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Ask Dr .Saeed ahmed Your Own Question
Dr .Saeed ahmed
Dr .Saeed ahmed, Doctor
Category: Cardiology
Satisfied Customers: 4403
Experience:  MBBS/FCPS/MRCP U.K(R), Senior Registrar Cardiology
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I have already asked a couple of questions about my heart,

Customer Question

Hi Doctor. I have already asked a couple of questions about my heart, however things have developed somewhat since then. I have since been to the hospital & been told that my symptoms are due to my autonomic dysfunction, but I would really appreciate a second opinion. I will now provide you with a bullet point summary of what has transpired -
* 40 year old overweight male with a 'mild' autonomic dysfunction
* Been on 10 mg of propanolol, twice daily for 4 months
* I noticed a faint & lower than my usual pulse over three day period.
* During that period I experienced palpitations & flutters.
* At one stage I became incredibly fatigued after doing housework- heart rate of 42
* Went to the emergency department. ECG & blood tests were normal.
* Decided to stop the morning dose of propanolol
* Heart rate went up a bit over the following few days, but was acting strange. It wasn't increasing much when walking & standing up. At one point when I was lying down it began to race to around 98bpm then slowed back down after 20 minutes.
* The following day I decided to rest in bed & not worry about it. Towards the end of the day, I got up & experienced several episodes of postural tachycardia. Upon standing I became dizzy & my heart went up from 75 - 148 BPM
* I went to the emergency department once again & the admitted me to hospital. I continued to experience the symptoms over the next few days.
* I was given another ECG, Stress echocardiogram & a 24 hour holster monitor. Nothing sinister was found.
* I was put on 5mg of Coralan which has seemed to control my tachycardia
* Since coming out of hospital my heart rate has been very low 55-60 BPM at rest.
* I decided to half the dose of Coralan to 2.5 mg (twice daily) & after two days there has been only a tiny increase in my heart rate.
* Last night at rest (after eating a bag of sweets) my heart began pounding. It went from 62 -80 BPM. It was beating so hard that I could feel it through clenched fists. This lasted for about 15 minutes.
As you can gather, I've been experiencing some strange things lately. My resting pulse before I started propanolol 4 months ago used to be around 80BPM. Now I'm on 2.5 mg of Coralan & it's just touching 60. Is this normal? Do you think I require further testing or should I put it all down to an autonomic dysfunction? The main reason why I'm concerned is that I have never heard of an autonomic dysfunction that lowers ones heart rate.
Any advice would be greatly appreciated
Kindest regards
Robert Adshead
Submitted: 10 months ago.
Category: Cardiology
Expert:  Dr .Saeed ahmed replied 10 months ago.

Thank you for your question, yes you need further tests, TSH levels, serum catecholamine levels.

Heart rate of 60 is normal, you should not lower the dose for heart rate of 60 unless your blood pressure in the sitting position is less than 100/60.

Let me know if you have questions, thank you.