Silly, just learned what palpitations means

[ShadowsPapa]

I've watched decades of TV - I tend to like the shows about fire fighters, first responders, that sort of thing, so I've heard most of the words over 50+ years and if I was in doubt, I often looked something up, sometimes it sounded really bad so I assumed it was really bad and moved on. You often see the paramedic mention something like "palpitations" when checking the downed person over. Man, that sounds really serious as heck, that's not a normal sounding word.
Now I feel stupid -
Went to urgent care Tuesday (again) for chest discomfort, dizziness (really bad this week) and described going to bed Monday night and feeling my heart really pounding hard. Could almost see it - not fast, not out of rhythm, but really hard. He said - oh, you had heart palpitations. I started to say - no - but he said - that's a big word for a pounding heart. Likely due to overly low blood pressure.
I felt so silly as normally the doctors and I can discuss things without them dumbing it down too far. All these years, and I thought it was an emergency, better call 911 sort of thing.
He was right - I decided since I'm tracking blood pressure I'd get up and check it - 110. Not horrible, but as he explained, if the body decides blood flow is not great enough or there's some shortage, it commands the heart to try harder.
I've seen them take BP on the left arm almost all the time - with me and with my wife (little choice there, her right arm isn't a great place to get that or use IVs) so that's how I've been doing it - then I decided let's try the right arm. Even lower.
Several times I've found the right arm to be 12 to 15 mm lower than the left arm. Looked that up and it didn't make me happy.
Super low today - below 110 on the right then later it was a whopping 141.

Anyway - now I know after living 66 years what the #$%@ palpitations means. Geesh. I had to laugh when he told me.

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[MPMB]

My wife has had palpitations for decades. Her BP has usually been in the 110-115 range (top number only). Unfortunately, over the past couple of months her BP has been spiking up around 200-211 and running anywhere between 150-180. A couple weeks of going in and out of ERs and she's finally been able to see her cardiologist.

Her BP between arms is different as well. I think the left is used normally because it's closer to the heart vs. the right side. Like the difference between running steel brake lines and rubber brake lines.

I think for her it's a medicine-induced elevated BP, because the alternative is not good.

She also had a mild "heart attack", her doc identified a septal infarct, which is some dead tissue in the heart, usually a result of heart attack. Women also present heart issues differently. They don't always get a numb left arm or pain in the chest.

So yeah, listen to your body.

 

[Hootbro]

Did urgent care discharge you with instructions to follow up with your primary care doctor? I assumed they did a EKG? You may need referral to a cardiologist to get a stress test and echocardiogram that will check your ventricular ejection fraction rate for blood flow out of your heart.

About 6+ years ago, went down a similar road with heart palpitations and they also hung their hat on blood pressure and managing it meds. Had the tests previously mentioned and within a year had defibrillator pacemaker implant. Not saying you will also end up there with a device implant but the follow up I would recommend because it is easy to overlook.

 

[ShadowsPapa]

Urgent care is staffed by primary care doctors - I went Tuesday for two reasons - I knew my normal doctor would be in urgent care on Tuesday and I was crazy dizzy for the second straight day, beginning before I got out of bed.
He suggested that the cardiologist's prescription for BP meds be cut in half as he was wondering if with my history of low BP, if it was lowering it too much.
(this isn't like ER - this is where you can't or don't wait 2 or 3 weeks for a regular appointment and are seen for more important or critical matters within a couple of hours)
So I cut that in half Wednesday, Thursday and the again, today - Friday. BP still wild up and down, still dizzy (but maybe not quite as much.........)

When I found the big differences in the BP between left and right arm, I started digging and found:
https://e-kcj.org/DOIx.php?id=10.4070/kcj.2018.0147

https://www.health.harvard.edu/blog...-linked-higher-heart-attack-risk-201403057064

https://myhealth.ucsd.edu/RelatedItems/6,1649591896

And more from Mayo and other respected researchers and clinics.

So far I have found differences of 10, 13, 15 and similar, but at times it's the opposite with the right being slightly higher than the left. Most often, the right is lower but it can be either way. When the right is lower it's sometimes lower by a fair amount.

I saw cardiologist last month, have a recheck later this month to see how BP is going. they wanted to lower it a bit due to some enlarged something at the top of the heart. not a lot, but they want to keep an eye on it and keep pressure under control. I find that ironic with my history of low BP numbers, really. I mean, 115, 110, that sort of thing, not uncommon for me. Typical in the 120 to upper 120s range, but the highest it's been as been is 140 and that was only a couple of times. Normally upper 110s to mid 120s maybe to summarize - so lowering it by much puts me in a really low are should it be in the 110s and the meds drop it further.

Anyway, saw my own doc in urgent care Tuesday, he said cut the dose in half.
Still dizzy, not seeing any impact on BP numbers with any dose of the meds, so went in today and saw a different doctor - the one "on duty" for that time today (normally in the same clinic as my own doc). She took a whole lot of notes. They've run multiple "EKGs" over the last couple of months - always looks good. Wore a monitor for a week last month - only a couple quick blips of bad rhythm but that lasted maybe a second or so, they said it looked good other than one time my heart rate dropped to almost nothing, but that was just for a brief time while sleeping, otherwise even that was normal.
Constant "pressure" in middle of chest- more horizontal, not lining up with heartburn or reflux and have no other symptoms of that. That comes and goes but the last couple of weeks it's mostly there. She noted that and made notes for the cardiologist to perhaps run some other tests beyond the heart to try to explain the BP differences between arms and the pressure/discomfort (not really a pain like real pain).

I found it interesting that at times when I feel the heart really pounding, almost see it happening, BP is low. Learned something for sure there.

Yeah, there's a small hole that they say has likely been there since birth - unchanged in the past year, that enlarged or whatever at the top of the heart they are closely watching - not a danger but they want pressure low to prevent trouble because it would be like running high hydraulic pressure on a swollen thinned hose.

My wife had "palpitations" starting over 30 years ago. It was the type where the heart races - I mean up to 150+ BPM, rapidfire, caused discomfort and her doctor put her on a drug to help with that. At time went on, it really wasn't getting better (luckily it wasn't often, but often enough and lasted sometimes several minutes).
More years went by, not really working. That doctor retired to go into med IT so we switched to our current doctor. He said well if that one isn't working, we'll try this other one. Nope, so after a year or two, up the dose. Still happening, but with increasing frequency, and lengths of time long enough to get an ambulance out and go to ER.
Over a couple of years time, she was in ER at least twice, laid there for hours, they got things under control, sent her home and said keep taking your meds.
She even got our doctor to refer her to a cardiologist who checked her over, seems like a couple years worth of visits, said keep taking the meds and come back next year. He was worthless.
As fate or luck would have it, she decided to go with me to Cleveland for a big AMO car show event. She took her sewing supplies and machine and stayed in the hotel and did her quilting thing. When the show wasn't going on we hit some area things and stopped at a couple of quilt shops for her, drove around a bit. Friday night shortly after going to bed she woke up holding her chest - it was happening and bad - over 150 bpm and wouldn't stop.
The hotel wasn't far from the hospital so I took her there. Same thing, laid in bed while they got it under control but questioned the cause and the drugs being used. OK, reason to look into this when we got back.
Talked to a neighbor who happened to have similar things a while back, not as bad or as frequent - but he had his totally fixed with no meds. He gave her the name of his doctor, we got set up with him.
First visit, he looked at her history and all and said "none of these meds could have possibly been any help at all to you, worthless. He said - I know what it is and I can fix it. Hell yeah!
A few minutes with out-patient surgery where he went into her heart through a vein or something and killed a number of nerve connections that should have never existed. He said it was like a short circuit - the signal to beat just kept bouncing around all of these nerves in there now and then causing that 150-180 bpm arrythmia.

Multiple doctors all prescribing worthless meds, ER doctors, 30 years, a cardiologist at a heart clinic who just said keep coming back, keep taking the meds, multiple ER visits, ambulance rides, all totally missed or screwed up. Finally, a doctor resolved it.
Frustrating as heck.

 

[bd100]

Knew someone else who also had the zap-the-nerves thing for the same reason.

We've had hit-or-miss with doctors through the years. Several times had docs almost kill someone in my family, caught in time by our own research and checking with another doc. One caused permanent damage and almost killed, another almost almost killed, and two others caused years of problems. Others have been great.

When caring for the elderly, they are sometimes fiercely loyal to a long-time doctor, even when the doc is pretty bad. We were able to lead them to specialists who straightened things out.

 

[Jaxmax]

So Bill, being a guy that has his chest cracked and new valve put in, being the guy dizzy enough to stumble, and high blood pressure for years. Keep going back , A-fib, wrong meds, that little enlarged thing. I had a Bicuspid heart valve two flaps instead of three, all the Mack family men have had it, it works the heart hard which enlarges it worse.
My docs were top notch, heart valve replacement went well, with me being one of only three people to walk from OR recovery room to my room floors away, in history of hospital but now as my doctors said hang on as my blood pressure with the valve job was real high 150-170, at cardiac rehab, staff wanted me to sit it out, my suregon told them, it's a Jack thing keep him moving hard, within three months my heart shrank in size, a year later it was less then half the size, but I still battled blood pressure again my docs, told me what I knew for years drop some weight, I was at 235, dropped to 205 pretty quick, got off a lot of meds, and still heading towards goal of 195, but tougher to get there., blood pressure in great feel great.
So why the freaking long story like both you and I always do...........
Read your own last post about your wife, get another look from someone else, but you are not right, it is probalby a heart thing, you can take my idea as correct as I was the Head Electrician of a state of art hospital and trauma center for 25 years, and have stayed at a Holiday Inn!
This has been going on too long Bill, get it done!.....Jack

 

[Hootbro]

Does your Primary Car doctor have a regular practice he works out of or do you have to go to urgent care anytime you need to see him?

 

[ShadowsPapa]

Does your Primary Car doctor have a regular practice he works out of or do you have to go to urgent care anytime you need to see him?

He's part of a place with several doctors and is our PC. What they do is have the regular PC doctors share duties in urgent care (which is right next door).
I can make an appointment to see him in the regular clinic but often that takes a few days to get in (doctors here are overwhelmed with patients and the corporate folks have rules - you must see at least xx patients in a regular day and can't spend over xx minutes - been told that twice, by doctors who eventually left for other practices)

Read your own last post about your wife, get another look from someone else, but you are not right, it is probalby a heart thing, you can take my idea as correct as I was the Head Electrician of a state of art hospital and trauma center for 25 years, and have stayed at a Holiday Inn!
This has been going on too long Bill, get it done!.....Jack

I've had 2 sonograms where I spent 30 minutes on a table while they ran that ultrasound thing all around my heart, and near the end injected "agitated saline" (I asked her what they did to make the saline so mad and she laughed and said she shook it around a bit)
Also had the type of scan where I was in the tunnel on the moving bed - can't recall what that one was called. All EKGs over years have been perfect. Perfect BPM every time, the monitor showed perfect BPM and a stress test done a few years ago (when they wanted to put me on adderall for the ADHD) I ran the whole time and they never did get my heart up to the rate they wanted - even on the incline. Over the years, even during harvest and planting seasons years ago the docs said "your heart just idles along, BP always fine, never high, rate never high". Of course that was years ago...... still, doctors have said my BP is normally on the low end of normal most of the time.
Current tests show valves working fine, they sound good and look good in the testing, not any valve issues, they are normal.
Since BP and being stable and not light-headed or dizzy or "jittery" depends on blood flow, I'm looking more at something is causing problems once the heart does its thing.
You can have great flow to legs and have restricted flow to the head or an arm. I guess, basic hydraulics. Sort of like engines of the past where passages to the rocker arm shaft got gunked up yet the oil pump was fine and oil pressure always fine - but no oil to the rocker arms.

This last doctor, urgent care on Friday, said although she and other primary care doctors could not order such a thing, she's strongly recommending to the next cardiologist that sees me to do an angiogram. She was typing for at least 5 minutes, making notes of almost everything I said and making "suggestions", looking over past test results. I had seen her before in urgent care.
I got up this am, went outside to check the coon traps, fed the birds (mostly blue jays who go through almost a pound of peanuts a day) and checked the other feeders. Went back in and checked BP.
I know it makes sense to have low BP in the morning, but after walking around outside, being up a while, I was still surprised to see only 116 in the left arm, and 106 at the right arm.
If it's that low in the right arm - where else is it low? That's another time of 10 mmHg difference.

 

[kacey]

Hi, that's really good to know thanks for the information.

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