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What Causes Severe Fatigue, Fluctuations In Heart Rate And Anxiety?
Question: Hello again Doctors,
I am due to see the cardiologist tomorrow for a follow up appointment after my angiogram last year.
My health has deteriorated so much recently that I have been counting the days and hours till I see him.
On 31st January, I had a bad bout of A.F. in the morning, I felt dreadful for two to three hours and passed over 2 litres of urine in two hours!
I check my BP. often (to see how my prescription drugs are coping), I noticed on the BP monitors,(Iv'e got 3 of them to cross check),
that my pulse had dropped to around 40 beats pm. on the following morning.
At the same time, I noticed that I had become much weaker and couldn't even get dressed without feeling exhausted and slightly ill.
Since that time, I have had one admittance to A and E for a milder bout of AF.( I didn't want to go to hospital, but my GP insisted-as I had
experienced some slight chest pain).
My pulse is normally about 63 bpm and when I arrived at the Hospital, the Nurse checked my wrist pulse to be in the low forties.
She agreed that was a cause for concern, but when she did an ECG test she said pulse was 76!
I am back to taking 50mg Losartan a day and 60mg Diltiazem, this morning I felt terrible and BP was over 200 over 100+ so i had two then one puffs of GTN spray,
and apart from some headache, I soon started to feel a bit better,( but they told me last year that I haven't got Angina!)
I have also noticed on the few occasions that I have used the spray, that my pulse returns to normal for a few hours.
At present I am very weak, feel ill if I bend over,move quickly,lift anything etc.
On Tuesday I was fitted with a 24 hour monitor, but did not have any real bad turns that day.
I am concerned that the Cardiologist may put o lot of store on the ECG results and less on my symptoms,(based on ECGs I have had in the past I dont have much faith
in their results.During the last 10days I am also experiencing very unpleasant and unsettling palpitations. Because of my increasing fraility and lessening of independance
my emotions are very labile causing me to have a sore thought when I think of loved ones missing me, I have had to reluctantly resort to taking 3.75mg of Zopiclone to get
some sleep.On a more optimistic note I am wondering,with input from family, if an ablation or a pacemaker could be an option. I would really value your thoughts
Kind Regards
I am due to see the cardiologist tomorrow for a follow up appointment after my angiogram last year.
My health has deteriorated so much recently that I have been counting the days and hours till I see him.
On 31st January, I had a bad bout of A.F. in the morning, I felt dreadful for two to three hours and passed over 2 litres of urine in two hours!
I check my BP. often (to see how my prescription drugs are coping), I noticed on the BP monitors,(Iv'e got 3 of them to cross check),
that my pulse had dropped to around 40 beats pm. on the following morning.
At the same time, I noticed that I had become much weaker and couldn't even get dressed without feeling exhausted and slightly ill.
Since that time, I have had one admittance to A and E for a milder bout of AF.( I didn't want to go to hospital, but my GP insisted-as I had
experienced some slight chest pain).
My pulse is normally about 63 bpm and when I arrived at the Hospital, the Nurse checked my wrist pulse to be in the low forties.
She agreed that was a cause for concern, but when she did an ECG test she said pulse was 76!
I am back to taking 50mg Losartan a day and 60mg Diltiazem, this morning I felt terrible and BP was over 200 over 100+ so i had two then one puffs of GTN spray,
and apart from some headache, I soon started to feel a bit better,( but they told me last year that I haven't got Angina!)
I have also noticed on the few occasions that I have used the spray, that my pulse returns to normal for a few hours.
At present I am very weak, feel ill if I bend over,move quickly,lift anything etc.
On Tuesday I was fitted with a 24 hour monitor, but did not have any real bad turns that day.
I am concerned that the Cardiologist may put o lot of store on the ECG results and less on my symptoms,(based on ECGs I have had in the past I dont have much faith
in their results.During the last 10days I am also experiencing very unpleasant and unsettling palpitations. Because of my increasing fraility and lessening of independance
my emotions are very labile causing me to have a sore thought when I think of loved ones missing me, I have had to reluctantly resort to taking 3.75mg of Zopiclone to get
some sleep.On a more optimistic note I am wondering,with input from family, if an ablation or a pacemaker could be an option. I would really value your thoughts
Kind Regards
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome back on HCM!
I carefully read your question and would explain that it is important performing a comprehensive differential diagnosis of the possible causes that may lead to this symptomatology:
1- Myocardial ischemia can not be excluded as it can cause cardiac arrhythmia. Besides, the fact that your symptoms are relieved by nitroglycerin raises suspicions of possible coronary artery disease
2- Sick sinus syndrome could cause such flunctuations in heart rate
3- Diltiazem intake can lead to bradycardia. But it would not explain the episodes of tachycardia.
4 - Anxiety could also exacerbate your symptoms and it should also be taken into consideration.
5 - Metabolic causes (thyroid dysfunction, electrolyte imbalance) could also lead to fluctuations in the heart rate.
I recommend consulting with your doctor and performing some tests:
- a cardiac ultrasound to examine your cardiac function and structure
- a prolonged ECG monitoring (48-72hours) to examine your heart rhythm trends for a prolonged period and exclude possible sick sinus syndrome
- a cardiac stress tests or a stress echo to exclude possible coronary artery disease
- blood lab tests (complete blood count, thyroid hormone levels, fasting glucose, blood electrolytes, cardiac enzymes).
- a coronary angiography may be needed if suspicions of possible coronary artery disease are raised.
If all these tests result normal, you should consider anxiety as a possible trigger of your symptomatology.
Hope to have been helpful!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome back on HCM!
I carefully read your question and would explain that it is important performing a comprehensive differential diagnosis of the possible causes that may lead to this symptomatology:
1- Myocardial ischemia can not be excluded as it can cause cardiac arrhythmia. Besides, the fact that your symptoms are relieved by nitroglycerin raises suspicions of possible coronary artery disease
2- Sick sinus syndrome could cause such flunctuations in heart rate
3- Diltiazem intake can lead to bradycardia. But it would not explain the episodes of tachycardia.
4 - Anxiety could also exacerbate your symptoms and it should also be taken into consideration.
5 - Metabolic causes (thyroid dysfunction, electrolyte imbalance) could also lead to fluctuations in the heart rate.
I recommend consulting with your doctor and performing some tests:
- a cardiac ultrasound to examine your cardiac function and structure
- a prolonged ECG monitoring (48-72hours) to examine your heart rhythm trends for a prolonged period and exclude possible sick sinus syndrome
- a cardiac stress tests or a stress echo to exclude possible coronary artery disease
- blood lab tests (complete blood count, thyroid hormone levels, fasting glucose, blood electrolytes, cardiac enzymes).
- a coronary angiography may be needed if suspicions of possible coronary artery disease are raised.
If all these tests result normal, you should consider anxiety as a possible trigger of your symptomatology.
Hope to have been helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi, Doctor
I saw a Doctor Dua at Hereford County Hospital Last Friday ,He is going to arrange for me to see a Doctor Griffiths at Queen XXXXXXX Hospital, XXXXXXX to discuss me possibly having an ablation.
I write to discuss my latest symptoms. For a long time I thought a lot of my symptoms were caused by side effects from prescription drugs.
Recently my symptoms have led me to question whether I have a physical condition other than AF. or Hypertension .
Last Friday I awoke not feeling too bad. took 20mg Omeprazole first thing, then had a boiled egg and Rice cakes for breakfast and took my blood pressure drugs-(as listed in last email)
About half an hour later I started to feel quite ill, had mild pain in my breastbone area and a dizzy type of pressure feeling in my head and a sick sort of feeling in my throat.
It is very hard to describe the symptoms-(Ihave had them many times before), but not always with noticeable chest pain..I am forever trying to describe symptoms to my Wife, on this occasion I said it felt like there was a saucer stuck in my chest and pulses of toxic gas going into my head and a vague discomfort out into my armpits.
I felt really unwell for 30 minutes or so , then gradually felt a bit better as symptoms fluctuated and became less severe.
After about 2 hours had passed I felt ok and boasted to my Wife that I felt"normal"!
I had soup and rice cakes for lunch, then about 45 minutes later all the morning symptoms reappeared!
I had a 4pm appointment to see Dr, Dua, felt terrible all afternoon,thinking I "cant go on like this, whats wrong with my heart"?
I think my BP was about 188 over 121at the hospital and they triple checked it.
Dr, Dua said my BP was high but could not account for my symptoms that day, he went on to say that because of my AF experiences ,he would arrange for me to see Doctor Griffiths from the Queen XXXXXXX hospital in XXXXXXX who is a Consultant Electropysiologist
My Wife and Sister-(a retired cardiac care nurse) came with me for support. towards the end of the appointment, I was feeling a lot better and over a cup of tea in hospital cafe, we thought that talk of an ablation was a positive outcome.
In bed that night, I thought about my bad day and remembered that I had often had similar symptoms after eating.
I had a Gastroscopy last August Oesophagus normal Stomach Polyps, Duodenum normal I have previously been under the care of the ENT specialists due to GERD so have taken proton pump inhibitors for many years.
Yesterday, MY Diet was planned to be bland throughout the day and I had a reasonable day. However today has been a nightmare,
I started with a Smoothie with XXXXXXX banana pineapple spinach and XXXXXXX and soon after experienced the above symptons but with chest ache rather than pain.
Lunch I wasnt able to complete as symptons returned,prior to dinner I felt ok finished the meal, 30mins later I went to PU [standing up] on returning to chair I started to feel ill then all the symptons returned.
I omitted caffeine and mostly acids except for pineapple in smoothie
I am having difficulty swallowing tablets [more noticeable lately}
These symptons are totally debilatating I am unable to do anything,which is so disheartening as I have always been very active, and just would love to feel well enough to play golf and
go for walks. The cardiologist did say I should rest as I am worn out from all the AF, but these other symptons dont allow.. My symptons seem so weird to me, I wonder if they
are familiar to you or your colleages.
Kind Regards
I saw a Doctor Dua at Hereford County Hospital Last Friday ,He is going to arrange for me to see a Doctor Griffiths at Queen XXXXXXX Hospital, XXXXXXX to discuss me possibly having an ablation.
I write to discuss my latest symptoms. For a long time I thought a lot of my symptoms were caused by side effects from prescription drugs.
Recently my symptoms have led me to question whether I have a physical condition other than AF. or Hypertension .
Last Friday I awoke not feeling too bad. took 20mg Omeprazole first thing, then had a boiled egg and Rice cakes for breakfast and took my blood pressure drugs-(as listed in last email)
About half an hour later I started to feel quite ill, had mild pain in my breastbone area and a dizzy type of pressure feeling in my head and a sick sort of feeling in my throat.
It is very hard to describe the symptoms-(Ihave had them many times before), but not always with noticeable chest pain..I am forever trying to describe symptoms to my Wife, on this occasion I said it felt like there was a saucer stuck in my chest and pulses of toxic gas going into my head and a vague discomfort out into my armpits.
I felt really unwell for 30 minutes or so , then gradually felt a bit better as symptoms fluctuated and became less severe.
After about 2 hours had passed I felt ok and boasted to my Wife that I felt"normal"!
I had soup and rice cakes for lunch, then about 45 minutes later all the morning symptoms reappeared!
I had a 4pm appointment to see Dr, Dua, felt terrible all afternoon,thinking I "cant go on like this, whats wrong with my heart"?
I think my BP was about 188 over 121at the hospital and they triple checked it.
Dr, Dua said my BP was high but could not account for my symptoms that day, he went on to say that because of my AF experiences ,he would arrange for me to see Doctor Griffiths from the Queen XXXXXXX hospital in XXXXXXX who is a Consultant Electropysiologist
My Wife and Sister-(a retired cardiac care nurse) came with me for support. towards the end of the appointment, I was feeling a lot better and over a cup of tea in hospital cafe, we thought that talk of an ablation was a positive outcome.
In bed that night, I thought about my bad day and remembered that I had often had similar symptoms after eating.
I had a Gastroscopy last August Oesophagus normal Stomach Polyps, Duodenum normal I have previously been under the care of the ENT specialists due to GERD so have taken proton pump inhibitors for many years.
Yesterday, MY Diet was planned to be bland throughout the day and I had a reasonable day. However today has been a nightmare,
I started with a Smoothie with XXXXXXX banana pineapple spinach and XXXXXXX and soon after experienced the above symptons but with chest ache rather than pain.
Lunch I wasnt able to complete as symptons returned,prior to dinner I felt ok finished the meal, 30mins later I went to PU [standing up] on returning to chair I started to feel ill then all the symptons returned.
I omitted caffeine and mostly acids except for pineapple in smoothie
I am having difficulty swallowing tablets [more noticeable lately}
These symptons are totally debilatating I am unable to do anything,which is so disheartening as I have always been very active, and just would love to feel well enough to play golf and
go for walks. The cardiologist did say I should rest as I am worn out from all the AF, but these other symptons dont allow.. My symptons seem so weird to me, I wonder if they
are familiar to you or your colleages.
Kind Regards
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
Thank you for the additional information!
Regarding your cardiac problems, I would recommend discussing with the cardiologist at Queen XXXXXXX Hospital on all the above mentioned tests.
Regarding your new symptoms, they could be related to gastro-esophageal reflux or to the irritation of gastric polips (resulted in your previous fibrogastroscopy).
I would recommend consulting with a gastro-enterologist and performing another ultrasound to examine better the mucosa for possible changes (irritation, inflammation), which could have progressed from the last exam. Biopsy may be taken too during this procedure.
The fact that your symptoms are related to eating could indicate a possible gastro-esophageal disorder, underlying this symptomatology.
I would also recommend you to closely monitor your blood pressure, as it is well known that uncontrolled blood pressure could lead to tightening chest pain, dizziness, headaches, etc..
Hope to have been helpful!
Best wishes,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
Thank you for the additional information!
Regarding your cardiac problems, I would recommend discussing with the cardiologist at Queen XXXXXXX Hospital on all the above mentioned tests.
Regarding your new symptoms, they could be related to gastro-esophageal reflux or to the irritation of gastric polips (resulted in your previous fibrogastroscopy).
I would recommend consulting with a gastro-enterologist and performing another ultrasound to examine better the mucosa for possible changes (irritation, inflammation), which could have progressed from the last exam. Biopsy may be taken too during this procedure.
The fact that your symptoms are related to eating could indicate a possible gastro-esophageal disorder, underlying this symptomatology.
I would also recommend you to closely monitor your blood pressure, as it is well known that uncontrolled blood pressure could lead to tightening chest pain, dizziness, headaches, etc..
Hope to have been helpful!
Best wishes,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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