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evo103179
evo103179, Board Certified Physician
Category: Medical
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Experience:  Board Certified in Internal Medicine (ABIM)
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Please, looking for help regarding possible cardiac or GI (including

Resolved Question:

Please, looking for help regarding possible cardiac or GI (including gallstones).

Having palpitations x1 week with the onset accompanied by tachycardia (hr remained above 110) that sent me to the ER. Yes, PVCs were evident on the monitor but I don't think the EKG caught it.

Been up and down since then. Palpitations are inconsistent but when they are present they last for a while. They seem to occur long after eating but no eating doesn't eliminate symptoms--in other word palps are more after eating but don't necessarily go away when I don't. .I was able to research and at least hypothesize this may be related to gas, gerd, H hernia or gallbladder. Not so much the heart being the source now but the symptom. Enzymes all negative and all other labs were normal aside a slightly elevated WBC. I left the ER with a script for Lopressor. I stopped taking this med around the same time some literature pointed me to GI. Then I saw my PCM yesterday and she said hold off for now.

Recently during a palp episode, I tried gas x and it relieved my symptoms for little bit. Not sure at this point If it was the act of putting something into the stomach or the med itself did something--thinking along the lines of acid fluctuations when swallowing.

Some med hx--42 yo male hx of Fibro, htn, tmj,and some mental health. I currently take narc pain meds for back and widespread pain. 2 weeks ago I was admitted overnight for constipation like symptoms and was released to a fiber rich diet. I was admitted just to ro Heart problems. I am also 70 lbs ow.

Tomorrow stress test and later this month GI, psych,endoscopy. Currently wearing a 30 day h monitor to assess palps.

The palps and fluctuations in hr are bothersome. I get pain in upper back a lot and I wonder now if there's a connection. Some neck pain and at time I feel like I'm being strangled. I've tried some stomach massages to relief possible Hh but all minimal help. Today, interesting sharp pain in my back between shoulder blades when drinking cold juice. Again I wondered was it the postural or some GI or both.

PPI ordered and I think it is helping but seems like a week dose at 20 mg Prilosec. Also palpitation are provoked laying down.

What do u all think. Am I stimulating my vagus nerve. That drinking episode scared me a lot.
Submitted: 1 year ago.
Category: Medical
Expert:  Vakul Aren replied 1 year ago.
Hypertension with obesity in middle aged male may be associated with tachycardia.The causes of palpitations would include atrial fibrillation, Paroxysmal Supraventricular tachycardia,other ventricular arrhythmias,increased intake of caffeine/tobacco/alcohol,thyroid disorders and systemic disease.Since you are wearing a Holter ECG monitor,are scheduled for a cardiac stress test any such problem is likely to be diagnosed.GI endoscopy and other investigations including scanning(ultrasound scan/CT scan) will help identify any oesophagitis/peptic ulcer,Gall stones,pancreatitis,hiatus hernia as a cause for your problems.Losing weight will definitely help,that will need a proper diet control as well as a increase in exercise levels.Use of sucralfate along with the PPI may help any GERD/Gastritis,prokinetics and life style alterations will help in hiatus hernia,oesophageal motility disorders may need to be evaluated.A Echocardiography and evaluation of the aorta and other vessels will help.Ruling out any Atherosclerosis or lipid disorders may help.
Vakul Aren, Doctor
Category: Medical
Satisfied Customers: 3378
Experience: MBBS,DTM&H,30 years of experience
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Customer: replied 1 year ago.
Relist: Answer quality.
Answer sheds no additional light on my problem. If GI is suspected I'd like to know how it's suspected to involve the heart? If gallbladder or anything else, a brief redirection would b helpful. Not looking answers overly detailed--I didn't pay for that. Perhaps a more simplistic explanation with broad statistic of people with same condition or pts served by md with similar sx.

I genuinely feel no more educated than before the question though I don't attribute this to the md entirely.. I appreciate the attempt.

I was thinking the information appeared plentiful but really didn't give me insight with the amount of text filling the page. I'd like the same text or less with quality.
Customer: replied 1 year ago.
Relist: Answer quality.
Answer sheds no additional light on my problem. If GI is suspected I'd like to know how it's suspected to involve the heart? If gallbladder or anything else, a brief redirection would b helpful. Not looking answers overly detailed--I didn't pay for that. Perhaps a more simplistic explanation with broad statistic of people with same condition or pts served by md with similar sx.

I genuinely feel no more educated than before the question though I don't attribute this to the md entirely.. I appreciate the attempt.

I was thinking the information appeared plentiful but really didn't give me insight with the amount of text filling the page. I'd like the same text or less with quality.
Customer: replied 1 year ago.
Relist: Answer quality.
How is GI suspected? Personal experience with patients? Gallbladder seem viable? Anything clinically important about back pain and drinking?

Explanation seemed like the same information I gave without medical insight pertaining to suspicion. The amount of informations appeared plenty but lacked what I needed.
Customer: replied 1 year ago.
Relist: Answer quality.
How is GI suspected? Personal experience with patients? Gallbladder seem viable? Anything clinically important about back pain and drinking?

Explanation seemed like the same information I gave without medical insight pertaining to suspicion. The amount of informations appeared plenty but lacked what I needed.
Expert:  evo103179 replied 1 year ago.
Hello. Thank you for your question. I am a board certified internal medicine physician. I also have additional training in a cardiology fellowship. I was trained in the US and hold an unrestricted medical license there. May I assist you?

Palpitations are a very common office complaint and can be very troublesome to my patients and pay particular attention to them to make sure they are not a sign of more serious heart pathology.

The way I evaluated palpitations in my practice in Cardiology was to capture them on a ECG rhythm strip. An ECG in the office is not adequate as the ECG only captures them for the 6 seconds you are attacked to ECG machine. When you were in the ER you demonstrated PVC's. I suspect this or another similar arrhythmia like premature atrial contractions (PAC's) are causing your symptoms. Sometimes, however, other arrhythmias like atrial fibrillation, atrial flutter, or even potentially lethal arrhythmias like ventricular tachycardia could be causing a patient's symptoms.

The right test for this condition is a HOLTER or EVENT monitor. A HOLTER monitor is an ECG monitor that is worn for 24 hours or more. When you develop these palpitations again, it will document what your precise heart electrical rhythm is when they occur. Cardiac causes can be ruled out with this test, which is the most likely cause. If you have the palpitations (symptoms) without an electrical problems, then other causes like GI should be explored. However, GERD and other GI causes can cause atypical chest pain, which is different than palpiations.

Palpitations are perceived forceful contractions of the heart and an abnormal electricity of the heart should be ruled out, especially given the PVC's you noticed in the ER. The good news is that beta-blockers like lopressor can suppress PVC's and PAC's, and sometimes the dose has to increased a bit to get their full effect.

Hope this helps.

-Dr. S
Customer: replied 1 year ago.
My docs don't think it's totally heart related.

What I like to know from an expert if if GI concerns such hiatel hernia, gallbladder or gerd can cause my palpitations due to the timing I described above. If so, can you connect them for me. Furthermore, I'm interested in the off chance my back pain as described earlier when drinking might also have something to with GI or even posture. ,

Thank you for your time.
Expert:  evo103179 replied 1 year ago.
The connection between the GI symptoms could be related to pain.

There very well may be a "GI-heart" connection in this way. Palpitations due to arrhythmia like PAC and PVC's can be worsen under times of stress and pain. Pain leads to release of "catecholamines" that can increase the frequency of premature beats like PVC's. Often times during surgeries and among my patients who are admitted to the hospital in pain I notice a vast increase in premature beats.

In regards XXXXX XXXXX cold fluids. There is a known and established relationship in some patients between drinking cold fluids and changes in the heart rhythm. Some patients even pass out (called syncope) due to this. It can stimulate what is known as the Bezold–Jarisch reflex, resulting in a rapid drop in the heart rate (bradycardia) leading to palpitations and dizziness or even syncope (fainting).

I think the palpitations are most noticeable when you lay down (which is often reported in patients with palpitations) because there is less external stimuli to distract the troublesome symptoms as compared to when you are walking around and engaged in other activities.

My guidance would be to see what the results of the Holter are first to establish the rhythm-symptoms correlation and to consider continuing Lopressor during this period of evaluation.

In addition, I think the cause of your abdominal pain should be evaluated with endoscopy (as being done) and the addition of a PPI (like Prilosec or twice daily Prilosec) to treat the symptoms in the interim (treating empirically for gastroesopahgeal reflex).
evo103179, Board Certified Physician
Category: Medical
Satisfied Customers: 524
Experience: Board Certified in Internal Medicine (ABIM)
evo103179 and 2 other Medical Specialists are ready to help you

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