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What Causes Pulsatile Tinnitus After A Meal?
Question: HELLO, my name is XXXXXXX For the past three weeks I have a problem immediately after eating a meal. Here is what happens. Within minutes I can basically hear in my ears the pounding of my heart. A quick wrist pulse check normally gives me a pulse of 48..this reading is most common. The pounding could last several minutes or could last a minute or could last several seconds. When the pounding stops there is a feeling of calmness. A quick pulse check gives me a pulse anywhere between 96-88-80-72. This bouncing of heart pounding and calmness normally lasts 1.5 to 2 hours after eating. What could be happening? I have no pain.On Oct.26,2016 is got so bad that I started to panic. Hyperventitation,totally dry mouth, dizzy, to the point of blacking out. I phoned 911. ECG was done. I was taken to a hospital for another ECG.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
I passed carefully through your recent medical history and would explain that your clinical symptomatology is likely to be related to what is called Roemheld syndrome.
It is a syndrome where triggering reflexes originated from the gastrointestinal system are manifested with cardiac symptoms.
Certain stimuli, like stomach distension (increased pressure within the stomach or over the bowel), mainly seen after eating may lead to over-stimulation of vagus nerve with subsequent low heart rate (bradycardia), abdominal and/or chest discomfort, fatigue, etc.
After that, a secondary catecholamines release to counteract the decrease in heart rate and blood pressure, may lead to increased heart rate, dry mouth, dizziness, breathing difficulty, etc.
That's why those symptoms are happening after you have your meals.
I recommend considering a more careful dietary plan; avoiding large meals (eating small portions instead) to decrease the potential triggering effect over mechanical receptors over the gastrointestinal walls; taking softer consistency foods and fluids.
Hope to have been helpful to you!
In case of any further uncertainties, feel free to ask me again!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
I passed carefully through your recent medical history and would explain that your clinical symptomatology is likely to be related to what is called Roemheld syndrome.
It is a syndrome where triggering reflexes originated from the gastrointestinal system are manifested with cardiac symptoms.
Certain stimuli, like stomach distension (increased pressure within the stomach or over the bowel), mainly seen after eating may lead to over-stimulation of vagus nerve with subsequent low heart rate (bradycardia), abdominal and/or chest discomfort, fatigue, etc.
After that, a secondary catecholamines release to counteract the decrease in heart rate and blood pressure, may lead to increased heart rate, dry mouth, dizziness, breathing difficulty, etc.
That's why those symptoms are happening after you have your meals.
I recommend considering a more careful dietary plan; avoiding large meals (eating small portions instead) to decrease the potential triggering effect over mechanical receptors over the gastrointestinal walls; taking softer consistency foods and fluids.
Hope to have been helpful to you!
In case of any further uncertainties, feel free to ask me again!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Good day Dr. Sharka. I have spent some time researching Roemheld syndrome and also the impact the vagus nerve has on the PNS and SNS systems. I am of the belief that my current extremely high stress level is playing a big factor with the Roemheld syndrome. Doctor do you have online access to my recent ECGs? In particular Aug.30,2016 and Oct.26,2016? There is a major change in the two ECG analysis. Is there a way of sending you an attachment online of the ECG analysis if you have no online access?
Brief Answer:
I would be happy to review your uploaded ECG!
Detailed Answer:
Hello again!
Please could you upload your ECG records as attachments on this question?
I would be happy to review them for another second professional opinion!
Greetings,
Dr. Iliri
I would be happy to review your uploaded ECG!
Detailed Answer:
Hello again!
Please could you upload your ECG records as attachments on this question?
I would be happy to review them for another second professional opinion!
Greetings,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr.Iliri,
I have just uploaded a document summarizing three ECGs: annual Aug.30,2016; ECG performed by EMS on Oct.26; and ECG at the hospital Oct.26,2016. I was released from the hospital within hours by Dr. Louw who informed my ECG was okay. Please note that my sinus bradycardia has been consistent for the past 15 years with vent.rates: 58,56,49,50. For years my morning resting pulse has basically been 52. During the day the pulse is in the 60's. May 11,2015 ECG also indicated "Incomplete Right bundle branch block".
I am a non smoker; non drinker; no carbonated drinks; no caffeine; no drugs. Only medication is synthroid. Have prided in healthy lifestyle and fitness.
Did develop an anxiety disorder after my father died in 1979 of pancreatic cancer.
I would appreciate another professional opinion. Thank you.
I have just uploaded a document summarizing three ECGs: annual Aug.30,2016; ECG performed by EMS on Oct.26; and ECG at the hospital Oct.26,2016. I was released from the hospital within hours by Dr. Louw who informed my ECG was okay. Please note that my sinus bradycardia has been consistent for the past 15 years with vent.rates: 58,56,49,50. For years my morning resting pulse has basically been 52. During the day the pulse is in the 60's. May 11,2015 ECG also indicated "Incomplete Right bundle branch block".
I am a non smoker; non drinker; no carbonated drinks; no caffeine; no drugs. Only medication is synthroid. Have prided in healthy lifestyle and fitness.
Did develop an anxiety disorder after my father died in 1979 of pancreatic cancer.
I would appreciate another professional opinion. Thank you.
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again, dear XXXX!
I carefully reviewed your uploaded ECG analysis results and would explain that incomplete Right Bundle Branch Block (iRBBB) is not a rare finding in normal healthy adults.
As long as you don’t have any specific cardiovascular symptomatology and your cardiac ultrasound does not reveal any abnormality, then you shouldn’t worry too much about.
Also, those lateral T wave changes may be explained by the presence of iRBBB (T wave changes are frequently found in the settings of bundle branch blocks).
Regarding the presence of those septal abnormal Q waves in septal leads, they may be explained by the presence of septal fascicular block (expressed with the presence of septal Q waves mimicking a septal infarction); but also by other health disorders, like a chronic pulmonary disorder, Interventricular septal hypertrophy (confirmed by cardiac echo).
So, to conclude, it is difficult to arrive to an exact conclusion only on the basis of some ECGs interpretations (as they are not specific).
Instead, I would prefer to directly review your ECG recording by myself.
Please, could you upload those ECG recordings here in order to be possible for me to give a second professional opinion?
Also, if you have any recent cardiac ultrasound report (cardiac ECHO), I would be interested to review it (could you upload it too?).
As far as you don’t have any obvious clinical symptomatology no suspicions of cardiac ischemia could be concluded.
Just keep following your healthy life-style and daily physical activity.
I remain at your disposal for your medical tests review and further discussions.
Regards,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again, dear XXXX!
I carefully reviewed your uploaded ECG analysis results and would explain that incomplete Right Bundle Branch Block (iRBBB) is not a rare finding in normal healthy adults.
As long as you don’t have any specific cardiovascular symptomatology and your cardiac ultrasound does not reveal any abnormality, then you shouldn’t worry too much about.
Also, those lateral T wave changes may be explained by the presence of iRBBB (T wave changes are frequently found in the settings of bundle branch blocks).
Regarding the presence of those septal abnormal Q waves in septal leads, they may be explained by the presence of septal fascicular block (expressed with the presence of septal Q waves mimicking a septal infarction); but also by other health disorders, like a chronic pulmonary disorder, Interventricular septal hypertrophy (confirmed by cardiac echo).
So, to conclude, it is difficult to arrive to an exact conclusion only on the basis of some ECGs interpretations (as they are not specific).
Instead, I would prefer to directly review your ECG recording by myself.
Please, could you upload those ECG recordings here in order to be possible for me to give a second professional opinion?
Also, if you have any recent cardiac ultrasound report (cardiac ECHO), I would be interested to review it (could you upload it too?).
As far as you don’t have any obvious clinical symptomatology no suspicions of cardiac ischemia could be concluded.
Just keep following your healthy life-style and daily physical activity.
I remain at your disposal for your medical tests review and further discussions.
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Again Dr. Ilir,
With regards to your request for a recent cardiac ultrasound report [cardiac ECHO], I am currently waiting for an appointment with my cardiologist.
I have researched the four types of ECHO: Transthoraic..Transesophageal..Doppler..Stress. Which ECHO is most practical? Is there a need for a combination of the four ECHOs?
With regards to your request for actual copies of my ECGs. I had another ECG done yesterday; Nov 10, as requested by my cardiologist. I will have a copy of the ECG by Nov.15 at which time I will submit to you along with the Aug.30 and Oct.26 ECGs.
Would HCM be able to keep our current discussion open or would it be closed automatically?
Thank you.
Regards, XXXXXXX XXXX
With regards to your request for a recent cardiac ultrasound report [cardiac ECHO], I am currently waiting for an appointment with my cardiologist.
I have researched the four types of ECHO: Transthoraic..Transesophageal..Doppler..Stress. Which ECHO is most practical? Is there a need for a combination of the four ECHOs?
With regards to your request for actual copies of my ECGs. I had another ECG done yesterday; Nov 10, as requested by my cardiologist. I will have a copy of the ECG by Nov.15 at which time I will submit to you along with the Aug.30 and Oct.26 ECGs.
Would HCM be able to keep our current discussion open or would it be closed automatically?
Thank you.
Regards, XXXXXXX XXXX
Brief Answer:
My answer as follows:
Detailed Answer:
Dear XXXXXXX
I would be glad to review all your cardiac tests, when they become available.
Regarding your cardiac echo, I would explain that a trans-thoracic cardiac ultrasound would be quite enough for investigating your cardiac structure and function. It would incorporate also Doppler techniques interrogation of blood flow through cardiac valves, as well as tissue Doppler techniques for exploring systolic and diastolic functions.
A cardiac stress echo would be a reasonable alternative if sufficient suspicions about cardiac ischemia would be raised. But actually, it doesn't seem to be necessary.
Regarding our discussion, I am afraid that all the three possible follow ups have been utilized and further discussions would be considered as new ones by HCM system.
Another option is that you can ask me directly at any time on my personal link as follows:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Let me know about anything!
Wishing all the best,
Dr. Iliri
My answer as follows:
Detailed Answer:
Dear XXXXXXX
I would be glad to review all your cardiac tests, when they become available.
Regarding your cardiac echo, I would explain that a trans-thoracic cardiac ultrasound would be quite enough for investigating your cardiac structure and function. It would incorporate also Doppler techniques interrogation of blood flow through cardiac valves, as well as tissue Doppler techniques for exploring systolic and diastolic functions.
A cardiac stress echo would be a reasonable alternative if sufficient suspicions about cardiac ischemia would be raised. But actually, it doesn't seem to be necessary.
Regarding our discussion, I am afraid that all the three possible follow ups have been utilized and further discussions would be considered as new ones by HCM system.
Another option is that you can ask me directly at any time on my personal link as follows:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Let me know about anything!
Wishing all the best,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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