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Doctors' Answers to "Frequently Asked Questions" - Heartbeat
Heart Arrythmia Medication Concerns
Answer: Probably because they originate from a different site or the drug is in reality only partially successful. This is pretty common with most of the antiarrythmic drugs. Risks of an ablation are pretty small if performed by someone with some experience. Risks would center around occasional excess voltage that would damage functioning heart muscle, damage that would result in a pacemaker, etc. As you describe it, you would probably be a good choice for ablation. But, see someone who has been doing it for awhile.
Concerns About Heart Medication
Interactions [posted 11/24/98]
Answer: Before I wasted a lot of time taking medications, I would see an electrophysiologist to see if your conduction problem can be fixed by cardiac ablation. This is a catherization which uses radio frequency waves to damage the offending conduction fibers. Very common now and most cities have one or two available. However, the beta blocker and calcium channel blockers can be used together without problems other than blood pressure lowering and pulse lowering. Side effects of the ca channel blocker will be constipation and swollen feet. Other side effects are drug specific and there are about 10 in the class all a little bit different. Are you sure that your symptoms bending over aren't your reflux? Sounds possible. Anyway, see an electrophysiologist.
Irregular Heartbeat [posted
Answer: Thanks for the input. Like you I have several patients whose lifes are complely different(for the better ) after this procedure. There is a risk and I think it depends on how disabled or how controlled your life is by the arrthymia. Generally, worth doing if in competent hands.
Heartbeat [posted 7/17/98]
Answer: Depends a lot on the individual. For example, healthy runners often have heart beats in the 40s without symptoms. In general, we don't get too excited about slow beats unless the person has symptoms (dizziness, passing out, etc.) this usually happens below 50 or 55 depending on their age and blood pressure. Fast heart rates are usually treated above 110 or so to reduce symptoms. The effect of rapid beating long term has a minimal effect on the heart, less than you would expect, but does limit the patients a great deal. The lungs fill with CHF due to increasing pressure in the lungs (back pressure in essence) from the heart.
Answer: The most common cause of dyspnea during pregnancy is mechanical. This is due to difficulty in contracting the diaphragm downward due to the impingement of the gravid uterus. That is, the diaphragm can't be pulled down due to the size of the baby in the uterus. I doubt that the irregular rhythm is causing her problem unless she has new atrial fibrillation. Irregular beats usually don't cause problems unless they are sustained. There are other causes of dyspnea including occult pulmonary emboli, cardiomyopathy of pregnancy, etc. All of these occur, but are unusual. Pulmonary tests will sort this out.
Answer: Usually between 60 and 95 beats per minute. In athletes it may go as slow as 38 and will beat to 160 or so from exercise. Faster rates than 160 are possible, but are pathologic and due to electrical abnormalities.
Heartbeat While Sleeping
Answer: Several possibilities, but, the most potentially serious is sleep apnea. The patient is usually heavy and will occlude their airway during the evening on several occasions. During these spells, the oxygen level drops and the heart is irritated due to low oxygen. Fatal arrthymias are common during this setting. She should see a sleep specialist and be seen in a sleep lab for an evaluation for sleep apnea-very important!
Answer: Have you had a heart monitor during the process? If it is normal then it
is not a racing heart. However, a stomach or gallbladder problem can often look like a
cardiac problem -this will need to be checked out. Lastly, it may represent a panic
attack. These usually start in the twenties with a family history being common. You will
need to get a cardiac monitor during one of the spells to decide if it is your heart or
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