Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I read carefully your question and reviewed all your tests results. I would explain that two main issues are to be considered as possibly related to your symptomatology:

1. Sick Sinus Syndrome. This disorder could be related to your heart rate changes and the episodes of bradycardia.

I would recommend performing an ambulatory 24-48 hours ECG monitoring to examine your heart rhythm trends during the day. (A normal resting ECG does not exclude this possibility).
Another test to be done would be atropine test, which would help examine the chronotropic response of the heart.

If the diagnosis of Sick sinus syndrome is confirmed, you should discuss with your doctor the possibility of pacemaker implantation.

2. Orthostatic intolerance. This disorder could explain the blurry vision, dizziness and light headedness when standing up.

I would recommend you to measure your blood pressure during sitting position and then in standing up position (after 5 minutes of standing up). A decrease in your systolic blood pressure more than 20mm Hg during standing position, compared to sitting position, would indicate an orthostatic intolerance.

A head up tilt test is necessary to rule in/out this possible diagnosis.

I would also advise you to perform some other blood lab tests (complete blood tests for chronic anemia, inflammation tests, blood electrolytes, thyroid hormone levels), to exclude other secondary metabolic causes that may aggravate your situation.

Regarding the other tests:

-Your blood glucose seems to be within the normal limits.
-Your blood pressure is normal too.

Regarding your insomnia problems, I would recommend taking zolpidem 10mg half a tablet or a full tablet for two weeks, in addition to melatonin. It will help stabilize your sleep problems. It is not recommended to take zolpidem for a prolonged time, because it can lead to addiction and tolerance. But after 2 weeks of intake before sleep, you can switch to every other day for a week and than occasional use (not regular).
You should also try to regulate your sleeping regime:
-avoid caffeine intake in the afternoon or evening
-avoid physical or emotional stress in the evening
-try to go to sleep at the same time, even if you don't sleep. stay in the dark with eye closed. This will help.

Hope you will find this answer helpful!

Feel free to ask any other questions whenever you need!

Kind regards,

Dr. Iliri

---

Brief Answer:
I would explain:

Detailed Answer:

Hi again, XXXXXXX

- Regarding your blood pressure changes (sitting/upright position), it is important the BP measures be performed consecutively, not in different periods of the day apart.


- Your heart rate may be around 60 bpm when checking the pulse or examining a resting ECG, but we can't be sure whether sharp heart rate fluctuations or even important cardiac conductance disturbances are present or no during the entire day-night interval.

- You should know that even a persistent bradycardia without any additional abnormality may be sufficient to rule in sick sinus syndrome. (In such case atropine test could be helpful).

Normally, when engaging in more intensive physical exertion (starting from standing up) heart response should be adequate in supplying with more blood skeletal muscles and several organs, fulfilling thus all the body demands. This is accomplished by increasing proportionally heart rate in addition to other compensatory measures.

In sick sinus syndrome these compensatory mechanisms are not present (heart rate does not increase proportionally), leading to body weakness, blurred vision, dizziness, etc.

That's why you need to perform an ambulatory 24 to 48 hours ECG monitoring (Holter). If cardiac conductance abnormalities (sino-atrial block, atrio-ventricular blocks, ventricular pauses, etc.), persistent bradycardia and/or supraventricular arrhythmia are interchangeably present, sick sinus syndrome would be confirmed.

- In such case a pacemaker implantation would prevent your heart from beating intermittently too slowly, avoiding the above symptoms.

Dear XXXXXXX

I hope that my explanations have clarified your uncertainties.

Nevertheless, feel free to ask me again whenever you need.

Meanwhile, I recommend you discussing with your attending doctor on all the above mentioned issues.

Best wishes,

Dr. Iliri

---

Brief Answer:
I would not recommend taking any of these supplements.

Detailed Answer:
Hello again Jim!

Here are my answers to your questions:

1.You should know that there is not enough clinical data based evidence to support the benefits of Arjuna and Ashwagandhia.
There are only some isolated studies, with small number of patients that have shown Ashwagandhia may be useful for chronic fatigue and to improve speed and lower limb muscular strength and neuro-muscular co-ordination. Arjuna may be useful to improve cardio-vascular endurance and lowering systolic blood pressure. But your blood pressure is normal. More studies are necessary to confirm these effects.
Besides, all these studies have been made in young adults and for short periods of time. The adverse effects of these drugs are unknown.

2. Regarding Shengongyangxin (SSYX), these studies are made in animals (rabbits). So they are in the initial phase of studies and have not been tried in humans. We can not conclude anything on the possible effects of these medicines on the human body and on the possible adverse effects.

As far as I know, there is no evidence to support the possible substitution of pacemaker to this medicine.

So I would not recommend neither of these drugs to be used in your clinical situation.

I would strongly encourage you to consult with your cardiologist and perform the tests I mentioned before.

Hope to have clarified some of your uncertainties!

Best wishes,

Dr. Iliri

---