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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6825
Experience:  14 years as clinician in the field of Family Practice
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I had a abnormal EKG and want to know what it means

Customer Question

I had a abnormal EKG and want to know what it means
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.

Anthony Bray, MD : Hello!
Anthony Bray, MD : Ok --- what did the EKG indicate?
Customer: It said inferior st elevation considered acute ischemia and my dr just blew it off I'm worried
Anthony Bray, MD : Did you have an abnormal rapid rhythm ? This dirt of dinging could tie in with your history....
Anthony Bray, MD : How old are you!
Anthony Bray, MD : Do you have any risk factors for heart disease ?
Customer: Sinus
Anthony Bray, MD : Family history, diabetes, smoke, high cholesterol??
Anthony Bray, MD : Normal sinus rhythm ?
Customer: Yes rhythm
Anthony Bray, MD : You could consult a cardiologist --- they would recommend further testing such as a stress test most likely....
Anthony Bray, MD : Possibly a combination of stress thallium test and echocardiogram to thoroughly evaluate the heart ...
Customer: Sinus rhythm yes what does it mean
Anthony Bray, MD : That is just the NORMAL EXPECTED RHYTHM... That is what is normal baseline ....
Customer: I had a event monitor and a 24 monitor normal
Customer: What's is a inferior st elevation considered acute ischemia
Anthony Bray, MD : It means that the rhythm is being initiated from the sinus node in the heart--- this is how it is supposed to be.. So normal sinus rhythm is what you want to see!!
Anthony Bray, MD : This raises the question of possibly poor blood flow to the lower portion of the heart' ventricles. This could be due to coronary artery disease but the finding may be related to other factors such as left ventricular hypertrophy( thickening of the heart muscle wall)
Customer: I'm worried I have a big problem like sick sinuis syndrome or worst
Customer: Why would he say no big deal
Customer: What tests need to be done
Customer: Will that cause lightheaded every day at dif times of the day with a fast or slow heart rate
Anthony Bray, MD : Well you have note relayed any results to me so far to indicate suck sinus syndrome ( no holter results to indicate this) but your history of episodes of the rapid tachycardia episodes that you have had could potentially fit with that diagnosis... I agree that this would be a potential concern with your history....
Anthony Bray, MD : Well it sounds to me that a stress thallium would be test to be considered --- this would evaluate in more detail how good( normal) the blood perfusion is of the heart muscle...
Anthony Bray, MD : If this test indicated a problem that was suspicious for coronary artery disease then an angiogram would then be considered...
Customer: Is this life threading
Anthony Bray, MD : Well if you had coronary artery disease then yes that is life threatening as this is the main underlying cause related to heart attacks...
Customer: My hr goes up and down on is own be be put it of to anixity
Anthony Bray, MD : How old are you? If very young then this would be less likely to be the case...
Customer: 41 what else could cause that result we they all serious
Anthony Bray, MD : Yes it is possibly related to anxiety.... This has to be included in the differential diagnosis of your tachycardia episodes....
Customer: I don't understand
Customer: Aniety can cause a inferior st elevation considered acute ischemia EKG
Anthony Bray, MD : The EKG result by itself is not necessarily serious--- it depends on the cause... If left ventricular hypertrophy ( thick muscle wall of heart ) then that is not as serious as coronary artery disease... So I would further consult cardiologist on this...
Anthony Bray, MD : At 41 you would still be expected to typically be low risk for coronary artery disease but it is not impossible either ....
Customer: Either way there is a problem with that result correct if so why would dr say its nothing
Anthony Bray, MD : No ... Anxiety would not be expected to cause ST elevation... Now you could have spasms of coronary arteries that could cause PRINMETAL's angina....this could correspond with chest pain and St segment depression or elevation possible...
Customer: What are treatments
Anthony Bray, MD : I think your doctor is interpreting it as being non- significant finding--- probably largely weighing your young age in to correspond with low risk for coronary artery disease... Your doctor may well be right in this estimation but I would recommend further review with cardiologist....
Anthony Bray, MD : Depends on which we are dealing with--- PRINMETAL's angina responds well to calcium channel blocker such as Nirvasc as an option...
Customer: He is a cardiologist so there could be the result and nothing wrong
Anthony Bray, MD : Blocked coronary arteries the treatment would depend on details such as degree of blockage and location ... Angioplasty ... Sometimes even bypass surgery or medical treatment may be part if treatment plan ...
Anthony Bray, MD : Yes that is probably the case ...
Customer: I have been dizzy and fast hr for years take atenolol but hr goes up and down for nor reason that's why I thought SSS or the EKG results as a cause
Customer: What is the case
Anthony Bray, MD : We look also at degree of ST segment change --- if low degree such around 1mm then this may not be significant.... Also there may be what we call "j point " elevation which could be confused with really ST segment change( technical difference --- j point elevation not associated with disease)
Customer: With a abnormal EKG means a problem somewhere or a false positive
Anthony Bray, MD : Right , with your history if the tachycardia episodes I would agree that SSS would be a potential concern...
Customer: What tests for that I had a few test like stress test 24hr events monitor he says all normal wondering if I need a new dr
Anthony Bray, MD : It depends on the nature of the finding. You can have some changes that may be flagged by computer but not really significant. You could have real pathology behind an " abnormal EKG" if cardiologist was reassuring to you the I would be assured by that opinion!!
Customer: Sometime I take my atenolol and it helps hr and other times after two hrs it races and others is 50
Anthony Bray, MD : Well I doubt that you need new doctor. If this was a cadiologist then I suspect opinion was accurate!
Anthony Bray, MD : cardiologist would if anything tend to be overly cautious ...
Customer: How can I explain my hr changes something is not right I think and dizzy everyday for 4 years so bad now I am bed ritten
Anthony Bray, MD : Well as I have advised I would TRY to find dose that works for you as best option... I realize there may be significant variations still with heart rate but I think less so with Atenolol...
Anthony Bray, MD : heart rate of 50 still acceptable but factors of dizziness , BP are important as well...
Customer: It's the dizzy that keeps me in the house and I can only go out for one hr before I get dizzy and hr 160
Anthony Bray, MD : Well if you feel that something remains that needs to be further addressed then by all means go ahead for second cardiology opinion... It may help to broaden the experience working for you...
Anthony Bray, MD : Well that is definitely not normal...
Customer: Will 12.6 atenolol help
Anthony Bray, MD : Continue to keep track of pulse and BP trends and averages... Not what meds you are taking along with the values you obtain...
Anthony Bray, MD : Yes it should but 12.5 is LOW dose ...
Customer: 25mg I can take twice a day if needed
Anthony Bray, MD : I would think you would do better to take AT LEAST 25mg/ day ...OK to take entire dose in AM....
Anthony Bray, MD : Yes you can take 25mg and repeat dose as needed but as I have told you I prefer to try to find right dose and just stick with that...
Customer: I was just wondering if it would lower hr to much and make me more dizzy if Bp goes down to far
Anthony Bray, MD : I know ... We have been around with this issue... Too fast of heart rate may cause dizziness but too low BP may also cause dizziness ... Even 25mg of Atenolol is not usually that strong of BP reducer in most people but we have to look at individual response ....
Customer: How long after taking it will it be at its most so I can test at that time so I know it won't go lower during the day and is half twice a day better hr control
Anthony Bray, MD : Every BP medicine will carry potential to cause dizziness via too low BP as well. Sometimes circumstances such as illness with nausea , vomiting and diarrhea could make you dehydrated and have lower BO so this could affect your need for medication for example. Such an illness might cause you to need to hold meds for few days or a week for example.
Anthony Bray, MD : 25 mg in AM is my preference as the difference to take 12.5 twice a day is acceptable BUT pushes more into sleep cycle overnight when you would least need effect. There is more influences biologically to increase hr and BP during the day for most people's schedules . As we discussed the main factor for the Atenelol is string binding to its target receptor...
Anthony Bray, MD : The clinical response of atenolol is present for 24 hours following dose...
Customer: But I need it for fast hr when standing and also get dizzy if I lay flat I have to sleep in a chair some days I can lay flat others no and what causes hr to go from 60 to 150 relaxing watching TV that's why I was thinking SSS as a cause but don't have a diagnose
Anthony Bray, MD : You might be right. SSS would seem to fit with your history. Further holter ministers may be helpful to detect if this may be the case....
Anthony Bray, MD : it sounds that do far the monitoring that you have has has not identified SSS though so this would seem to be in question...it can be a difficult diagnosis due to the very irregular nature of this problem...
Customer: So after 12 hrs 25mg will be only 3mgs witch will do nothing and might have to be taking again
Anthony Bray, MD : No it does not work that way... The half life for this medicine does NOT ACCOUNT FOR ITS BINDING TO TARGET RECEPTOR... The pharmacokinetics can not be estimated solely based on it elimantion half life!!!!!
Anthony Bray, MD : I hope this helps! Let me know if you have further questions! I will be happy to get back with you!
Anthony Bray, MD : If my answers are helpful and to your satisfaction then please remember to leave positive feedback .
Anthony Bray, MD : Thank you and best regards,
Anthony Bray, MD : Anthony Bray MD
Customer: If 12.6 does lower hr after 2 or 3 hrs that would mean I need the whole pill correct
Anthony Bray, MD : I would suspect that you would be likely to do better on 25 mg / day ( or 12.5mg twice a day if you prefer) based on the normal dosing... Most people on this medication are on 25 to 50 mg/ day and some100mg/ day . So I am looking at your dose in context of the dosing more often needed for most people!!
Anthony Bray, MD : 12.5mg is just a very low dose...,
Customer: Ok so 25 in the am is best will do and hope hr don't go to low
Customer: Sounds good cause I took 12 before and after two hrs hr was high when I was standing up try to do cleaning in the house
Customer: I also have been trying to get off ativan maybe this is the cause I was on 4mg now I'm on 1 mg but its hard to go all day without taking more any idea how to get off the one mg and how long or should I just stick it out for a few day for withdrawels do go away
Anthony Bray, MD : Hello again, if down to 1mg/ day of Ativan per day then that seems very good progress from 4mg/ day .... It would seem to depend on your need of the medication or not due to anxiety...
Anthony Bray, MD : If you have anxiety disorder and this benefits from the medication then that is fine...
Customer: I just don't like to take this everyday for life but if I stop I get dizzy and then I take half send in 30 mins I'm fine so I don't know if its withdrawals or anxiety
Anthony Bray, MD : if you do not have anxiety ( presumably being considered cause if the tachycardia ?) then of course it would in this case be best to continue taper to zero... So it depends on what is going on with you clinically... It depends on whether your symptoms are related to anxiety or not...
Anthony Bray, MD : It sounds then that anxiety may play a part in the dizziness symptom...
Anthony Bray, MD : I would not expect the Ativan to benefit you if not symptom tied to anxiety...
Customer: So It's not withdrawels
Customer: I was thinking it was withdrawels and when I took it the ativan stop the withdrawel
Anthony Bray, MD : At that low dose... No I would not think so ... ... I would not anticipate withdrawal off from 1 mg/ day really...
Customer: K thanks
Anthony Bray, MD : You are very welcome!
Customer: Will ativan help or cause dizzy
Customer: I will try the 25 mg in the morning now I take half after six hrs cause hr high and dizzy
Anthony Bray, MD : I would not expect a low dose to be a cause although more possible with high dose. I think that if it is perceived as helping dizziness then it is likely to be perhaps brought on by stress/ anxiety....
Customer: And is not good for long term that's hat happened to me I had to take more for the same result
Anthony Bray, MD : No , you would not expect rebound tachycardia if you take Atenolol every 24 hours... If you take it for several days and stop then this could cause rebound higher BP and pulse though....
Customer: I meant ativan
Anthony Bray, MD : Right you can become used to Ativan and its effect may be reduced at same dose over time....
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6825
Experience: 14 years as clinician in the field of Family Practice
Anthony Bray, MD and 7 other Health Specialists are ready to help you
Customer: replied 1 year ago.
I took 25mg atenolol felt good for 8 hrs and could get up and walk around but then got dizzy and hr was at 50 to 80 laying down and was dizzy it feels like my body is shutting down
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

The timing of you feeling so bad sounds rather late in the day for it to have been so much a medication effect ...

Rate was ranging 50 to 80?? Is this what you meant? That is fairly broad range...

The atypical features of your dizziness such as feeling worse with laying down is really counter to the expected mechanism of your dizziness ( POTS syndrome) So it is that I remain puzzled by the dizziness symptom that would be worse with laying or standing but better with sitting?? This makes me think that perhaps a stress related psychosomatic form of dizziness might be playing some role here...

The treatment with Ativan might be helpful toward a somatization disorder as a possible cause or your dizziness symptom....

I hope this helps. Further questions are welcome. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Hr laying down was up and down 50 to 80 never got over 120 today standing up cleaning house now it's 60 but I would think there is no atenolol in me now or not much to do anything correct to make it go this low
Expert:  Anthony Bray, MD replied 1 year ago.
Hello,

As we have discussed you can expect the effect of Atenolol to be present for 24 hours after dose. The medicine has strong binding to its target receptors . You can' t equate it's elimination HALFLIFE with its duration of action!! I hope this helps.

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
So I have 25mg for 24 hrs is that correct
Expert:  Anthony Bray, MD replied 1 year ago.
Hello,

Yes you have the dose working for you ... 24 hour clinical response is what is expected for this... Dosing once a day is fine for Atenolol...

I hope this helps. Let me know if you have further questions. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
It seems to not work as good after 12 hrs hr goes up more than 8 hrs after dose is it wearing off
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes the dose may wear off to an extent by this time. Most people do not note difference in pulse rate( but realistically most are not paying very close attention to this) for this reason if you feel that you do better taking the dose split into halves every 12 hours then it is OK to do this. This is balanced by a need to keep dosing convenient and reduce forgotten doses which tend to be much higher in a twice a day regimen. The effect in day 1 is likely to be different than after several days of regular dosing... You reach an equilibrium between open receptors and bound ones after several days of the dose ...

I hope this helps! Let me know if you have further questions! Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
So after a few days I wl feel better at once a day witch you believe is better than twice because twice will give to many ups and downs at a low dose
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well I think that once a day works best for the average person ... Part of the difference is the significant tendency for many people to take the second dose if the day... I also think in your case that your control of pulse and blood pressure should avoid rapidly altering the dose that you take...( I've noticed this pattern with you in the past--- a but too much checking and correcting to the point if over- correcting...)

So ---yes ---I would predict that you would more likely do well on 25 to 50mg/ day of the Atenolol... Definitely start with 25 mg/ day ( this may be in the AM or split twice a day but -yes -- my preference is entire dose each AM..)

I hope this is helpful. Keep me posted on how you are doing! Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Good morning my heart rate is 55 to 60 siting drinking my coffee should in still take 25mg atenolol or will it lower hr and Bp to much I'm confused what to do seems like I don't need it today so far or do I take it anyways
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well take half the dose and see how that goes. I would try taking only 12.5 mg each AM for the next week and see how this goes . You would want to avoid jerky starts and stops of the medicine altogether.

I hope this helps. Let me know how things are going. Take care,

Anthony Bray MD
Customer: replied 1 year ago.
Ok thanks I will try to get up today and see how I do if its goes crazy I can take the other half right the problem I am seeing is trying to treat the standing hr and sit hr is not working out cause my sit is always good or low in the 55 to 60 sometimes in the 70 or 80 but good but standing trying to do anything I get dizzy and hr is crazy 140 to 170 i don't know if its my pots or SSS cause it goes up and down at all differant times of the day I wish I could treat the dizzy not the hr so much but with the hr is causing the dizzy I think but yesterday was a good day and did stuff with hr never going over 120 but last night tring to sleep I was dizzy with hr of 50 witch was probably not pushing blood to the brain
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

It would helpful to take notes of your pulse and blood pressure over time on a given dose---say trying Atenolol 12.5mg each AM--- note your dose and symptoms of dizziness. Note what positions seem to cause the dizziness ... It should be clear with time paying attention to these factors..

I hope this helps. Let me know if you have further questions. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
My hr is 55 siting and in 1 min it's 110 and dizzy and I sit still dizzy wondering if I need the other half it's been 2 hrs since first half
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well since you seem to get rapid pulse so easily with position change I would try taking second 12.5 mg dose and follow pulse, blood pressure and symptoms. Hopefully you will find your best comfort zone with the medication ...

I hope this helps. Keep me posted.. Take care,

Anthony Bray MD
Customer: replied 1 year ago.
Ok it will not lower hr to much it's 50 to 55 now siting watching TV
Expert:  Anthony Bray, MD replied 1 year ago.
Hello ,

Well I think it unlikely that just 12,5 mg of atenolol would lower your heart rate to less than 50 but if you are already down to 50 now then I would hold off on further dosing.

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I took other half this morning when I got up to walk around hr was 140 and now I am trying to sleep but can't hr is at 50 and I feel like my body is shiting down its so slow
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

As long as heart rate is 50 then you are fine! 50 is OK! It is the minimum heart rate that we remain comfortable with but you are not shutting down! 50 is decent heart rate.

I hope this helps. Let me know if you have further questions. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I thanks I will try to sleep to ight cause I didn't last night cause as soon as I was falling asleep I go dizzy and had to sit up and then I was fine but couldn't get to sleep
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Perhaps you sleep with a bit of incline to feel better??

I hope that you feel better tonight and get decent night's rest!!

Take Care,

Anthony Bray MD
Customer: replied 1 year ago.
I do I sleep in a chair for a year now it sucks on my back but I can't lay flat thanks I hope I sleep too
Expert:  Anthony Bray, MD replied 1 year ago.
Hi again,

I'm sorry to hear that this has been such an ongoing issue for you... Well I hope that you do get a decent night's rest tonight.

Hang in there,

Anthony Bray MD
Customer: replied 1 year ago.
I was wondering g if it could be a pich nerve or muscles causing lightheaded
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well perhaps a pinched nerve might lead to dizziness as a symptom but I have not heard details within your history to make me think that really...shooting pains up the back of the neck to the scalp perhaps.. pain associated with nausea perhaps...

I don't think muscular cause is really possible...

Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
It's blood flow most likely
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes I agree that it is likely to be related to blood flow. That would be common reason to experience dizziness. Yet the combination of the laying down and standing ..yet not sitting is unique to your case... do you feel worse to look up ?? (looking up may cause bend of the neck and may at times inhibit flow to the vertebral arteries at the back of the neck to the brain... this is sometimes part of the cause of certain cases of dizziness..)

I hope this is helpful. Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
Yes I get dizzy when I look up and down slow and if I move my head to fast or turn my head around slow nothing fast very slow movements but ent said I was ok I went on a ent test where I sat in a chair and they spun me around I only lasted 15 second before I was so dizzy I had to stop test and almost passed out
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well the ENT I suspect was looking at your vestibular function.. that part of your balance related to inner ear mechanism for sense of position...

You might have benefit to look at the circulation within the neck via ultrasound to look at carotid flow and flow of the vertebral arteries. You might ask your primary care doctor about this at your next visit..

I hope this is helpful for you. Take Care,

Anthony Bray MD
Customer: replied 1 year ago.
Hr is 60 to 65 today siting so I guess I will take half and if in an hr take other half if hr is still the same cause I felt better when I took the whole pill the other day
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

OK, I hope that it helps. I hope that you have good day today..

Take Care,

Anthony Bray MD
Customer: replied 1 year ago.
Hi if I lay on my left hr is 55 on my right 65 is this normal
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I would not worry about this minor difference in rate. It may be related to variation of the internal pressures in the atria (upper chambers of the heart) These will vary some based on your position. These pressure changes within the atria could affect your heart rate some. This small difference is not indicating any pathology though... I don't want you to be unnecessarily alarmed...

I hope that this helps. Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
Hr is 55 resting and 100 standing is it ok to take atenolol now
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Sorry I have not been online until now. I hope that you went ahead and took the Atenolol. I think it would be helpful to keep you from having too high of a rate and unlikely to may your rate too low. So I would advise with above numbers to take the dose(12.5 mg) and follow pulse readings following that.


I hope this helps. Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
I took 12.5 then it went down to 50 hr and four hrs later it went up again so I took other half so it's been 25 mg everyday for three days I think I can take the whole thing even with hr of 55 to 60 resting cause hr goes high after 4 hrs taking half
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Good,I am glad to hear that you have been taking the Atenolol. That is fine to split the dose if it seems to work better for you this way. The rate between 50 and 60 on a beat blocker is acceptable..

I hope this is helpful for you. Take Care!

Anthony Bray MD
Customer: replied 1 year ago.
Ok thanks it makes my wonder if I need it with a hr that low I'm confused with the ups and downs is it better to have a higher or lower hr if the high don't cause me to get dizzy
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well I would expect that waking around and having your pulse rate go up sharply would be expected to correspond with dizziness. From my recall on this it was my understanding that both the periods of tachycardia and periods of normal pluse ( or low pulse rates) with laying down was also causing dizziness...

The combination is odd...

It is key goal of medicine to prevent dizziness.

Your case is unusual in the scope of circumstances that seem to be associated with the dizziness. I would try to continue the Atenelol and follow and write down in a journal as to your symptoms on a given day . Note your dose of Atenelol and your pulse and blood pressure.

I hope that this is helpful for you! Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I seem to start to get dizzy around 2 hrs after taking atenolol and feel better around 4 or 5hrs but hr high so I take another one and hr goes down to 50 within 30 mins
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

You seem to be all over the map! It seems only a few days ago that you were feeling that the beta blocker had little effect after 2 hours...

I would strive to find best timing and dose for you and try to stay consistent. It is hard to judge the dizziness as you note dizziness with fast heart rate and standing/ walking but also low heart rate and laying down . So I would keep a journal of dose Atenolol taken, pulse, blood pressure and time ... Note also periodically how you are feeling!!

I think that a careful record of these factors vs when you feel bad( dizzy) vs feeling good and see what seems to be the best pattern with feeling your best . This approach I think should be helpful to you to know where your best comfort lies with regard to the Atenolol...

I hope this helps! Let me know if you have further questions! Best regards!

Anthony Bray MD
Customer: replied 1 year ago.
What do you think about propranolol my dr says we can try that he says I can take it during the day or as needed so at night hr isn't 50bpm to try to help night time dizzy I read up on it alittle it's a dif kind a non selective what advantages or disadvantage does it have I think it only last 6hrs
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well I tend to favor Atenolol as the propranolol in my opinion would make you " chase your tail" more than you already do. You tend to second guess every move you make and worry too much, I think. I think it would be best to get to a point in which you could take your medicine and forget about it but that may not be possible... It seems that there is not an easy solution. Let me know of your patterns and numbers which ever you decide. I will be happy to help make sense of the responses. I hope that you are able to titrate on one of these meds to help keep resting pulse in range (50 to 90 ) resting with medicine .... Usual resting 60 to 100)...

Take care,

Anthony Bray MD
Customer: replied 1 year ago.
Ok I will stay on atenolol then in home watching TV and hr is 55 to 60 and I feel ok but when I tried to get up and walk around hr shout up to 110 in 5 mins and was dizzy wondering if it the hr making me dizzy or something else like blood flow cause I am dizzy at time with hr 69 and now I'm not
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

Pulse 110 with walking is perfectly normal. Normal walking stress test will typically see heart rate range from 80 at start to about 135 with about 5 minutes walk ( at times a bit higher) Be careful not to confuse the normal range at rest with that of exertion!! Your rate with exertion will depend on the vigorousness of exercise and time!!

Blood pressure too goes up with exertion as normal!! It comes back down with rest. Period of rest may see BP dip below resting value( this may be several minutes into rest) blood vessels are very dilated and as pulse rate comes back down after exercise it can drop to low values. I would pay attention to whether period after exertion corresponds with your dizziness too...

I hope this is helpful! Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Yes it does after working for 2 hrs I get dizzy and come sit down and still dizzy for 1 or 2hrs after and hr takes 30 mins to come down if that help I'm fine now but siting and didn't take atenolol yet but when I get up to do thinks I will get dizzy hr now is 70 I will try to things around the house and see what happens so if I get to dizzy I can sit down I'm wondering if it pots or something else or both
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again ,

Well it sounds like same experiment that you have tried numerous times..... BTW I take a beta blocker daily for my blood pressure ( Toprol XL 50 mg) my experience includes no dizziness such as you have and pulse rate is consistently 55 or higher at rest... I know that we are two i divi duals and that I can't reliably compare my experience with yours. I do hope to provide an example that it can be done and usually is done without the type of trouble that you relate!!

My issue is high blood pressure and not tachycardia though and that is important difference. Still I take my Toprol religiously each AM. To start and stop a beta blocker is just a formula for more problems in my opinion!! Other agents could be tried if the Atenolol seems to not be a good fit for you. Zebeta (bisoprolol tends to be mild for example ) I think that the better approach would seek consistency of dose however!!

I hope this helps! Let me know if you have further questions!

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I my resting hr is 55 now without atenolol I will take it now then half or the whole thing is my question I need it for standing hr the most
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well your heart rate will be under more influence to race with exertion . You do not need worry about mildly elevated heart rate with standing or walking but rather you may feel better to keep rate below say the 140 to 150 range... You may feel dizzy with exertion if you have a very high rate for example... If you run the rate would be pushed higher. The rate will be proportional to your exertion. It sounds that your rate is just too easily pushed too high for you. A beta blocker does not stop this effect but dampens it . The same exertion that might give you an abnormal high rate of 160 for example may be more likely to give you a normal moderate exertion rate of 135... That would be the kind of response that we would be looking for...

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I see so resting hr will not go down much it helps standing hr more I should be treating standing hr not resting
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well you need to PREVENT abnormal tachycardia which in turn may make you dizzy! That would be the treatment goal! Yes you are looking more to prevent racing of the heart which is going to be more pressured to race with standing/ walking/ exertion... The NORMAL. Range resting is 60 to 100 but down to 50 is acceptable on a beta blocker!! The normal range non- resting is not so closed or defined because it is influenced by your degree of exertion. Also the more conditioned or " in shape" a person is the less dramatic the rise of pulse rate with exertion. Age is also a factor in this as well...

I hope that this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Good morning hope you are having a good weekend btw I was wondering if I take half 2 or 4 hrs after first dose is that the same as taking it all at once what I mean if I take at once will it do more or the same as twice a day is it stronger if once a day
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

The effect of spaces doses of 12.5mg a few hours apart would be very similar in effect to taking 25mg once ... Not much difference in effect would be expected...

I hope this helps . Let me know if you have further questions. Take care!

Anthony Bray MD
Customer: replied 1 year ago.
Ok thanks I will just take it once a day then for a week or so and see what happens is it normal for hr to be 130 I was standing up cleaning house not doing much and took one hour to come back down to 65 after I sat down that was 5 hrs after taking second half of atenolol
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

There is not a strict bracket of normal for standing and with some exertion( even just walking around) this lack of strict brackets is because the degree of exertion varies all over the place. A persons status of conditioning will affect the heart rate response. A person's weight affects this as well. So we don't assign strict brackets to non- resting open ended standing/walking heart rates.

130 would not be unreasoned and would not be beyond an expected maximum( this varies by age) so you need not worry about 130 rate with walking!!

I hope this helps! Best regards!

Anthony Bray MD
Customer: replied 1 year ago.
What causes hr to take so long to get back to resting hr
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Usually the return to resting heart rate is not that long... Only a few minutes.. Maybe about ten minutes except when you have had more if a period of exertion. You know if you have been running or working over a longer period then you would have more of an oxygen deficit to catch up. So an hour for heart rate to return to normal is unusual except for extended vigorous exercise...

Best regards!

Anthony Bray MD
Customer: replied 1 year ago.
Could a blockage cause this to happen or my pots syndrome I was reading pots lowers Bp when standing to long and causes fast hr so I'm confused why take atenolol witch will lower Bp more and cause more problems
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

No, atenolol lowers heart rate. It may lower blood pressure but this effect would be secondary...in fact your heart has a max effective rate and going too fast can make pressure drop as well... If you had rate in excess of 180 this would likely be the case... Then dropping rate from too high say 200 back down to say 165 may stabilize blood pressure and improve cardiac output... So the rate is not the only factor to consider ... Lower rate also corresponds with increased stroke volume if the heart... So for the rates at which you are being effected by the medicine there will be proportionally more effect on your rate and less effect on your blood pressure level.. That is what to expect

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
So a hr of 120 can't cause lightheadedness I'm thinking something else is causing lightheaded not the hr
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well I did not say that pulse rate of 120 could not correspond with dizziness exactly as I am sure that every rate possible has corresponded to someone's dizziness. But rate of 120 specifically causing the dizziness ---probably not!! Pulse of 120 is easily within typical person's normal for a comfortable walk for example so this in itself I would agree would NOT be expected to be the cause...

We do look for clues as to the body's responses. Lying still and having pulse rate resting of 120 would be abnormal for example and we would wish to find explanation for that...

Dizziness itself may exist at low heart rate, normal heart rate or high heart rate. Often dizziness may correspond with low blood pressure which might be the case for when you are standing. Your sense of dizziness while lying down does not seem to fit with pulse or blood pressure being the expected cause in this position though!! I remained puzzled at that pattern!!

Best regards,

Anthony Bray MD
Customer: replied 12 months ago.
Seems to be two hrs after atenolol I get dizzy and last for 1 or 2 hrs it lowers resting hr to 50 and standing after a few hrs standing 120 and get dizzy with movement of head or laying flat and in car I get dizzy driving too I'm so confused if I'm helping or making it worst
Expert:  Anthony Bray, MD replied 12 months ago.
Hello!

Well as I recall you were having dizziness and tachycardia when you were NOT taking the Atenolol. It seems that treating with the Atenolol does help to control what tendency you may have had for the racing heart rate but it does not end the dizziness.

The dizziness may be caused by more than one factor here. That would make the most sense to me considering the range of circumstances or position in which you feel dizzy.

I would advise further evaluation by a neurologist perhaps... they may be able to make sense of your pattern ???

Have other measures been helpful for the dizziness such as treatment for anxiety?? Has that helped this some in the past??

Look for helpful clues I would say based on your past with this problem...

I hope this helps. Let me know if you have further questions or discussion. Best Regards,

Anthony Bray MD
Customer: replied 12 months ago.
I'm taking ativan when I get dizzy but it don't help it so I am not sure it anixity the only other thing I can try is zoloft but it helped years before but I tried it again and it didn't seem to help now for some reason
Expert:  Anthony Bray, MD replied 12 months ago.
Hello again,

The meds for anxiety IF they are going to help will help more to PREVENT the symptom but will not quickly correct it at all. This is an important distinction to keep in mind!!

I think for one you have too much of a tendency to chase your tail and try to correct things when it is too late!!

It is easier to keep a cat inside than to catch it once it gets outside!!

I hope this is helpful for you! Take Care and let me know if I may be of further help!

Take Care!

Anthony Bray MD
Customer: replied 12 months ago.
I get it I take .5mg ativan every 5 hrs and an extra one when I get dizzy about 2mg a day at first it was working but been on it for two years and don't seem to work but I don't want to up the dose I can take 4 mg a day but don't want to get addicted to it and have a hard time stoping it i know it's not for long term use so confused why I'm still on it I was on klonopin years ago to wondering if I should try that again it last longer I think this ativan is not helping I might me getting rebound effects before next dose not helping the dizzy
Expert:  Anthony Bray, MD replied 12 months ago.
Hello again,

OK, No I agree with you that it would not be wise to push the Ativan dose up and up...

Perhaps you could ask your doctor about returning to Klonapin. You are right in that it does have much longer duration of action...

This may help. I hope that you are able to find relief from this sense of dizziness. I would continue a steady , routine AM dose of Atenolol for now. I don't think that a return to episodes of tachycardia would help anything. Obviously there is more to your dizziness than controlling the tachycardia but I think to stop the Atenolol would just make matters worse for you...

I would suggest that perhaps having an ENT and neurologist may be of help. BUT I fear that your dizziness may defy a straight answer from the experts. Your case seems very atypical....

Good luck. Let me know if I may be of further help. Take Care!!

Anthony Bray MD
Customer: replied 12 months ago.
I have bed we by three ent and many tests and seeing a neurologist specialist for my pots and no help he says there is something else going on and my symptoms are not all from pots cause sitting would stop my dizzy and symptoms only happen on standing and the hr itsnt causing dizzy he says so I am not sure what to do anymore I have wasted thousands on drs tests to they say everything is fine
Expert:  Anthony Bray, MD replied 12 months ago.
Hello again,

Perhaps see a psychiatrist. Or better yet a dual neurologist/psychiatrist... This dual specialist may be of some help where others have not been.. I agree that your symptoms are atypical and therefore seem to defy the logic of the usual causes of dizziness. This may be an important clue that it may at least in part be psychosomatic. I think that perhaps you had POTS for example and developed a fear of dizziness due to this. The fear may kick in to reproduce the symptom when the pulse and blood pressure no longer cause it. This would make more sense to my point of view.

So a broad symptom of dizziness that historically probably started with a physical cause but later broadened to psychological cause as well is the more likely mechanism I think.

I recall one patient of mine with a similar story. She had physical reason for dizziness but it became more broad. She developed agoraphobia from it and was afraid to be outside in the open.... open spaces without something to hold onto came to make her feel dizzy but this was not the case early on in her illness...

So if this is the case then continuing with controlling the physical factors that may cause dizziness such as the tachycardia may be of help but also further addressing psychological factors may be of equal importance...

I hope this is helpful for you! Let me know if you have further questions! Take Care,

Anthony Bray MD
Customer: replied 11 months ago.
Dr put me on zoloft what can I expect and what side effects will I have and will they go away and how long
Expert:  Anthony Bray, MD replied 11 months ago.
Hello!

The Zoloft is an antidepressant of course that is also helpful for anxiety. It may have side effects of nausea -- not typical but if you feel a bit queasy this typically stops within a few days. Feeling tired or sleepy may occur and this would usually adjust back to you feeling normal again within a week or two , sometimes longer. I usually advise taking Zoloft in the evening but a fraction of patients may have insomnia...

Fairly rare -- some may have an ongoing diarrhea with this and this would be reason to need to stop the medicine. The fast majority have no trouble with this but it can be a limiting side effect when it occurs.

Try not to focus on SIDE EFFECTS-- it is easy for a person to psych themselves out to the negative when it is not necessary. Try your best with the medicine. Let's hope that you find it helpful! I do suspect that part of the dizziness is psychological in origin. I think it is multi-factorial. So I do think it needs to have multiple components treated. I think that the beta blocker( Atenelol) is definitely part of the answer for you but not able to eliminate all of your symptoms.

I agree with this approach that your doctors are trying. I hope this helps! Good luck! I hope that you feel better soon!

Best regards,

Anthony Bray MD
Customer: replied 11 months ago.
He wants to start it at 25mg is that to much should I start ar half for two weeks and then the whole will 12.5 do anything or to little will that lessen side effects if I get them
Expert:  Anthony Bray, MD replied 11 months ago.
Hello!

I see no need to start at a dose lower than 25 mg. this dose for one week followed by 50 mg / day would be reasonable. If you take 25 mg for two weeks then increase to 50 mg then that would be fine.

The lowest dose likely to be effective would be 50 mg but max is 150 mg/ day.

I hope this is helpful. Best regards!

Anthony Bray MD
Customer: replied 11 months ago.
Do I just stop ativan now I been on 2 mg a day .5 every 4 hrs 4 times a day
Expert:  Anthony Bray, MD replied 11 months ago.
Hello,

No I would not stop the Ativan unless you were directed to do so by your doctor. To go from Ativan to ONLY Zoloft would be in effect a DECREASE in treatment for your anxiety. I would think that the combination would be recommended for you even if the dose of Ativan might be lessened for example...

I hope this helps, best regards ,

Anthony Bray MD
Customer: replied 11 months ago.
An anxiety cause a slow hr at rest or at night if so how is it treated
Expert:  Anthony Bray, MD replied 11 months ago.
Hello again,

Can anxiety cause a slow heart rate? No not really.. There can be different reasons for bradycardia..

What has been your range of heart rate??

Let me know...

Anthony Bray MD
Customer: replied 11 months ago.
I been taking 25 mg atenolol everyday and during the day it's from 60 to 120 and at night it's 50 to 60 and its it better to take ativan twice a day at 1 mg each time instead of .5 four times a day maybe that is causing alittle dizzy after 3 or 4 hrs to many ups and down I think with ativan I think it's a good drug for as needed only worked great but not so well now after 4 years I want off this but if I try to ween off I get more dizzy and hr goes faster
Expert:  Anthony Bray, MD replied 11 months ago.
Hello,

Well for one your lower aspect of rate(50 to 60) is perfectly normal for taking a best blocker and WOULD NOT be expected to cause you trouble here.

I think historically that you get into real problems off of the Atenolol so I favor you staying in consistent dose as you have been doing with this.

You may have benefit from the Ativan vs anxiety and possible psychological reasons that may be a part of the cause of your dizziness. So maybe look to move gradually such as 0.5 mg Ativan three times a day for a month. If that goes ok the maybe twice a day for a month. Check in with your psychiatrist and other doctors to update your prowess.

I hope this helps! Best regards !

Anthony Bray MD
Customer: replied 11 months ago.
If I take 1mg and dizzy gets better then its from anxiety right and I try to get off ativan but after 4 or 5 hrs I get dizzy and after I take it again it gets better after and hr so is that withdrawels that I can just tough it out my dr wants me off it but its hard I was on 4 mg but can only get down to 2 mgs can't seem to get lower
Expert:  Anthony Bray, MD replied 11 months ago.
Hello again,

Well if your doctor wants you to wean off I would just do that gradually. Ativan 0.5 mg three times a day for 2 to 4 weeks/ 0.5 twice a day for two to four weeks/ 0.25 mg twice a day for two weeks then OFF...

This would not be harmful to you physically at all.

It sounds that your doctor wishes to change to using Zoloft instead to avoid the abuse possibility. It also helps with anxiety. It may be that part of the dizziness is psychosomatic in nature. Hopefully you will get a good result from the Zoloft.

Best regards,

Anthony Bray MD
Customer: replied 11 months ago.
The new dr said my b12 is low and can cause my problems and vitamin d is low I asked what caused that he says he don't know I'm wondering what's eating them b12 was 210 normal but low and d was 20 would any of this cause or make my symptoms worst I'm not convinced yet and when is best time to take b12 morning or night he has me on 500 a day mcg sublingual
Expert:  Anthony Bray, MD replied 11 months ago.
Hello!

Well unless you are vegetarian chances are that you do not absorb B12 properly. B12 is the most COMPLEX nutrient that our body absorbs. Your stomach makes a special protein called intrinsic factor which binds to B12. This complex is ONLY absorbed in the last 6 inches of the small intestine.

Thus you are welcome to try oral or sublingual B12 but chances are that it will not work.

Most people with B12 ( > 90%) have intake that is fine but lack of proper absorption. This then usually needs to be treated with shots once a month 1000mcg once a month is the typical dose. This is usually given at two week intervals for the first 2 or 3 doses to help catch you up.

B12 deficiency ( yes even borderline low) may cause neurological symptoms... This could cause peripheral neuropathy as a common consequence. If neuropathy has been related to you having poor sense of position then it could relate to dizziness. It may help but I can't guarantee that it will fix everything. You need to treat it however. On this point there is absolutely no doubt!!

The oral or sublingual may be attempted with a follow up level in 2-3 months . There are some people whom may have 20% normal absorption for whom this approach may work for a while...

My preference is the shot. It is 100% effective. The cost of this medicine is such that less than 20 dollars provides more than a year if medicine!!

It is related to neurological symptoms and must be treated or you will suffer increasing neurological consequences as time goes forward. Weakness , decreased sensation and confusion included...

The vitamin D by contrast is the most COMMON dietary deficiency. This you may treat with oral supplement of vitamin D3 800IU/ day... Vitamin D has more to do with your calcium absorption, excretion and use within the body... It helps to support the strength of your bones. Calcium and magnesium supplementation along with vitamin D is a good idea.

Unlike B12 --- vitamin D is not the reason for your dizziness ( certain on this one )

Vitamin D is also supported by sun on your skin. 15 minutes of sun to arms and legs for fifteen minutes daily are enough to provide your daily needs as well. The sun concerts vitamin D to its most active form.

I hope this helps! Let me know if you have further questions. Please start a new thread due to the length of this one!!


Best regards !!

Anthony Bray MD
Customer: replied 11 months ago.
For vitamin d I take 50,000iu d2 every over week and it was 40 and after three months on that dose it was 38 went down I'm confused how this can happen with a mega dose I'm taking
Expert:  Anthony Bray, MD replied 11 months ago.
Hello again,

Well with vitamin D2 this is prescribed in high dose but only a fraction of D2 is then converted to D3 which is THE MOST ACTIVE FORM...

It is a gradual process and your results are not atypical.

Hang in there and it will correct. Either the large dose of D2 as prescribed will work or the D3 at 800IU/day OVER TIME would also work.

Do not take excess than what you are prescribed or advised by your doctor because too much vitamin D can be toxic to the liver...

I hope this helps. Best Regards,

Anthony Bray MD

PS >> You will need to start a new thread soon if you continue to have further questions...
Customer: replied 11 months ago.
I've been noticing after an hr of taking atenolol I start to get dizzy and it last about 4 hrs but taking ativan to so do you think it's atenolol the cause and my b12 is low and starting shoots weds anything I can expect with side effects cause I seem to get them easy
Expert:  Anthony Bray, MD replied 11 months ago.
Hello!

No side effects to expect with B-12 shots as B12 is a critical nutrient that your body must have. Well the usual shot effects of minor local reaction with brief soreness of the site of the shot. These are superficial shots with narrow needle and are not that bad at all really. Patients that I have started on these are usually amazed at how little pain there is.

Hopefully the B12 may help you to feel better. It may improve your sense of energy for example. B12 deficiency may have neurological effects so reversal of such would be possible with replacement. Time will tell more than anything as to what symptoms might be reversible with bringing your B12 back to normal levels...

To the best of my recollection you have more history if doing worse when you were not taking the Atenolol so I tend to think that this is not really a culprit here so much for you.

Keep track of symptoms/ medication/ timing/ quality of the dizziness/ pulse rate and blood pressure. I think a careful review of an accurate record may the best way to gain clues.

I hope this helps! Let me know if you have further questions! Best regards !

Anthony Bray MD
Customer: replied 11 months ago.
Ok thanks what is normal Bp standing I think I'm high it's 150/100 and sitting is 140/90 and that after taking atenolol an hr ago laying down 130/80 I am dizzy when standing is that from Bp to high
Expert:  Anthony Bray, MD replied 11 months ago.
Hello again,

Well the norms are based much more sitting and resting. For standing it would be a reasonable estimate to add ten points to the normal range ( 100-135/ 60- 85) .

The BP standing is a bit high but not so much that I would expect you to be symptomatic from it.

As we have discussed I think your dizziness arises from more than one factor...

I hope this is helpful. Best regards,

Anthony Bray MD
Customer: replied 11 months ago.
Can a blood sugar of 80 cause lightheadedness
Expert:  Anthony Bray, MD replied 11 months ago.
Hello,

No it shouldn't . 80 is well in normal range ( 65 - 109) ( some scales of normal vary slightly) a value of 80 is normal by any scale though ....

I hope this helps! Let me know if you have further questions...

Please consider starting a new thread for further questions soon as this one is getting quite long.. You can address question to me on main Justanswer site or go to my profile page and use box to start new question thread..

http://www.justanswer.com/medical/expert-anthonybraymd/

Question in the box on that page would also be directed specifically to me ..


Thank you and best regards,

Anthony Bray MD
Customer: replied 11 months ago.
Get b12 tomorrow only once a month will that be enough and should I ask to take b12 pills or don't need them with shot will it last a month and how high will it bring my levels and do they take another test btw I am opening a new one after I get your answer so I can pay you for your time
Expert:  Anthony Bray, MD replied 11 months ago.
Hello again!

Once a month B12 at 1000mcg / dose is the standard dose for B12 replacement . You would not need and probably have little to no benefit with further oral supplementation. You may have a follow up B12 level done after a few months.... That would be common. We pretty much know that that dose will bring you into normal range or even" high" levels. High levels are fine as B12 has no toxicity...

The shots are most often needed for B12 deficiency because it is most often caused by a breakdown in the complex absorption of this nutrient.... Stomach makes protein called intrinsic factor and this protein must form complex to bond B12 for the vitamin to be absorbed only in last six inches of small intestine. So the shot bypasses this complex absorption system of the body... If you have breakdown of this absorption then any oral B12 that you take might be absorbed only at very low percentage... Absorption may be close to zero percent causing the deficiency for example...


I hope this I formation helps! Best regards!

Anthony Bray MD
Customer: replied 11 months ago.
Any side effects can I drive there they also told me I can do it myself at home so they only last for a month and then goes down btw how do I get you to answer my new same questions lol
Expert:  Anthony Bray, MD replied 11 months ago.
Hello!

No adverse side effects from B12!

Yes you may drive!

Many will have someone help with giving shots but yes you may learn to give them to yourself.

Two ways to start new thread to me...1) go to my profile page at http://www.justanswer.com/medical/ expert-anthonybraymd/ ..... On this page just type question in the box on that page and it should be directed to me...

2) you may ask question to " Dr. Bray" and if another expert should offer to answer you can always ask to be referred back to me!!

As the thread grows too long it does begin to develop more problems with more pages getting stuck as well wait times to upload....

Thank you and best regards!

Anthony Bray MD

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