Brief Answer:
I would explain as follows:

Detailed Answer:

Hello Andy!

Thank you for asking on HCM!

Regarding your concern, I would like to explain that after having meals, a heart rate increase is a normal physiological response. Probably 110 bpm is a bit high, but it is necessary to further investigate if this is an exaggerated intrinsic chronotropic response, or is related to any possible pathological disorders.

Even an excess meal may raise the diaphragm level and impede the heart form normal functioning in its usual position.

Also, heart rate is normally lower when lying than sitting. So, nothing to worry about!

But, if your heart rate is persistently high, and associated with clinical symptomatology (heart palpitations and other associated symptoms), it is necessary to perform a comprehensive medical checkup.

First, cardiac auscultation, a resting ECG and if suspicions are raised a cardiac ultrasound and especially an ambulatory 24 to 48 hours ECG monitoring would be necessary to analyze the day-night heart rate trends and give a full response to the fact (is tachycardia persistently present or not).

If tachycardia is abnormally present (incompatible with psychological and physical stress), then a comprehensive diagnostic work up is necessary.

After a careful physical exam, some blood tests would be helpful:

- A complete blood count, PCR, etc. would rule in/out a possible anemia or inflammation/infection.

- A chest X ray study, eventual cardiac ultrasound, an arterial blood gas analysis will be helpful to rule in/out possible pulmonary disorders, leading to hypoxemia, acidosis, pulmonary hypertension, or mixed cardio-pulmonary implications, etc. which consequently would lead to excessive tachycardia.

- Thyroid hormone levels, fasting blood glucose, HbA1c, etc. would clarify possible hyperthyroidism, or diabetes (which leads to neuropathy) and consequently to persistent tachycardia.

- Other reasons of possible persistent tachycardia may be some forms of orthostatic intolerance (if other disorders are excluded). A Head up Tilt test would be helpful to clarify this issue.

Hope to have been helpful to you!

Feel free to ask me whenever you need! Greetings! Dr. Iliri

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Brief Answer:
A Holter monitoring would clarify heart rate tends issue.

Detailed Answer:
OK XXXX!

Seems that you have performed a good proportion of the recommended diagnostic work up.

Psoriatic arthritis may be associated with tachycardia. I exclude a heart inflammation disorder (pericarditis, myocardiis, endocarditis), as there are no associated clinical signs and symptoms to confirm.

A pulmonary thromboembolism may be a reason of tachycardia, but it is presented within a special clinical picture (severe sudden respiratory distress, an altered blood gas test, etc). It is not just an after meal tachycardia phenomenon.

Best regards,

Dr. Iliri

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Brief Answer:
Nothing to worry about!

Detailed Answer:

Hi again, XXXX!

There is no need for any treatments. As long as your heart rate varies around there ranges, and it keeps going only on normal sinus rhythm, there is nothing to worry about. No need for Plavix or Warfarin!

Physical activity is highly recommended (if no contraindications imposed by arthritis exist), as it helps to better modulate your chronotropic response to several daily stressful conditions, as well as to realize a beneficial myocardial conditioning.

I wish you a good health! Dr. Iliri

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Brief Answer:
A differential diagnosis is necessary.

Detailed Answer:

Hi XXXX!

If your diastolic blood pressure is persistently low (like around 55mmHg), especially when associated with low systolic BP and clinical symptomatology (excess weakness), them further investigations are necessary.

First of all, a close BP monitoring for a couple of days (several times daily), is necessary, to better judge about day-night BP trends.

A decreased cardiac performance (right and left ventricles), including also any important cardiac valves dysfunctions (by cardiac ultrasound), should be ruled out.

An overall medical check up to exclude any chronic organs disorders is helpful in the differential diagnosis process.

If everything result normal, a probable orthostatic intolerance should be sought (especially if the low BP is associated with an immediate standing up position or the prolonged standing upright).

Hope to have been helpful! Greetings! Dr. Iliri

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Brief Answer:
A careful medical check up may rule out this possibility.

Detailed Answer:

Hi XXXX!

Sure! As I have explained you at the beginning of our thread, the role of diaphragm position is important for normal heart functioning (as it severs like a kind of support).

A hiatal hernia could also be a reason for such a symptomatology. It is ruled out by several imagine tests (including GI endoscopy).

Wish you a good health! Dr. Iliri

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Brief Answer:
I would explain as follows:

Detailed Answer:

Hi again, dear XXXX!

Sweating and palpitations (increased heart rate) after meals may be explained in several ways (as a clear cut consensus over this clinical picture doesn't exist):

a) When the stomach volume is increased after meals, stretching of the gastric walls, leads to the expression of the so called "gastro-cutaneous reflex" demonstrated by the above complains.

In certain individuals, has been found a more heightened response of such a reflex. But, this is not a disease.

b) Another explanation of the above clinical scenario, tries to connect the symptoms with a postprandial hypoglycemia, as a result of increased insulin production.

c) In a subgroup of individuals, especially in diabetics, it is found what is called "gustatory sweating", expressed with sweating after eating. It often involves profuse sweating on both sides of your face, scalp, neck and chest. The reasons are not well understood, but some implications of possible neuropathy or nephropathy have been found responsible.

These are possible explanations of your complains. You should consult with your attending doctor about all the above mentioned opinions, so he could properly drive you through the diagnostic process.

Hope to have been helpful to you!

If you have further uncertainties in the future, do not hesitate to ask me!

Wish you a good health! Dr. Iliri

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Brief Answer:
You should talk to your attending doctor about the several options.

Detailed Answer:

As salads cause more stomach distension than a smoothy, it is more possible for gastro-cutaneous reflex to happen.

Greetings!

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