Hello,

Thank you for your query.

118kg for a height of 184 cm indicates that you are considerably obese. You need to reduce your weight to around 85 kg over a period of time. You will also probably need to be investigated for the cause of obesity. Diet control and exercise regimens will be needed. Weight reduction alone can result in considerable improvement in your BP control.

Effexor is venlafaxine, which belongs to Serotonin–norepinephrine reuptake inhibitors (SNRIs) class of anti-depressants. However, when your BP is elevated, it might not be a suitable drug for you, since it is also known to increase the BP. You may have to discuss this with your treating doctor and get an alternative drug prescribed.

Micardis is telmisartan, which is an angiotensin II receptor blocker. It is a good drug for hypertension. The dosage that you are taking appears to be 20 mg (not 25 mg).This is a relatively low dose, If I were your physician I would recommend increase in the medication. However today’s research indicates that a move toward individualizing the dosing of prescription agents is warranted and it can happen only after physical consultation with your treating doctor.If your BP is not controlled with this, your dosage may have to be increased or an additional medicine may need to be taken. At the same time, it is also not completely safe if you have liver "problems". Your liver function will have to be closely monitored.

I would like to know exactly what is the liver problem. Is it chronic hepatitis or is it cirrhosis? Which enzymes are elevated? what about bilirubin?

Your symptoms may be related to inadequate BP control or fluctuations in BP with posture, unrelated causes like gastritis, hypothyroidism, some other rare diagnoses like pheochromocytoma, porphyria etc. You need to be evaluated in detail and relevant blood and urine tests done. I am sure your physician will guide you.

I hope I have been able to answer your query. If you need any further clarifications, please get back to me.

Regards,
Dr RS Varma

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Hello,

Thank you for your reply.

The blood reports that you have submitted suggest a very mild elevation of the liver enzymes. I do not think that it is a major cause of worry. I would advise you to abstain from alcohol, avoid fatty foods/fried foods, reduce weight and continue taking your drugs regularly.

If the palpitations are sustained, you could get an ECG done during the episode. If that is not feasible and you have these symptoms on a daily basis, the diagnosis can be achieved by doing a Holter monitoring where the ECG is recorded for a period of 24 hours. If it happens only once in a few days/weeks, the options are between an Event Recorder and an invasive Electrophysiologic study. At the very least, you can check your pulse rate during the episode of palpitations.

Palpitations are felt by you when the heart beats stronger or faster than usual, or if there are irregular/extra beats. It need not always be abnormal. Stress and anxiety can increase the BP and the heart rate and manifest as palpitations.

In this situation, it is better to try and control your panic attacks rather than trying to control the heart rate. Treatment directed to reducing anxiety will automatically result in improvement in your symptoms. You may discuss this with your treating physician/psychiatrist. Yoga is also useful in reducing stress/anxiety. Rarely, you might need a beta blocker to control the symptoms. If an arrhythmia is detected, you might need specific treatment as mandated by the specific diagnosis.

Kindly discuss the differential diagnosis that I had given you earlier with your physician and do the necessary work-up to rule out those conditions. I am sure that you will experience significant improvement by the measures as outlined.

Hope I have provided you adequate reply and reassurance.

I wish you all the best for a healthy life. Feel free to ask for any clarifications at any time.

Regards,
Dr RS Varma

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