses. On the other hand, for Lopressor (Metoprolol), the half-life ranges from approximately 3 to 7 hours. Hence, the serum concentration falls and multiple doses are essential per day. Nadolol is much better off in this regard.

Hope that helps.

Regards
Dr. Kunal Saha
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Prof. Kunal Saha (4 hours later)
thank you for your response. after reading up i agree with the ectopic beat. just never picked one up feeling my pulse. i also read that these jolts i get laying down right before i fall asleep may be a pvc. its like right when i fall asleep its like being startled and i wake then after a few minutes go to sleep. they happen maybe once a week. all blood work is normal. sugar 93 and cholesterol 155. had nuclear XXXXXXX stress test and perfect. 67% efraction rate.
doctor
Answered by Dr. Prof. Kunal Saha (12 hours later)
Brief Answer:
These are commonly seen and not a cause for concern

Detailed Answer:
Thanks for writing back. Sorry for not being able to respond earlier.

There is no need to get concerned about ectopics or minor irregularities in heart rate. These are pretty common and not a cause for concern. The mentioned reports are normal and the ejection fraction indicates good cardiac functional health. Stay relaxed and maintain a healthy lifestyle.

Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
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Dr. Prof. Kunal Saha

General & Family Physician

Practicing since :1954

Answered : 4471 Questions

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Suggest treatment for severe sleep apnea and spikes of tachycardia after eating

Brief Answer: Nadolol is a better drug (in terms of half life) for similar mode of action Detailed Answer: Thanks for asking on HealthcareMagic. I am really glad that you liked the site. I have gone carefully through the details. Let me mention that at your weight, you can perhaps expect much more health hazards that you might really be presently experiencing. So, cutting down on your weight would be a key to a healthy life. Now, let me come to your questions: * It seems to me that you were having atrial ectopic beats. They are pretty common and may manifest with heart rate irregularities like this. Other types of arrhythmias are possible but I doubt if it is atrial fibrillation (afib). In any case, i is really hard to comment without getting an ECG. In any case, the medicines like nadolol or lopressor would bring it in control. * Maximum serum concentrations of Nadolol is reached in 2 to 4 hours after oral administration, while steady state serum concentrations are reached after 6 to 9 days. The serum half-life is 20 to 24 hours at therapeutic doses. On the other hand, for Lopressor (Metoprolol), the half-life ranges from approximately 3 to 7 hours. Hence, the serum concentration falls and multiple doses are essential per day. Nadolol is much better off in this regard. Hope that helps. Regards Dr. Kunal Saha