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Ask Anthony Bray, MD Your Own Question

Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6678
Experience:  14 years as clinician in the field of Family Practice
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Had three tachycardia within 14 days..1st time I was told the

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Had three tachycardia within 14 days..1st time I was told the cause was low pottasium so I started a pottasium regiment..no one knows what caused the last two..currently wearing a heart monitor..cardiologist could not find a defect with my heart..now I'm having a lot of pressure behind eyes and nose sometimes near temple..the pressure comes and goes like spasms..sometimes there is a tingling feeling that goes to the back of my head..feel light headed most of the day..also have tingling numbness feeling in my legs and feet..legs sometimes cramp..no one seems to know whats wrong with me
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.

Anthony Bray MD :

Hello!


 


 


The holter monitor that you are currently wearing will probably be the most informative test as to the racing of the heart that you have noticed.

Anthony Bray MD :

It could be that you periodically jump into an abnormal rhtyhm > SVT = supraventricular tachycardia is one example. With this rhythm your heart may have an electrical conduit that allows 2 ventricular beats for each sinus nose signal to beat. This type of rhtyhm may have a startling jump from a resting rate of say 75 to sudden jump to rate of 150. This rhtyhm may last seconds to hours depending on the individual. It is certainly alarming when it occurs. At times patients present to the ER with this type of rhtyhm and may require treatment to break back into a normal rhtyhm again.

Anthony Bray MD :

Fortunately SVT often breaks back into a normal rhythm on its own. This process may be helped by what are called vagal maneuvers>> cold water to the face and bearing down with abdominal pressure are a couple of techniques.

Anthony Bray MD :

Atrial fibrillation is another possible cause of an abnormal and fast rhythm. This rhtyhm is characteristically irregular and the patient may feel a sense of fluttering in the neck /chest of thrat area. It tends to be fast but irregular with a rate of about 130 typically for those whom first eperience this.

Anthony Bray MD :

These two are the most common so I will stop there as there are other potential possible causes for what you have experienced.

Anthony Bray MD :

Panic attacks can also cause a person to feel a racing of the heart,. Panic attacks may cause a flurry of uncomfortable sensations >>racing of the heart, shortness of breath, tightness of the chest, dizziness, numb and tingling sensations (often the hands and around the mouth) a sense of panic and often patients describe the sensation as feeling "like they are about to die". A perosn with a panic attack is often motivated to move to a different area from where the event started. If in a car then they feel that they must get out! The heart rate with a panic attack may be modestly elevated such as 115 but it is not as high as other causes. It may FEEL much worse and more intense however.

Anthony Bray MD :

There are different factors that may have caused a sinus tachycardia. Basically this is a normal type rythm but the heart is pounding faster for some reason. The reasons for this may include an infection, blood loss, anemia, dehydration or other bodily stress. It is a response to stress in this case. This type of rhtyhm would typically be modestly elevated ( depending on the stressor) Often this type is accompannied by abnormally low blood pressure.

Anthony Bray MD :

On other issues that you mentioned>> the leg cramps would readily be explained by the low potassium but there is the question as to why you would have a low potassium in the first place....

Anthony Bray MD :

The tingling sensation of the legs>>how long have you noticed this?? Does it come and go? Has been bothering you for a while?? If it has been bothering you for some time and seems more intense as you try to go to sleep then this would be a pattern consistent with possible peripheral neuropathy. This problem may have many causes >> blood sugar problems, electrolyte problems, thyroid, liver, kidney, metabolic, toxins, and auto-immune as possible realted causes.

Anthony Bray MD :

If the tingling sensation comes and goes but lasts on the order of about 30 minutes (plus/minus) then this could be a symptom of panic attacks.

Anthony Bray MD :

The pressure sensation behind the eyes may be eye strain, tension headaches, sinus related headaches as some possible causes.

Anthony Bray MD :

The tingling at the back of the scalp sounds like you may have some nerve impingement of the nerves at the very top and back of the cervical spine >> this is where your sensation of the back of the scalp comes from.

Anthony Bray MD :

I hope that this information may contain some useful clues as to possible causes that are behind your symptoms. If you have further questions/information for me/ points of discussion then let me know and I will be happy to get back with you!

Anthony Bray MD :

If my answer has been helpful and to your satisfaction then please remember to leave positive feedback. That would be very much appreciated! Thank you and Best Regards,

Anthony Bray MD :

Anthony Bray MD

Customer:

I've been feeling light headed since the 1st tachycardia..any idea why?

Anthony Bray MD :

The feeling of being light headed is often associated with lower than normal blood pressure. has this been checked? How is your BP running???

Customer:

my blood pressure is excellent

Anthony Bray MD :

Low BP may also cause a reflex rise in heart rate > this can be due to low blood volume, shock, dehydration....

Anthony Bray MD :

OK

Anthony Bray MD :

Have you had any fever/chills /night sweats/ any suspicion for infection???

Anthony Bray MD :

You have not had any shortness of breath have you??

Customer:

I've had night sweats..this all started when I was being treated for an infection under my wisdom tooth..I had an allergic reation to the antibiotics so I took benadryl..accidentally took too much benadryl..was suppose to take 4 teaspoons and I took 8...almost an hour later I got very light headed and this is when I had the 1st tachycardia..no shortness of breath

Anthony Bray MD :

The wisdom teeth infection gives me some concern that you could be having episodes of bacteremia...a flurry of bacteria into the blood stream. The bacteria of the mouth have the potential as well to infect the heart >> bacterial endocarditis>> you would probably be sicker and have more persistent symptoms if this were the case. Still the dental infection could represent more trouble than you may think....

Anthony Bray MD :

Blood cultures times three sets may be advisable with the combination of things in your history. If this episodic tachycardia were due to bacteremia then you would have spisodes of sinus tachycardia (normal rhythm except faster than normal with a rate probably 100 to 120 range)

Customer:

I read something online about endocarditis..I asked the cardiologist about it and he said that endocarditis would've showed up on EKG but it didn't

Anthony Bray MD :

Well as I said I would expect you to be sicker if this were the case but you could have a dental abscess that has not yet been eradicated and this could seed bacteria into the bloodstream. This is bacteremia which may make you sick for a while with recovery. If you hasd a large ongoing load of bacteria in the blood then this would be sepsis and you would go into shock....

Anthony Bray MD :

It is a possible explanation that may be worht pursuing further.... if you had such an abscess then I would expect that you would have an elevated C-reactive protein and elevated white cell count>> especially neutrophils....

Anthony Bray MD :

Do you have any dental pain now??

Anthony Bray MD :

If your holter results show sinus tachycardia then this is basically a normal rhythm but just fast >> this would mean something was stressing your system in some way....

Anthony Bray MD :

Do you have abnormal fatigue??

Customer:

yes...very very tired

Anthony Bray MD :

I would review with cardiologist your dental abscess history too>>make sure that they are aware of this....

Anthony Bray MD :

Early endocarditis could be missed on EKG.. may start to involve one or more valves especially....

Customer:

I have dental pain when eating because I need my wisdom teeth extracted..I was scheduled for surgery the same week I had my 1st tachycardia but now the surgeon does not want to extract due to the unexplained tachycardia

Anthony Bray MD :

Not saying that you have this but it would be a potential concern

Anthony Bray MD :

Catch 22 it sounds like in a way...

Customer:

yes..catch 22

Anthony Bray MD :

Well in my opinion I would cover the base of bacteremia or early subacute bacterial endocarditis with blood cultures, CBC with differentila and C-reative protein. Also an echocardiogram to check your valves....

Anthony Bray MD :

Watch for any signs of splinter hemmorhages of finger nails >> these are streak like smears of blood under the nail >> these can be a sign....they are smalland narrow....

Anthony Bray MD :

Have you noted any chest discomfort at all??

Customer:

a little tightness at times..not pain

Anthony Bray MD :

OK that sounds pretty nonspecific....

Anthony Bray MD :

WEll hopefully they will get you figured out soon. I think the holter will be an importantr step in the right direction. This will tell if you have some arrythmia causing it such as SVT or atrial fibrillation and that would put you down one treatment path....

Anthony Bray MD :

If it shows episodes of sinus tachycardia then as I mentioned this is a sign of the body being stressed for some reason and it is then a matter of finging the source of this.., a rapid heart rate in adults may be thought of in similar way as having a fever....

Anthony Bray MD :

You don't take any stimulants, right??

Anthony Bray MD :

You have no history of abnormal blood clots either do you??

Customer:

the cardiologist prescribed magnesium and atenolol..I'm taking the magnesium..scared to take the atenolol because I read it lowers your heart rate and blood pressure..this may make me feel worst cause I'm already very fatique..plus I'm concerned about taking the atenolol because my blood pressure is always normal..I'm frighten it may lower it too much and they really don't know what's wrong with me

Anthony Bray MD :

The atenolol (what dose? 50 mg??) would probably lower BP only by about 10 points....

Anthony Bray MD :

The magnesium is the most benign possible treatment to stabilize the heart's rhtythm IF that should be the source of the problem.....

Customer:

I've never had blood clots and I've been on birth control bills for the last 6 years at least..I've discontinued those for now

Anthony Bray MD :

If heart rate races too fast you can reach a point at which faster actually drops your cardiac output>> too fat can be tiring as well


 

Anthony Bray MD :

How fast was your heart rate>> do you know??

Customer:

not sure what a stimulant is?

Customer:

the atenolol is 25mg

Anthony Bray MD :

Caffeine, decongestants (not benedryl but psuedoefedrine) , cocaine, amphetamines, ritalin

Anthony Bray MD :

That is mild dose of Atenolol >> I think that you would be fine to take this unless tyour baseline BP was actually LOW < 100/65

Anthony Bray MD :

Beta blockers are helpful to stabilize the heart's rhtyhm as well if you did have an arrythmia causing the problem....

Customer:

no stimulants..1 can of soda..every other day maybe

Anthony Bray MD :

OK I would not count that as being significant.

Customer:

my heart rate topped at 160

Anthony Bray MD :

OK that sounds like you may have had episodes of SVT. That rate is really suspicious for that.

Customer:

I was told to do the grunting down action and that brought it down

Anthony Bray MD :

OK that makes sense >> vagal maneuvers can help break SVT in particular. You may also massage the left carotid artery and this works often

Anthony Bray MD :

Stimulation of the vagus nerve slows the heart rate.

Customer:

it topped at 160 the 1st time...last 2 times it bounced around but never really went over 110

Anthony Bray MD :

Hmmm > not sure what to make of that combination.....

Anthony Bray MD :

SVT is generally a very fast rhythm because it typically doubles your heart rate....

Anthony Bray MD :

Hopefully your holter will shed more light on what exacrly is going on with you. Be sure to keep your diary of any symptoms and turn this in with your test....

Anthony Bray MD :

I hope this discussion has been somewaht helpful for you. Let me know if you have further questions or discussion. I will be happy to get back with you!!

Anthony Bray MD :

Episodes #1 sounds more like SVT but #2 and #3 sound like thay may have been something prompting sinus tachycardia.....

Anthony Bray MD :

Ask for C-reactive protein as part of your tests>> this is most sensitive marker of abnormal inflammation within the body....

Customer:

I will..thank you..the entire episode has me stressed, petrified, and really not living..this has been helpful..I will bring the dental situation to the the doctor's attention again..

Anthony Bray MD :

I realize that this type of episode is its own type of toture as it is normal to fear the worst. Hang in there though. I am sure that you will be fine,you need to definitely follow through on the tests but you will get there.


 


 

Anthony Bray MD :

Take Care and Best of Luck to you!!

Anthony Bray MD :

Anthony Bray MD

Customer:

if this is happening due to my dental issues..do u think it would benefit me to start taking the atenolol??

Anthony Bray MD :

It would not hurt >> I would put it that way>> if you had the issues due to dental abscess then of course the underlying problem would need to be fixed....

Customer:

do u feel that that spasms in my head..tingling feet and legs could be associated with this as well or separate issues??

Anthony Bray MD :

The low potassium can casue paresthesias and leg cramps but I don't know how low your potassium was. Often magnesium and potassium go,low together. This may prompt a need to further work up some endocrine functions.

Anthony Bray MD :

The head discomfort might be a sinus infection or headaches triggred by the dental problems. I don't think this is as likley to be directly related but there may be some relationship....

Anthony Bray MD :

Paresthesias are abnormal sensations like pins and needles... tingling, etc...

Customer:

the last time it was checked my potassium was at 3.2 and I think the normal would've been 3.5

Anthony Bray MD :

You are right. It is only slightly low at 3.2...

Customer:

I think the potassium was blamed because they couldn't find anything else

Anthony Bray MD :

Even at 3.2 you may have tendancy for leg cramps but I doubt this level would cause heart arrythmia....

Customer:

but I will try to get in with my primary doctor again for more blood work in the morning..this has been helpful

Anthony Bray MD :

OK good luck.

Anthony Bray MD :

I'm signing off for the night unless you have anything further>>>>

Anthony Bray MD :

Take Care and Good Night!!

Customer:

ok..thanks again..good night

Anthony Bray MD :

You are very welcome. I'm glad to help to what extent that I can>>

Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6678
Experience: 14 years as clinician in the field of Family Practice
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