Newbie...questions

[redoctober]

Greetings all:

I started this journey thinking I had PVC's back in April 2010...occasional palpitations that might wake me at night. At the time...I also noticed that my digestion was slower...things weren't moving through me as fast as they used to. Anyway, I ignored these symptoms for the most part...until they became severe enough to land me in the hospital in Ocbtober 2011 (along with bad GERD). After consulting with my PCP and obtaining a Cardio consult...I was cleared of any cardio issues after a full workup (Echo, 30-day Holter). My PCP opted to start me on 30mg Prevacid BID + antibiotics to address the GERD and any potential h pylori...which it did nicely. I no longer had any complaints of palpitations...so I assumed they they were simply related to GERD.

Nonetheless, I still had some GI complaints...motility/constipation issues and some stomach pain, along with some dizziness, tinnitus, and shortness of breath (which I attributed to the PPI's). An EGD in December 2011 was perfectly clear...as was a gastric emptying study in January 2011. Serum gastrin levels were also normal. As the days/weeks went by...I continued to feel awful...mostly in the mornings...gradually better in the afternoon. I finally insisted on a HIDA scan...which revealed a 23% ejection fraction. Hoping that a bad gallbladder might be at the root of my GI issues...I had it removed 2 weeks ago. First few days were pretty rough...but digestion appeared to be working better shortly thereafter. Nonetheless, my dizziness, tinnitus, and shortness of breath continued.

I also noticed recently that my blood pressure was abnormally low...especially in the mornings. Normal BP for me is 130/85...now I need to stay VERY hydrated to come close to maintaining that BP. I'll typically sleep for about 2-3 hours...and wake up feeling like my heart is beating too fast...trying to compensate for low blood pressure. When I stand up in the morning...my heart rate might jump from 85 to 130 attempting to compensate for BP changes. It almost feels like my body's ability to maintain BP homeostasis is really off...like the veins in the body are not contracting anymore to move blood around and the heart is attempting to make up the difference.

Anyway, here are my current symptoms:

* Low BP unless I stay hydrated.

* Othostatic hypotension unless I stay hydrated. HR increase is worst in the morning.

* Dizziness.

* Fatigue.

* Cold intolerance.

* Headache/vision issues.

* Muscle twitching (had these forever).

* Increased heart rate that wakes me up at night...heartburn feeling like blood pools in the abdomen.

* Anxiety

* Perceived weakness/tremulousness

* Dry skin (arms, scalp)

Stupid tests that I've done myself:

* Cold hand in water...no increase in BP

* Hand grip: nominal increase in BP/HR

* Valsalva: seems normal...HR drops, then races with an overcompensation of BP

* Deep breathing: seems normal...HR rises and slows in cycles with breathing

Does anyone have any advice or input here? I have a consult with my Cardiologist on Thursday...but I would appreciate any insight that anyone has to offer...even stuff that might improve my symptoms (like sleep!).

Many thanks...

[faint factory]

If you're into doing home tests, have you tried taking your pulse supine (after being at rest for at least ten minutes), and then after standing once a minute for a few minutes? Try that, especially in the morning when you haven't had a chance to hydrate. Do it with someone nearby if this sounds like something that will bother you/make you lightheaded.

It sounds silly/like a poor man's tilt, but it was how I figured out that the doctor must have missed my large pulse increase in my tilt. I requested the records and discovered I was right.

Have you tried increasing your salt intake to see if it changes anything?

[redoctober]

Just tried the poor-man's tilt...after dinner:

lying down after 10min: 101/67 (64 bpm)

standing: 116/81 (75 bpm)

Those make no sense to me. It'll definitely be worse in the morning.

I've been drinking more Gatorade recently...not like I've been watching my sodium, but perhaps my water intake is diluting things. I drink an Alka-Seltzer Gold before bedtime as well (sodium & potassium).

[Chaos]

Try doing the poor man's tilt table test in the morning. Check your pulse (and BP) before you get up and then do it during the first 10 minutes you stand. I did it right by the edge of my bed in case I needed to get down quickly. I believe they recommend testing it at 1,3 5, and 10 minutes, but I always checked it again around 7 or 8 minutes as well. A lot of us on here have much worse symptoms in the morning, tend to feel better at night and dread having to go to bed because we know what the morning will bring.

Also with the Valsalva test, they usually have a BP "thing" (highly technical term that! LOL) attached to your finger so they can measure beat to beat BP fluctuations. Not sure you can test that at home. I believe they are looking for various phases of the reaction with the beat to beat measurements that you can't get with a normal BP cuff.

And with the HR response to deep breathing, they have a very specific pattern they want you to follow at a specific speed so again, you may not notice it by testing it at home if you're just breathing deeply on your own.

I was recently at Mayo and told by the neuro there that surgery can be a precipitating factor in triggering autonomic neuropathy so the gall bladder surgery may not have helped you in that regard, but may have been beneficial for other issues.

Have you had your thyroid checked too, just to make sure that's not an issue?

Good luck!

[redoctober]

Thanks for the feedback. I tried checking my BP first-thing this morning:

lying down: 110/64 (73bpm)

1 minute: 117/82 (102 bpm)

3 minute: 117/81 (84 bpm)

5 minute: 123/85 (86 bpm)

Regarding the Valsalva...I was looking at this doc and my pattern roughly follows the "normal" pattern for BP/HR response. Not scientific of course...but I was using it as a guideline.

Thyroid has been checked recently by my PCP, I believe. He took some bloodwork...so I assume that thyroid tests were in the panel.

Would any medications potentially cause this problem? Like Zoloft or any of the PPI's?