Brief Answer:
I recommend as follows:

Detailed Answer:
Hello!

Thank you for asking on HCM!

I reviewed all your reports, and would conclude that an ambulatory 24-48 hours ECG monitoring (Holter) is necessary to optimally investigate, whether we have to do only with ectopic beats (extra systoles), or other cardio-arrhythmic events as well.

Your heart rate is very fluctuant and it is important a direct view of the ECG recording of a continuous ECG recordings.

That's why I recommend Holter monitoring.

Further blood lab tests like:
- complete blood count
- thyroid hormone levels
- blood electrolytes
- fasting glucose
- kidney and liver function tests, etc

are needed to exclude other possible metabolic causes, related to these heart rate fluctuations.

I would also advise avoiding all possible triggering factors of cardiac arrhythmia like caffeine and illicit drugs.

Regarding your other complain (spitting up blood), I would explain that it is not related to any cardiac disorder.

You blood spitting up is related to coughing or spontaneous?
Do you have other symptoms like chest pain, burning sensations after eating etc?

I recommend consulting with the ENT specialist to examine your upper respiratory airways.

Further tests are needed such as: a chest x ray and airways endoscopy to examine the lower airways and rule in /out any possible lesions of these ways (like bronchitis, bronchectasia, etc). ( In such a case blood spitting is associated with coughing)

A gastro-intestinal endoscopy is needed to examine your digestive tract, if suspicions of a gastro intestinal cause (like esophagitis, hiatal hernia etc) are raised. ( In such a case the blood is usually coming out with vomiting).

You blood spitting up is related to coughing or spontaneous?
Do you have other symptoms like chest pain, burning sensations after eating etc?

Hope to have been helpful!

I am at your disposal if you have any further questions.

Best wishes,

Dr. Iliri

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Brief Answer:
I recommend to perform the other mentioned tests

Detailed Answer:
Hello again!

Thank you for the information provided.

A resting ECG can not exclude cardiac arrhythmia, during the day or night. So I recommend continuing with the ambulatory 24-48 hour ECG monitoring, which will help to examine your heart rhythm during these period.

Regarding the chest CT scan, it can exclude major lung disorders or a hiatal hernia related to the blood spitting.

But you should continue with the other tests that I mentioned before, to examine better the mucosa of the upper and lower respiratory ways and the gastro-intestinal ways, for possible irritations or small lesions of the mucosa, non detectable by the CT scan.

Hope to have been helpful!

Best regards,

Dr. Iliri

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Brief Answer:
Diltiazem (cardizem) seems to be a good choice.

Detailed Answer:

Hello again,

Coming to this point, as coronary spasms are confirmed, calcium channel blockers would be an optimal choice, to prevent further spasms occurrences.

So diltiazem is a good choice.

If used under medical prescriptions, its heart rate lowering effects are not problematic.

So don't worry about them.

Just perform regularly scheduled follow ups.

Regards,

Dr. Iliri

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