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Old 09-27-2020, 06:58 AM
 
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Quote:
Originally Posted by trusso11783 View Post
What are PPIs?i have no environmental allergies and only a slight allergy of dairy. (Whole milk, cheese, etc) which I rarely have.

I had a good day at my niece’s son’s 4th birthday and as soon as I got home, my palpitations began. No stress all day. No anxiety. Just showed up unexpectedly as usual. I took my Magnesium supplement and beta blocker I was told to take when I get the palpitations. It has been 30 minutes and no better yet. I hate this. My wife and son went upstate for the weekend and I am with my 10 year old daughter. I hope nothing happens when she is with me because she will be alone and can’t handle this well at all.
Did you have anything different to eat at your great nephew’s birthday party? It’s still best to try an elimination diet to see if that helps at all. It seems like you’ve tried almost everything else, what can this hurt? Cut out all of the most common causes of reflux- coffee, carbonated drinks, mint, tomatoes, citrus, alcohol, spicy food- then slowly introduce them back in to see what your triggers are. I can eat most items on the list, but have problems with mint, citrus, and some types of coffee. If I overindulge, I also have issues. Other medications like Aleve and ibuprofen can also cause reflux. Sometimes I use BC powder (aspirin and caffeine) for headaches and that will definitely cause reflux, but it works the best for my headaches when nothing else is cutting it. What is it going to hurt to seriously cut back your diet? I did the diet and it helped me quite a bit. That’s not to say I don’t still have problems, but I did cut out the biggest problems.
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Old 10-01-2020, 05:30 PM
 
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I didn’t eat anything I shouldn’t have at the party. I am already on a reflux diet, which means no spicy foods, citris, tomato based food, coffee, chocolate, soda and seltzer, etc. I have been eating that way for the past month. So, Saturday’s episode was not food related. I take Omeptazole for the reflux and no other medication.

I saw the neuorologist today to see if my problems could be related to my vagus nerve. He said no way. The vagus nerve slows the heart down and my palpitations are from beating too fast. He told me that I have absolutely no symptoms that are related to neurology that he could not even justify an MRI or any test. He called my cardiologist and also the electrophysiologist to see why they didn’t give me some monitor that the place under the skin and monitors for three years.mso, I have an appointment with Another electrophysiologist next week to schedule that. I asked about the possibility Of it being anxiety and he said that if these episodes happen when I am sleeping, then that is highly unlikely.

I’m not sure what this monitor will do other than send Ana left to the doctor when the palpitations are. What are they going to do at that point. The only difference between that and what is happening now is that they will know in real time. It won’t tell them why or how it is happening, will it? I’m not hopeful but will give anything a shot.

Last edited by trusso11783; 10-01-2020 at 06:00 PM..
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Old 10-02-2020, 07:35 AM
 
Location: SW Florida
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Quote:
Originally Posted by trusso11783 View Post
I didn’t eat anything I shouldn’t have at the party. I am already on a reflux diet, which means no spicy foods, citris, tomato based food, coffee, chocolate, soda and seltzer, etc. I have been eating that way for the past month. So, Saturday’s episode was not food related. I take Omeptazole for the reflux and no other medication.

I saw the neuorologist today to see if my problems could be related to my vagus nerve. He said no way. The vagus nerve slows the heart down and my palpitations are from beating too fast. He told me that I have absolutely no symptoms that are related to neurology that he could not even justify an MRI or any test. He called my cardiologist and also the electrophysiologist to see why they didn’t give me some monitor that the place under the skin and monitors for three years.mso, I have an appointment with Another electrophysiologist next week to schedule that. I asked about the possibility Of it being anxiety and he said that if these episodes happen when I am sleeping, then that is highly unlikely.

I’m not sure what this monitor will do other than send Ana left to the doctor when the palpitations are. What are they going to do at that point. The only difference between that and what is happening now is that they will know in real time. It won’t tell them why or how it is happening, will it? I’m not hopeful but will give anything a shot.
Sounds like that neurologist is advocating well for you to get those palpitations checked out and dealt with once and for all.
That's a good thing, especially since so many other tests, other doctor visits and measures to rule out non-cardiac explanations for your palpitations haven't turned up anything, and they continue to make your life miserable.

What you are referring to is the "implantable"cardiac monitor. It's about the size and reminds me of a thumb drive, and it's inserted just under your skin over your heart ( or in that general area) by a cardiologist. It serves the same function as any of the monitoring devices in that it records your cardiac activity ( heart rhythm) and is paired with a transmitter that sends this information to a monitoring company/your doctor. There is also a means for you to record your symptoms as they occur and these are correlated with any changes in your heart rhythm.


The advantages of the implantable monitor include its unobtrusiveness-you won't even feel it after the site heals, and its longevity- it will continue to monitor your heart rhythm for up to 3 years, though I've read the new Medtronics monitors can go for up to 5 yrs. They're used to find arrthymias that occur infrequently in people with symptoms or problems associated with arrthymias but which have not been found on shorter time monitoring. The implantable monitor will pick up every bit of your heart activity for all that time, including any of the arrthymias, and depending on what's there, you can be notified for immediate action if your doctor feels that is indicated, or findings can be discussed with your doctor during your visits as time goes by.

They will see any arrthymias that occur- these are characterized as to the type, ( properties seen on an EKG), when they occur and how long they last, and correlated with any symptoms you report-`electrophysiologists are experts at this. The findings will indicate the treatment, which may include lifestyle changes, medication, possibly cardiac ablation as options. The treatments sometimes are trial and error as individual responses vary, but you work with your healthcare team to see what works for you.

As I see it, you are on your way to getting those palpitations characterized and under control. I hope the realization that your palpitations will be monitored each and every time they occur, that this will make it much easier for your doctors/healthcare team to see what is occuring, the type(s) of arrthymias there, and go from there with a treatment/management plan, will make your life a little less anxiety-ridden.

Best of luck, and keep us updated, ok?
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Old 10-02-2020, 05:28 PM
 
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Thanks lassie. I have little faith in this but you make it sound goo$. In other words, how is this different than me telling them when my palpitations occur? So far, it is so infrequent, no one will do anything. So, if things go the same way in the future, the monitor will cooborate what I claim, but why would they do anything by seeing the results as opposed to me just telling them. Is this more effective than just getting an Apple Watch and wear it all the time?

If I remember correctly, you were a big part of my original thread that was closed. How are you doing these days? I believe a lot of your tests came back negative.
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Old 10-03-2020, 12:15 PM
 
Location: SW Florida
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Quote:
Originally Posted by trusso11783 View Post
Thanks lassie. I have little faith in this but you make it sound goo$. In other words, how is this different than me telling them when my palpitations occur? So far, it is so infrequent, no one will do anything. So, if things go the same way in the future, the monitor will cooborate what I claim, but why would they do anything by seeing the results as opposed to me just telling them. Is this more effective than just getting an Apple Watch and wear it all the time?

If I remember correctly, you were a big part of my original thread that was closed. How are you doing these days? I believe a lot of your tests came back negative.
The purpose of any monitor is to document the heart rhythm ( like an EKG ), and to capture arrhythmic events as they occur, including correlation of symptoms ( palpitations, shortness of breath, lightheadedness, etc) with those arrhythmic events. As you know, though, when those arrhythmic events are infrequent, a time limited monitor(such as a 24 hour Holter, a 21 or 30 day event monitor) will not capture a person's arrythmia if it occurs outside the monitoring period. Doesn't mean it's not important to find and address the problems,, but it's not possible to do so properly until the doctors can see and characterize the arrhythmia.

The implantable monitor is used to detect and characterize arrhythmic events that occur only infrequently. It can remain implanted for up to three (or some new models 5 yrs I have read). They are counting on catching any infrequent arrhythmia sooner or later within the implanted time, and can characterize, determine the frequency and length of time of the arrhythmias, determine their clinical significance and come up with a treatment plan from there.

They often use implanted monitors for patients who have had strokes for unknown reasons. In this case, they are looking specifically for atrial fibrillation since this is associated with clot formation in the heart and a high risk of stroke. They also use implanted monitors for people who have fainted ( they call that syncope) for unknown reasons, and other causes of fainting have been ruled out.

As to your question about differences between your having the monitor vs. telling your docs when your symptoms show up, how long they lasted, that's really a matter of documentation of your heart rhythm activity at the time your palpitations occur.
There are any number of different types of arrhythmias, the types and context ( ie, frequency, length of time, presence or absence of structural heart disease) determine their significance and treatment. But they pretty much all feel the same to the patient, ie, the feelings of fluttering, flopping, pounding of the heart ( described as "palpitations), possibly lightheadedness and shortness of breath, and these symptoms vary from patient to patient, and they are by definition subjective.

So your description of your symptoms can't give your doctor anywhere near a complete picture of what is happening with your heart when you are feeling those symptoms, or even when you aren't. Hence the reason for the monitor.

I get the impression that your getting an implantable monitor is not written in stone at this point. I think your upcoming appoinment with the EP is a good idea, as an EP is the best judge, IMO, of the usefulness of an implantable long term monitor for a given patient. He/she will take into account your history of palpitations, your symptoms, test results, including previous monitor results ( make sure the doc has access to, or copies of these at your visit). He/she may be able to determine the type of arrhythmias you've had during your palpitations, and maybe will believe additional long term monitoring isn't needed. He/she will take your informed preferences into consideration, so ask any questions you may have.

As for me, I'm doing very well, at least for the most part. I guess I was lucky in one sense that my "palpitations" were taken seriously from the getgo ( maybe showing up in the ER with a heart rate of 210 beats/minute, and symptomatic will do that?), and the arrhythmias were documented ( as SVT) and I was started on medication- metoprolol to control them, along with other meds for the high blood pressure. I was in my early 50's when this happened.

Welp, these were controlled with the meds till I hit my mid 60's, then a several hour bout with what they determined was atrial flutter landed me in the ER, and a cardiac consult. I was followed by the cardiologist from then, and ok for another couple years till the tachycardia reared its ugly head again ( these would be several hours a day some days, not as much other days) and when it wasn't tachycardic, my heart rate would drop- into the 40s and even 30's. We thought it was due to the medication, but as time went on this occurred no matter what I took or how little of it I took. And when I didn't take the meds the tachycardia reigned supreme ( at least till the heart rate dropped into the 40's again.). And I felt lousy most of the time.

The referral to the EP was what made the biggest difference to me. He made a diagnosis of "sick sinus syndrome" ( malfunctioning of the cardiac sinus node, causing both slow and fast heart rates), characterized the tachycardia ( from several monitor records over the years) as atrial tachycardia, and recommended medication to control it, with a pacemaker to keep the heart rate from falling too low. Before the pacemaker implant, though, he switched the medication from metoprolol to diltiazem to see if this med would keep the tachycardia under control, and lessen the bradycardia. It did neither very well, so I got the pacemaker. He also addressed my blood pressure issues, and explained the relationship between poorly controlled hypertension and arrhythmias, told me I was on my way to worse times, including afib if I didn't get the blood pressure under control. Made a believer out of me.

It's made a big difference, I feel so much better now, more energy with a heart rate not in slug ranges. And I can take enough meds to keep the tachycardia at bay, for the most part, without worrying that the heart rate will fall too much.

Though I guess I still have some issues with the tachycardia. To be expected, I guess, though I don't worry about minor events that don't last long as the pacemaker and its paired monitor (on my nightstand) with the monitoring company have alert functions to notify my doctor in the event of tachycardias that exceed certain preset thresholds. Sure enough, this happened the other day, a call from the cardiologist's office informing me of a pacemaker monitor alert. It reported some pacemaker activities associated with atrial tachycardias, and the doc instructed me to increase the amount of metoprolol to counter it. Which I hope did the trick.

Anyway, it's good, in the majority anyway.

And best of luck to you.
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Old 10-03-2020, 07:08 PM
 
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Thanks for such a detailed response. You should work in a cardiologist office. I am glad to hear that you are doing much better these days.

I am not too optimistic because I already went to an EP. my sister said he was great and he gave her an Ablation. I saw him after he reviewed all of my records from my cardiologist. He looked at me and said he doesn’t want to see me again because he sees nothing wrong With me. He said that I only had one episode of palpitations during a two week period wearing the monitor that lasted 15,000 of a second long. I told him it lasted a few hours long but he only saw 15,000 of a second. He said my sister has thousands of events a day compared to me so I am fine from his point of view. I was disappointed when I left which is why I saw a neurologist who also said he sees absolutely nothing neurologically wrong with me and cannot help me. He knows the EP I saw and tried to reach him. When he couldn’t, he called the EP’s associate and asked if it would be a problem if I saw him. He said he would see me. He also knows my cardiologist and they spoke while I was there.

My problem is that everywhere I go, everyone says I am fine. My cardiologist said that A Fib or any blockage has been ruled out as has any issues with Thyroid, anemia, low magnesium. All of my level are great. In fact, on paper, I am great, except for the few times I get palpitations like I have as I am writing this. I hate this. No one is home and I have my local fire Dept’s EMT phone number ready to be dialed on my cell phone. What a way to live.

Thanks again.
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Old 10-06-2020, 11:41 AM
 
Location: SW Florida
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Quote:
Originally Posted by trusso11783 View Post
Thanks for such a detailed response. You should work in a cardiologist office. I am glad to hear that you are doing much better these days.

I am not too optimistic because I already went to an EP. my sister said he was great and he gave her an Ablation. I saw him after he reviewed all of my records from my cardiologist. He looked at me and said he doesn’t want to see me again because he sees nothing wrong With me. He said that I only had one episode of palpitations during a two week period wearing the monitor that lasted 15,000 of a second long. I told him it lasted a few hours long but he only saw 15,000 of a second. He said my sister has thousands of events a day compared to me so I am fine from his point of view. I was disappointed when I left which is why I saw a neurologist who also said he sees absolutely nothing neurologically wrong with me and cannot help me. He knows the EP I saw and tried to reach him. When he couldn’t, he called the EP’s associate and asked if it would be a problem if I saw him. He said he would see me. He also knows my cardiologist and they spoke while I was there.

My problem is that everywhere I go, everyone says I am fine. My cardiologist said that A Fib or any blockage has been ruled out as has any issues with Thyroid, anemia, low magnesium. All of my level are great. In fact, on paper, I am great, except for the few times I get palpitations like I have as I am writing this. I hate this. No one is home and I have my local fire Dept’s EMT phone number ready to be dialed on my cell phone. What a way to live.

Thanks again.
Well, it's a good thing to have ruled out either coronary artery/structural heart disease, or afib. This puts the palpitations you are feeling in a better light, ie, most likely not dangerous and not life-threatening. The other tests (neurologic, thyroid, anemia, electrolyte levels) within normal ranges rule out these extracardiac problems as a cause of your symptoms, which puts things back into the possibly cardiac category. Not that this makes you feel much better if you continue to feel those symptoms, but it could serve to reassure you that you won't die when you are feeling those palpitations. To the extent that you let those symptoms dominate your life, make you live in fear that you will die during one of your events, well, it makes the psychological consequences of those symptoms worse than the physical effects of the palpitations. And if there is a psychological component to those palpitations ( not saying there is), your fear of them might even make them worse.

That said, I know how frightning those palpitations can be, and being it's your heart after all, it's easy to believe you just might die (or feel bad enough you wish you would- been there done that) during one of those events. It takes a lot if work to power through an event, especially when nobody has figured out what is happening, but you know it will stop and you will be ok.

But documented monitor results are essential to see just what is happening with your heart at the time of your symptoms. These results can be seen as changes in the EKG, especially when the person is feeling the symptoms. The changes can be anything from PVCs or PACs, singly or even in pairs, or multiples, atrial arrhythmias such as SVT, or afib/flutter, or ventricular
tachycardia. If these occur at the same time the person reports symptoms, that is the evidence for those EKG changes causing the symptoms, and treatment or management can go from there.

But no changes in the normal EKG on monitor results at the time those symptoms are reported is considered a negative test..When this occurs it's assumed that the patient's symptoms are caused by something other than cardiac rhythm abnormalities, otherwise these would show on the report.

That's apparently what the first EP you saw was reacting to when he informed you there was nothing wrong with you. You apparently reported hours of symptoms, but the monitor during that time showed only a single arrhythmic event (possibly a PVC or PAC?) of very short duration, otherwise normal findings. This would indicate that something other than cardiac arrhythmias are responsible for your symptoms.

Hard to tell what a new EP will tell you. Sounds as though the second guy, having spoken to your primary cardiologist, and the neurologist you saw, will be familiar with your medical history, test findings and your complaints. Perhaps he will go from there with repeat monitoring, or be able to reassure you that whatever it is causing those symptoms, it's benign and he can help you manage it.

Best of luck.
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Old 10-07-2020, 10:48 AM
 
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Thanks again for the post. You have a calming way of informing me about this. Of course, it doesn't make me feel much better but I appreciate it. My concern is that when I went to the Emergency Room and was on a monitor, it was happening for a couple of hours. I would ask the nurse if she saw the monitor move when I told her exactly when it was happening and she said nothing showed up. How can that be. I wasn't imagining it. I also bought a Kardia monitor, which is a portable unit that you put both sets of fingers on and on your leg and it is supposed to give a 6 lead EKG. When I was having a bad night of palpitations, I used the Kardia and it showed nothing was wrong and my heart was HEALTHY. How are these very disturbing and real palpitations going by undetectable. Is there any benefit of having a monitor implanted in my chest as opposed to using an Apple Watch 5 which records heart issues?
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Old 10-07-2020, 02:25 PM
 
Location: SW Florida
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Originally Posted by trusso11783 View Post
Thanks again for the post. You have a calming way of informing me about this. Of course, it doesn't make me feel much better but I appreciate it. My concern is that when I went to the Emergency Room and was on a monitor, it was happening for a couple of hours. I would ask the nurse if she saw the monitor move when I told her exactly when it was happening and she said nothing showed up. How can that be. I wasn't imagining it. I also bought a Kardia monitor, which is a portable unit that you put both sets of fingers on and on your leg and it is supposed to give a 6 lead EKG. When I was having a bad night of palpitations, I used the Kardia and it showed nothing was wrong and my heart was HEALTHY. How are these very disturbing and real palpitations going by undetectable. Is there any benefit of having a monitor implanted in my chest as opposed to using an Apple Watch 5 which records heart issues?
Wow, that's frustrating to be feeling so bad when these symptoms occur, thinking they *must* be heart-related, yet nothing shows on a cardiac monitor during your symptoms. The thing is, though, that if your palpitations were heart-rhythm related, there WOULD be changes on the EKG during those symptoms during the time you felt them, and the only conclusion anyone can come up with looking at this situation is that whatever it is you're experiencing is not cardiac--related.

It's different from the situation where a patient with sporadic palpitations goes through a cardiac event monitoring period, and does not experience any of the symptoms at the time he/she is wearing the monitor. Unless the patient has asymptomatic arrhythmias, this patient's EKG would be expected to be normal. A report of no symptoms with no abnormal EKG findings would not rule out that the patient has an arrhythmia, it just didn't show up during the monitoring period. It may show up any time, but the paroxysmal nature of many arrhythmias makes it hard to know when that will be. Which is why, if a patient has had a stroke for unknown reasons, has unexplained cardiac issues affecting his/her health, and an arrhythmia ( especially afib) he may have a long term implantable monitor put in.

Correlating symptoms with the presence of an arrhythmia at the same time is essential for determining the cause of those symptoms. So when you report symptoms but your EKG readings at the time of those symptoms show only normal sinus rhythm, the only conclusion can be that the cause of those symptoms is something other than the heart. And if this occurs repeatedly, your healthcare providers will no doubt encourage you to look elsewhere for the source of your issues- and some of them are more blunt about it than others, as you no doubt have seen.

In your case I'd probably have to agree that maybe a long term implanted monitor isn't a great plan right now, based on your previous monitor findings of normal EKG results at the time you are experiencing symptoms. A Kardia monitor, or an Apple watch could at least be a way for you to continue to record your EKGs when you feel those symptoms- these recordings can be shown or transmitted to a doctor as indicated, but that is best discussed with your own doctor.

In your shoes, I might see the second EP, especially if you already have an appointment, just to see what he/she has to say about your history.

And IIRC you already have an established relationship with a cardiologist whom you see on a regular basis. He is familiar with your history, your test results, has spoken directly to the other doctors you have seen. Perhaps he can help you find out what's happening, or at least help you find a better perspective on what could be a frustrating but perhaps benign process.

Good luck.
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Old 10-07-2020, 04:47 PM
 
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If the Karelia unit didn’t detect palpitations as they were happening, I wonder how an Apple Watch would. So, if the palpitations are not originating from the heart, what else can cause a heart to skip beats and Beat faster, yet not be detectable? That’s what scares me. It is definitely happening. Normally, my heart beats around 68 bpm. It goes to a bit over 100 when the palpitations begin. How I’d that not detectable by a Kardia unit or even the heart monitor in the hospital? I have a stethoscope and it’s scary to listen to. I also cough every skipped beat. The neurologist said it can’t be anxiety, especially if it happens while I am sleeping. It’s as if it is completely random and Can’t be pinned to anything. I go on Friday to the EP. We’ll see what he says
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