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I Have Skipped Beats On Exercise Does It Mean I Have Heart Failure?
Question: I keep getting notices about heart failure on my emails..just because I have skipped beats on exercise does it mean I have heart failure? Is it true on my elevated heart rate sessions with exercise indicates a heart failure or could it just be anxiety? I have never had skipped heartbeats on exercise before now I get them all the time.. my echo is ok and holter monitor shows non dangerous skipped beats like pvcs..!but why all of the sudden I am getting skipped beats on exercise?
Brief Answer:
No, it does not mean heart failure
Detailed Answer:
Hello,
Skipped beats do not necessarily mean heart failure, however they can occur in patients with heart failure (so their presence is not helpful in heart failure diagnosis). And its expected for heart rate to go up with exercise. Most important thing in you would be symptoms like new onset breathlessness on exertion, chest pain or heaviness on exertion (which I guess are not there). So there are no definite indicators of heart failure in you. Anyways, normal echo rules it out.
Now regarding skipped beats, firstly they can be benign and harmless, and can occur at any age without any obvious cause, but at this age the possibility of ischemic heart disease should be ruled out with stress test (like treadmill test) or CT coronary angiography (Just screening, doesn't mean you have ischemic heart disease). Other precipitating factors would be stress, sleep disturbances, addiction or too much coffee, thyroid disorders etc. So thyroid profile should also be done. We would also want to rule out electrolyte disturbances, so if you not had any tests recently for electrolytes then should have one like potassium, magnesium, calcium level.
So usually these are benign, but priority is to rule out possibility of ischemic heart disease by undergoing stress test or CT coronary angiography.
Hope this helps you and get back if you have any doubts.
No, it does not mean heart failure
Detailed Answer:
Hello,
Skipped beats do not necessarily mean heart failure, however they can occur in patients with heart failure (so their presence is not helpful in heart failure diagnosis). And its expected for heart rate to go up with exercise. Most important thing in you would be symptoms like new onset breathlessness on exertion, chest pain or heaviness on exertion (which I guess are not there). So there are no definite indicators of heart failure in you. Anyways, normal echo rules it out.
Now regarding skipped beats, firstly they can be benign and harmless, and can occur at any age without any obvious cause, but at this age the possibility of ischemic heart disease should be ruled out with stress test (like treadmill test) or CT coronary angiography (Just screening, doesn't mean you have ischemic heart disease). Other precipitating factors would be stress, sleep disturbances, addiction or too much coffee, thyroid disorders etc. So thyroid profile should also be done. We would also want to rule out electrolyte disturbances, so if you not had any tests recently for electrolytes then should have one like potassium, magnesium, calcium level.
So usually these are benign, but priority is to rule out possibility of ischemic heart disease by undergoing stress test or CT coronary angiography.
Hope this helps you and get back if you have any doubts.
Above answer was peer-reviewed by :
Dr. Kampana
I have exercised for years and have never experienced anything like this.. I do not drink coffee drink or smoke.. I exercise everyday..I do not experience breathlessness or dizziness or pain during exercise.. I have had a echo test and a ct screening calcium test 6 years ago and it was at 0.. do I need to redo? I had a stress test 6 years ago too it was fine..do I need to redo that too? They have me taking a beta blocker 12.5 but it drops my blood pressure to 91/58! But it does stop the skipped beats but low blood pressure is bad too right? Does the frequency of these skipped heart beats usually indicate more serious heart disease?
I have exercised for years and have never experienced anything like this.. I do not drink coffee drink or smoke.. I exercise everyday..I do not experience breathlessness or dizziness or pain during exercise.. I have had a echo test and a ct screening calcium test 6 years ago and it was at 0.. do I need to redo? I had a stress test 6 years ago too it was fine..do I need to redo that too? They have me taking a beta blocker 12.5 but it drops my blood pressure to 91/58! But it does stop the skipped beats but low blood pressure is bad too right? Does the frequency of these skipped heart beats usually indicate more serious heart disease?
Brief Answer:
See the description
Detailed Answer:
Hello,
Did you undergo CT coronary angiography or non contrast CT just to see calcium score ? If you have had CT coronary angiography and if it was absolutely clear then need not repeat. However if it was just calcium score then you should undergo stress test atleast like treadmill test, because arteries may harbor some blockages despite calcium score being 0, as the blockages might have been there without calcium. You need undergo both tests again, either of two is fine.
PVCS burden more than 10 percent (number of pvcs against total number of beats), which is quite high number, is bit worrisome issue and needs treatment. Below that may be just observed. Also, PVCS (Skipped beats) occurring continuously without normal beats has also got somewhat poor prognosis, especially 3 or more in row (even 2 in a row).
Metoprolol 12.5 mg is low dose and should not affect the BP significantly.
Now is it like that your baseline BP itself is low? Because in some individuals may have BP on lower side normally as well. If your baseline BP itself is in the range of 100 then no harm in having it if you not getting any symptoms due to low BP like dizziness or blackouts, excessive fatigue.
But if not then 90 systolic BP is not acceptable and we should try to maintain it atleast 100 systolic. Alternatively you may check your prior to every dose and if it's more than 110 to 120 then have it.
All the best
See the description
Detailed Answer:
Hello,
Did you undergo CT coronary angiography or non contrast CT just to see calcium score ? If you have had CT coronary angiography and if it was absolutely clear then need not repeat. However if it was just calcium score then you should undergo stress test atleast like treadmill test, because arteries may harbor some blockages despite calcium score being 0, as the blockages might have been there without calcium. You need undergo both tests again, either of two is fine.
PVCS burden more than 10 percent (number of pvcs against total number of beats), which is quite high number, is bit worrisome issue and needs treatment. Below that may be just observed. Also, PVCS (Skipped beats) occurring continuously without normal beats has also got somewhat poor prognosis, especially 3 or more in row (even 2 in a row).
Metoprolol 12.5 mg is low dose and should not affect the BP significantly.
Now is it like that your baseline BP itself is low? Because in some individuals may have BP on lower side normally as well. If your baseline BP itself is in the range of 100 then no harm in having it if you not getting any symptoms due to low BP like dizziness or blackouts, excessive fatigue.
But if not then 90 systolic BP is not acceptable and we should try to maintain it atleast 100 systolic. Alternatively you may check your prior to every dose and if it's more than 110 to 120 then have it.
All the best
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Brief Answer:
See the description
Detailed Answer:
Hello,
Did you undergo CT coronary angiography or non contrast CT just to see calcium score ? If you have had CT coronary angiography and if it was absolutely clear then need not repeat. However if it was just calcium score then you should undergo stress test atleast like treadmill test, because arteries may harbor some blockages despite calcium score being 0, as the blockages might have been there without calcium. You need undergo both tests again, either of two is fine.
PVCS burden more than 10 percent (number of pvcs against total number of beats), which is quite high number, is bit worrisome issue and needs treatment. Below that may be just observed. Also, PVCS (Skipped beats) occurring continuously without normal beats has also got somewhat poor prognosis, especially 3 or more in row (even 2 in a row).
Metoprolol 12.5 mg is low dose and should not affect the BP significantly.
Now is it like that your baseline BP itself is low? Because in some individuals may have BP on lower side normally as well. If your baseline BP itself is in the range of 100 then no harm in having it if you not getting any symptoms due to low BP like dizziness or blackouts, excessive fatigue.
But if not then 90 systolic BP is not acceptable and we should try to maintain it atleast 100 systolic. Alternatively you may check your prior to every dose and if it's more than 110 to 120 then have it.
All the best
See the description
Detailed Answer:
Hello,
Did you undergo CT coronary angiography or non contrast CT just to see calcium score ? If you have had CT coronary angiography and if it was absolutely clear then need not repeat. However if it was just calcium score then you should undergo stress test atleast like treadmill test, because arteries may harbor some blockages despite calcium score being 0, as the blockages might have been there without calcium. You need undergo both tests again, either of two is fine.
PVCS burden more than 10 percent (number of pvcs against total number of beats), which is quite high number, is bit worrisome issue and needs treatment. Below that may be just observed. Also, PVCS (Skipped beats) occurring continuously without normal beats has also got somewhat poor prognosis, especially 3 or more in row (even 2 in a row).
Metoprolol 12.5 mg is low dose and should not affect the BP significantly.
Now is it like that your baseline BP itself is low? Because in some individuals may have BP on lower side normally as well. If your baseline BP itself is in the range of 100 then no harm in having it if you not getting any symptoms due to low BP like dizziness or blackouts, excessive fatigue.
But if not then 90 systolic BP is not acceptable and we should try to maintain it atleast 100 systolic. Alternatively you may check your prior to every dose and if it's more than 110 to 120 then have it.
All the best
Above answer was peer-reviewed by :
Dr. Nagamani Ng
I only had the screening test for ct calcium of the heart..my doctor did not want to do the stress test because I don’t have any other symptoms like pain dizziness or shortness of breath.. should I go to another doctor? I have had spikes of blood pressure due to anxiety over the years but have controlled it with exercise .. would that cause these problems? I do not understand why I am having so many during exercise .. it was so sudden .. one day they just appeared..I would have an occasional one before ..I have the holter info I will send you.. my heart rate has always been on the high side of normal but my blood pressure has been pretty good except for occasional spikes.. will they go away ? What kind of problems will this lead to for me in the future.. can I continue to exercise?
I only had the screening test for ct calcium of the heart..my doctor did not want to do the stress test because I don’t have any other symptoms like pain dizziness or shortness of breath.. should I go to another doctor? I have had spikes of blood pressure due to anxiety over the years but have controlled it with exercise .. would that cause these problems? I do not understand why I am having so many during exercise .. it was so sudden .. one day they just appeared..I would have an occasional one before ..I have the holter info I will send you.. my heart rate has always been on the high side of normal but my blood pressure has been pretty good except for occasional spikes.. will they go away ? What kind of problems will this lead to for me in the future.. can I continue to exercise?
Brief Answer:
Holter shows predominantly PACs and PVCs
Detailed Answer:
Hello,
Your holter monitoring predominantly shows PACs and occasional PVCs. And your symptoms correlated to these PACs and not PVCs. PACs are atrial ectopics and less worrisome than PVCs. So with this, you need not undergo repeat stress test.
This is primarily an age related issue with some contribution from hypertension, anxiety etc. Anxiety may precipitate these.
These may come in episodes and subsequently may vanish. The risk associated with those is that of transition of these PACs to atrial fibrillation. However they are occassional now and are more likely to subside in you.
Atrial fibrillation if happened, puts one at a risk of stroke, so one has to be blood thinners subsequently. At present, you don't need one.
You should try to be on beta blockers as they are suppressing those, and subsequently may be withdrawn. However intermittently you ll need holter monitoring just to keep a check over these and see if you are having atrial fibrillation. You may continue to exercise, however since exercises are precipitating these, avoid heavy activities for few days and subsequently may resume.
I guess you are not obese or have history of snoring or suspicion of OSA, which should be ruled out, as it can cause it.
So it's not a worrisome issue, but keep some watch.
Holter shows predominantly PACs and PVCs
Detailed Answer:
Hello,
Your holter monitoring predominantly shows PACs and occasional PVCs. And your symptoms correlated to these PACs and not PVCs. PACs are atrial ectopics and less worrisome than PVCs. So with this, you need not undergo repeat stress test.
This is primarily an age related issue with some contribution from hypertension, anxiety etc. Anxiety may precipitate these.
These may come in episodes and subsequently may vanish. The risk associated with those is that of transition of these PACs to atrial fibrillation. However they are occassional now and are more likely to subside in you.
Atrial fibrillation if happened, puts one at a risk of stroke, so one has to be blood thinners subsequently. At present, you don't need one.
You should try to be on beta blockers as they are suppressing those, and subsequently may be withdrawn. However intermittently you ll need holter monitoring just to keep a check over these and see if you are having atrial fibrillation. You may continue to exercise, however since exercises are precipitating these, avoid heavy activities for few days and subsequently may resume.
I guess you are not obese or have history of snoring or suspicion of OSA, which should be ruled out, as it can cause it.
So it's not a worrisome issue, but keep some watch.
Above answer was peer-reviewed by :
Dr. Yogesh D
Brief Answer:
Holter shows predominantly PACs and PVCs
Detailed Answer:
Hello,
Your holter monitoring predominantly shows PACs and occasional PVCs. And your symptoms correlated to these PACs and not PVCs. PACs are atrial ectopics and less worrisome than PVCs. So with this, you need not undergo repeat stress test.
This is primarily an age related issue with some contribution from hypertension, anxiety etc. Anxiety may precipitate these.
These may come in episodes and subsequently may vanish. The risk associated with those is that of transition of these PACs to atrial fibrillation. However they are occassional now and are more likely to subside in you.
Atrial fibrillation if happened, puts one at a risk of stroke, so one has to be blood thinners subsequently. At present, you don't need one.
You should try to be on beta blockers as they are suppressing those, and subsequently may be withdrawn. However intermittently you ll need holter monitoring just to keep a check over these and see if you are having atrial fibrillation. You may continue to exercise, however since exercises are precipitating these, avoid heavy activities for few days and subsequently may resume.
I guess you are not obese or have history of snoring or suspicion of OSA, which should be ruled out, as it can cause it.
So it's not a worrisome issue, but keep some watch.
Holter shows predominantly PACs and PVCs
Detailed Answer:
Hello,
Your holter monitoring predominantly shows PACs and occasional PVCs. And your symptoms correlated to these PACs and not PVCs. PACs are atrial ectopics and less worrisome than PVCs. So with this, you need not undergo repeat stress test.
This is primarily an age related issue with some contribution from hypertension, anxiety etc. Anxiety may precipitate these.
These may come in episodes and subsequently may vanish. The risk associated with those is that of transition of these PACs to atrial fibrillation. However they are occassional now and are more likely to subside in you.
Atrial fibrillation if happened, puts one at a risk of stroke, so one has to be blood thinners subsequently. At present, you don't need one.
You should try to be on beta blockers as they are suppressing those, and subsequently may be withdrawn. However intermittently you ll need holter monitoring just to keep a check over these and see if you are having atrial fibrillation. You may continue to exercise, however since exercises are precipitating these, avoid heavy activities for few days and subsequently may resume.
I guess you are not obese or have history of snoring or suspicion of OSA, which should be ruled out, as it can cause it.
So it's not a worrisome issue, but keep some watch.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you so much..just one more question any signs of long qt syndrome? I appreciate you so much!!
Thank you so much..just one more question any signs of long qt syndrome? I appreciate you so much!!
Also my heart looks structurally sound based on the echo correct..thanks again so much!!!!
Also my heart looks structurally sound based on the echo correct..thanks again so much!!!!
Brief Answer:
Grade I diastolic dysfunction
Detailed Answer:
You are welcome.
There is a grade I diastolic dysfunction, which is again an age or hypertension-related issue and not worrisome, and no treatment is needed.
For QTc, I will need your 12 lead ECG. Here holter machine has interpreted as >450 msec, but not specified the exact value. Up to 460 msec is normal, even up to 470 msec is considered fine in some literature. So it might be all right, otherwise, your doctor would have pointed it out.
All the best.
Grade I diastolic dysfunction
Detailed Answer:
You are welcome.
There is a grade I diastolic dysfunction, which is again an age or hypertension-related issue and not worrisome, and no treatment is needed.
For QTc, I will need your 12 lead ECG. Here holter machine has interpreted as >450 msec, but not specified the exact value. Up to 460 msec is normal, even up to 470 msec is considered fine in some literature. So it might be all right, otherwise, your doctor would have pointed it out.
All the best.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Brief Answer:
Grade I diastolic dysfunction
Detailed Answer:
You are welcome.
There is a grade I diastolic dysfunction, which is again an age or hypertension-related issue and not worrisome, and no treatment is needed.
For QTc, I will need your 12 lead ECG. Here holter machine has interpreted as >450 msec, but not specified the exact value. Up to 460 msec is normal, even up to 470 msec is considered fine in some literature. So it might be all right, otherwise, your doctor would have pointed it out.
All the best.
Grade I diastolic dysfunction
Detailed Answer:
You are welcome.
There is a grade I diastolic dysfunction, which is again an age or hypertension-related issue and not worrisome, and no treatment is needed.
For QTc, I will need your 12 lead ECG. Here holter machine has interpreted as >450 msec, but not specified the exact value. Up to 460 msec is normal, even up to 470 msec is considered fine in some literature. So it might be all right, otherwise, your doctor would have pointed it out.
All the best.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
I am still waiting for my ekg report.. since I have been taking the beta blocker my blood sugar has gone from 86 to 150! Is this a side effect of a beta blocker.. I have always been borderline 86-99 but never have I been so high! Is there another drug that helps with skipped beats that does not raise blood sugar?
I am still waiting for my ekg report.. since I have been taking the beta blocker my blood sugar has gone from 86 to 150! Is this a side effect of a beta blocker.. I have always been borderline 86-99 but never have I been so high! Is there another drug that helps with skipped beats that does not raise blood sugar?
Brief Answer:
Yes beta blockers may raise sugar
Detailed Answer:
Hello,
Beta blockers can elevate sugar, however 12.5 mg is low dose and a bit unusual to raise sugar this much. So we should try to find out some other reasons as well like changes in diet, reduction in exercise, stress or sleep disturbances etc. And I guess your previous reading of 86 was just before the initiation of metoprolol (and not few months ago), because if it was a old reading then sugar elevation might be a part of impaired glucose tolerance or diabetes only.
However if there is strong correlation with metoprolol then it should be attributed to it. But for atrial ectopics, do not have a very good drug as effective as it to suppress it, obviously other than anti arrhythmics. However in this scenario, we may try calcium channel blocker, and if not effective then can be low dose antiarrythmics for some time.
Yes beta blockers may raise sugar
Detailed Answer:
Hello,
Beta blockers can elevate sugar, however 12.5 mg is low dose and a bit unusual to raise sugar this much. So we should try to find out some other reasons as well like changes in diet, reduction in exercise, stress or sleep disturbances etc. And I guess your previous reading of 86 was just before the initiation of metoprolol (and not few months ago), because if it was a old reading then sugar elevation might be a part of impaired glucose tolerance or diabetes only.
However if there is strong correlation with metoprolol then it should be attributed to it. But for atrial ectopics, do not have a very good drug as effective as it to suppress it, obviously other than anti arrhythmics. However in this scenario, we may try calcium channel blocker, and if not effective then can be low dose antiarrythmics for some time.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Brief Answer:
Yes beta blockers may raise sugar
Detailed Answer:
Hello,
Beta blockers can elevate sugar, however 12.5 mg is low dose and a bit unusual to raise sugar this much. So we should try to find out some other reasons as well like changes in diet, reduction in exercise, stress or sleep disturbances etc. And I guess your previous reading of 86 was just before the initiation of metoprolol (and not few months ago), because if it was a old reading then sugar elevation might be a part of impaired glucose tolerance or diabetes only.
However if there is strong correlation with metoprolol then it should be attributed to it. But for atrial ectopics, do not have a very good drug as effective as it to suppress it, obviously other than anti arrhythmics. However in this scenario, we may try calcium channel blocker, and if not effective then can be low dose antiarrythmics for some time.
Yes beta blockers may raise sugar
Detailed Answer:
Hello,
Beta blockers can elevate sugar, however 12.5 mg is low dose and a bit unusual to raise sugar this much. So we should try to find out some other reasons as well like changes in diet, reduction in exercise, stress or sleep disturbances etc. And I guess your previous reading of 86 was just before the initiation of metoprolol (and not few months ago), because if it was a old reading then sugar elevation might be a part of impaired glucose tolerance or diabetes only.
However if there is strong correlation with metoprolol then it should be attributed to it. But for atrial ectopics, do not have a very good drug as effective as it to suppress it, obviously other than anti arrhythmics. However in this scenario, we may try calcium channel blocker, and if not effective then can be low dose antiarrythmics for some time.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you so much for your detailed answers!! When I was thinking back I started taking the generic form of norvasc alphodophine.. the first night I took it I started having lots of skipped beats on the elliptical I called my doctor and they told me to keep taking it so I did .. they said I would adjust to it.. I guess I finally because the etopmics went away.. I stopped taking the drug because my bp got too low.. about a week later I had more skipped beats.. would that have caused these.. can I take norvasc would it suppress the skipped heartbeats? I could take a lower dose ..
Thank you so much for your detailed answers!! When I was thinking back I started taking the generic form of norvasc alphodophine.. the first night I took it I started having lots of skipped beats on the elliptical I called my doctor and they told me to keep taking it so I did .. they said I would adjust to it.. I guess I finally because the etopmics went away.. I stopped taking the drug because my bp got too low.. about a week later I had more skipped beats.. would that have caused these.. can I take norvasc would it suppress the skipped heartbeats? I could take a lower dose ..
I just do not like the idea of this blood sugar! I have enough problems with the skipped beats! The fact that I have so many of them at exercise .. you don’t think I need a stress echo? Thanks so much .. I have learned so much from you! My doctor just told me not to drink caffeine reduce my stress and exercise! I have found out so much from you!! Am I over stressing about this?
I just do not like the idea of this blood sugar! I have enough problems with the skipped beats! The fact that I have so many of them at exercise .. you don’t think I need a stress echo? Thanks so much .. I have learned so much from you! My doctor just told me not to drink caffeine reduce my stress and exercise! I have found out so much from you!! Am I over stressing about this?
Do I really need to even take a drug if my blood pressure is ok most of the time ? Thanks soooo much!!!
Do I really need to even take a drug if my blood pressure is ok most of the time ? Thanks soooo much!!!
Brief Answer:
Norvasc unlikely to help you
Detailed Answer:
As these are atrial ectopics, which are usually not worrisome or dangerous (only risk is of progression to atrial fibrillation) and are usually not caused by blockages, stress test is not absolutely necessary for this purpose. However in general considering your age, its advisable to have treadmill test every five years as screening test.
Norvasc (amlodipine) is a different type calcium channel blocker, and its unlikely to help you suppress ectopics. Its diltiazem (it's also a calcium channel blocker), which can suppress these ectopics.
You need not be on medications, if BP is alright. You may have medications to suppress these ectopics, if these are giving you lot of symptoms, otherwise may just observe.
All the best.
Norvasc unlikely to help you
Detailed Answer:
As these are atrial ectopics, which are usually not worrisome or dangerous (only risk is of progression to atrial fibrillation) and are usually not caused by blockages, stress test is not absolutely necessary for this purpose. However in general considering your age, its advisable to have treadmill test every five years as screening test.
Norvasc (amlodipine) is a different type calcium channel blocker, and its unlikely to help you suppress ectopics. Its diltiazem (it's also a calcium channel blocker), which can suppress these ectopics.
You need not be on medications, if BP is alright. You may have medications to suppress these ectopics, if these are giving you lot of symptoms, otherwise may just observe.
All the best.
Above answer was peer-reviewed by :
Dr. Yogesh D
Brief Answer:
Norvasc unlikely to help you
Detailed Answer:
As these are atrial ectopics, which are usually not worrisome or dangerous (only risk is of progression to atrial fibrillation) and are usually not caused by blockages, stress test is not absolutely necessary for this purpose. However in general considering your age, its advisable to have treadmill test every five years as screening test.
Norvasc (amlodipine) is a different type calcium channel blocker, and its unlikely to help you suppress ectopics. Its diltiazem (it's also a calcium channel blocker), which can suppress these ectopics.
You need not be on medications, if BP is alright. You may have medications to suppress these ectopics, if these are giving you lot of symptoms, otherwise may just observe.
All the best.
Norvasc unlikely to help you
Detailed Answer:
As these are atrial ectopics, which are usually not worrisome or dangerous (only risk is of progression to atrial fibrillation) and are usually not caused by blockages, stress test is not absolutely necessary for this purpose. However in general considering your age, its advisable to have treadmill test every five years as screening test.
Norvasc (amlodipine) is a different type calcium channel blocker, and its unlikely to help you suppress ectopics. Its diltiazem (it's also a calcium channel blocker), which can suppress these ectopics.
You need not be on medications, if BP is alright. You may have medications to suppress these ectopics, if these are giving you lot of symptoms, otherwise may just observe.
All the best.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you so much Doctor!!! I know I took a lot of your time but I really appreciate the information you gave me ! You are a wonderful doctor!!!!
Thank you so much Doctor!!! I know I took a lot of your time but I really appreciate the information you gave me ! You are a wonderful doctor!!!!
Brief Answer:
Thank you very much
Detailed Answer:
Thank you very much. All the best.
Thank you very much
Detailed Answer:
Thank you very much. All the best.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Brief Answer:
Thank you very much
Detailed Answer:
Thank you very much. All the best.
Thank you very much
Detailed Answer:
Thank you very much. All the best.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
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