cardiactec

why is he canceling clinic for may?

have you worn an event monitor during your symptoms/post ablation? although EP ablations are around 95% successful there is a small chance of tachyarrhythmic conductive tissue that may not have been fully ablated, OR you could have another site in the heart "acting up" that perhaps wasnt inducible and thus at the time you had your EP study. I have just learned that I have a second ectopic atrial tachycardia (SVT) that my doc didnt even know about - had an ablation in december of a single ectopic atrial tach, and it was not known at the time of my EP study/ablation that i had another atrial tach from a different area in the heart....... because at the time of my ablation, the only inducible tachyarrhythmia was the one a-tach.

I take 100mg's a day of torpol xl. it has helped me immensely. it doesnt drop my BP. other than feeling a little fatigued from it, it has helped my high heart rates, shaky feelings/tremor, much more than anything else.... good luck.

Anyone here taken accutane for acne? i have been suffering with horrible acne for 10 + years and have tried EVERYTHING, LITERALLY EVERYTHING for this and nothing has helped. my doc is now going to put me on accutane to help my acne. it is quite the fiasco to go on this med and has some pretty serious side effects (mostly though birth defects if you become pregnant on accutane) .. anyone taken this and found it to be helpful with acne problems?

how slow is your HR? during sleep, it is normal for HR to be slow, but wondering how slow you are? there are different meds that work JUST ON BP issues and do not interfere with heart rate. your cardiologist, or A cardiologist can work with you on this. i believe ACE inhibitors and diuretics work just on BP issues and do not cause change in HR.

hey jacquie, i too feel like a stranger, have been super busy and havent been posting/adding replies here. i wanted to chime in and ask you if you have tried tigan - tigan and zofran are the most potent kinds of anti-emetics you can get, i believe. i take both, but find that tigan actually seems to help me a tad bit more than zofran. check into tigan if you have never before. take care and feel better.

hey jacquie, been awhile since we've chatted. sorry to hear you're still having troubles with your tummy. i totally can relate. have you tried tigan? tigan is right up there with zofran (at least i think). i take both zofran and tigan, but tigan alone generally is enough to cut my nausea. try it out if you havent. i hope it'll help you.....

I think a POTS diagnoses is confirmed by having (if you want to get strict about it) a thirty beat point increase or more from supine to stand with accompanying symptoms within TEN minutes or less. from the vitals maggy provided, she was tilted up to 20 mins without isuprel injection and hr's only approached 100's from a supine baseline of 80's. magg, personally i think, after seeing your signature, you might look into a reoccurance of your PSVT or another rhythm problem as being the cause of your symptoms. do your symptoms you're experiencing now feel the same as when you had PSVT? PSVT can be triggered by emotional stress, exercise, sex, etc. and sometimes it is very difficult to differentiate between true PSVT, POTS, or just a "normal" tachycardic variant from exerting yourself.

I agree with doctorguest. actually, at the hospital I work at, more and more cardiologists are looking into discontinuing the administration of Isuprel during tilt table testing because we've found that there are far too many false positives that come with isuprel. for my own personal experience, and i know i'm a bit of the extreme, my HR's supine were 95 and within a minute of upright tilt were 160, and after 20 minutes, were well above 180. they wouldnt even give me isuprel standing, and were hesitant to give it to me supine because of such a dramatic HR response and symptom response to upright tilt. hang in there and i hope your symptoms improve.

RARELY do I ever experience dizziness, and my BP generally does not drop at all. I have only passed out a few times in the 5 years i have had pots, and i think those few times were due to meds. My symptoms pretty much are just shaky feeling in my extremities, extreme fatigue, extreme tachycardia, a "full" feeling in my legs, and horrific nausea. i dont get the lightheaded, dizzy sensations much - maybe a couple times a year.

hey there, didnt you recently say you had started taking a beta blocker? beta's drop your rate out, to what degree generally depends on the dosage and how sensitive you are to meds..... hope you feel better.

so sorry you have to deal with this....I understand your frustration completely, about loving your work, wanting to be a help and not a hindrance to your patients, wanting to be and feel well. My heart (no pun! goes out to you.......I only wish there was a quick fix for you, for all of us here. many of the folks here know my story pretty well in that since the very first day i started posting on this site, i questioned my cardiologist and pushed for further answers, further intervention, further diagnostics - even though I battled my cardiologists, and others' doubt about my diagnoses, my treatment, etc. I fought for TWO YEARS to get the care i know I needed. long story short, turns out I was right - they were partly wrong - yes I do have pots as they originally diagnosed, but also have other rhythm disturbances going on that complicated and exacerbated pots symptoms even more. finally, after two years, i feel a little better post EP study/ablation, having fought through the doubt, the questioning of doctors of what i was telling them and after expecting MORE from and out of my doctors. dont settle for less. fight for yourself, because you're worth it. my cardiologist was and has been great, even when he doubted and questioned what i was ttrying to tell him was up. doctor's DONT know everything (as you obviously are aware of working in the med field). if you feel as though you have provided your doc with all the necessary information to try and either get you further diagnostics to investigate further and/or for better treatment options to try and get you feeling well and you arent getting anywhere, my advise to you, first, is keep pushing that one doctor. if you dont have the energy to keep pushing, find another doctor. I personally operate a little different, I think, than the "normal" person, lol, in that I will fight for a long time with one particular doc in order to eventually prove a point, in order to validate myself and also the next person that i might be helping out who sees the same doc .......why you ask? because if you work with ONE doc for years, and you get to the end of two, three years, and presto, answers come, that one doc learns a lot from you, and hopefully moves forward to learn that it pays to listen and to dig a little deeper with intervention and sometimes with diagnostics. YOU the patient invest just as much into your doc as your doc invests into you, I believe. I know others operate differently, and that is fine as well. Just telling you my story and how I go about things. It may or may not work for you. My advise to you is to find someone who will truly listen to you, EVEN IF it takes a couple years for them to "get it". cut them some slack, they will learn a lesson from you, and from others here that dont fit into a perfect medical diagnoses and treatment box. my cardio and I are on very good terms, but we have had many ups and downs over the years. ultimately though I'm glad I remained a patient of his, because HE FINALLY GOT IT! and our relationship as patient/doctor is that much more meaningful and fruitful now than it has ever been. Take care. I pray you get over this hurdle and are able to get back to work. cardiactec.

I've had quite a few tilts, in many different facilities but my results have always turned out the same, no matter where/what facility. Supine: 120/68 HR 96 Stand: (1 minute) 128/74 HR 166 Stand: (5 minutes) 108/78 HR 170 Stand: (10+ minutes) 120's-130's/70's HR 204 I wasnt given isuprel standing like they normally give it, because my HR's were too high. they gave it to me supine and my rates only got up to around 146 BPM and BP didnt drop much. with me, i felt pretty cruddy. my legs felt completely swollen (and were!), i felt nauseous to the point where i had one of the nurses get me a bucket cuz i thought i was going to puke, felt sweaty, not a fun time.

My cardiologist told me the other day, after i told him i was engaged, that when i start thinking about pregnancy and kids, that i would have to see a high risk doc because i definitely would be considered "high risk" -- due to POTS mainly, but then he mentioned also the other rhythm disturbances i have. has anyone here been told that they would be a high risk pregnancy because of POTS????

as long as your HR isnt high constantly it is not a concern. my HR's still get up in the 180's intermittently throughout the day and i'm on 100 mg's of toprol and 100 mg's of flecainide. if the heart is getting a "break" during the day, than a HR of 179 for a couple seconds/minutes here and there throughout the day when you go upstairs/take a shower/whatever is fine. i know it doesnt "feel" fine, but it's not going to hurt your heart any for an occasional increase to that rate throughout the day. only a sustained high HR would be of concern for things like tachycardiac induced cardiomyopathy, etc. take care. cardiactec. i see dr.grubb in july, and cant wait to see him also. i actually saw my cardiologist a couple days ago and he had one of his other patients go out to see him and the patient had nothing but good things to say about dr.grubb. i have heard such wonderful things about him......sounds like a really humble and compassionate guy.....

well, more info -- let's see.....we met in chemistry class, lol, about five years ago and had just been really good friends up until four months ago.....we started dating and just fell in love, on a deeper lever. i totally believe it is so much more beautiful and authentic when you are really good friends FIRST, and then to see the relationship blossom into more. so sweet. he is such a good guy. he is a respiratory therapist, and as you all know i'm a cardiac tech. nothing goes together better than the heart and lungs! hahahaha! he is such a patient guy, an understanding guy, and has been my biggest support system through all the medical challenges, not once heee and hawwing over my aches, my pains, my symptoms, but is consoling and is a comfort - not a harm. I'm blessed beyond belief.

I'M engaged!!!! I'm so happy, I thought I'd share the news with you all! I'm so blessed!

Generally, though a SINUS tach has the potential of running at a 200 + BPM rate, it is rarely seen - even in someone young who is running at max (I do stress testing and rarely ever see sinus rates over 200 at maximal exercise capacity - and i do pedi's up to 90 year olds, and even in the kids, never have seen over 200) have you ever worn a holter or event monitor when your rates are this high so the doctor can look at the onset and offset mechanism of the tachycardia along with it's morphology to make sure that this is just sinus tach (ie: pots) instead of true PSVT? ....or less likely VT? that rate is very fast, i'm sure i dont have to tell you that. you need to check in with your doctor if this is something new and/or has not been further investigated. take care.

I just had an SVT ablation (a TRUE SVT, not sinus tach) and I am doing much better having had the ablation - now I only have sinus tach (POTS) and occasional v-tach (they couldnt induce it to fix it) and not the SVT (a-tach) on top of it all. I do not believe that ablations cause IST or POTS. ablations however of the sinus node or any remodification of sinus node in someone who has underlying autonomic dysfunction has proven time and time again to be a big no no and tends to leave people worse off post ablation. I'd hope your electrophysiologist would be knowledgeable to differentiate a sinus node tachyarhythmic mechanism than an atrial or av nodal mechanism (these of which would constitute a "true" SVT and not that of sinus origin) when you went into the EP lab to have your ablation. I hope you start feeling better and that you get some answers. cardiactec.

I am with the group here in regard to d-dimer. i personally have had d-dimers several times in the recent past come back 5x the normal limit - a follow up chest CT always proved negative for a PE (clot in lung). i have seen more false positive ddimer's both on myself and on my patients than any other diagnostic. I wouldnt be too concerned about the ddimer. as for everything else you're going through, i'm sorry to hear you're having a rough haul. feel better. an interesting theory would be that of any correlation or connection between ehler danlos and false positives with d-dimers.....i know there are people who do not have ehler danlos that probably have elevated ddimer, but i just noticed you signature that says you have ehler danlos. i do as well. would be a cool research project. i am such a nerd!

ick. sorry Rachel that you have this.....it is NOT fun and for me has been one of the more challenging things to deal with, aside from pots symptoms. if you remember, i was on the brink of going in to have a pacer put in because mine was just getting out of hand..........i decided against it in the long run............. i hope you find better relief with one of the several meds they have to "treat" gastroparesis. i went as far as the botox shots and it didnt help... small frequent meals is what i would recommend. and if you are still having problems, then look into pro kinetics like domperidone. what were your percents from your study? did they make you do a two hour or four hour GES? hang in there girl. -Angela.

the doc probably hasnt considered this with you because it involves a trip into the lab and is an invasive procedure. though it is minimally invasive, if they are pretty certain your problems are from autonomic dysfunction and not a true arrhythmia, that is probably the reason why it hasnt been mentioned. have you worn an event monitor? event monitors can be worn for a month, sometimes longer if your doc requests it, and does just a good a job as the implantable loop w - that is, if your able to capture the "event" yourself before losing consciousness, etc..... I've never had an implantable loop, but i think there are one or two here that have had it. btw, good to hear from your via email! i'll get back to you later! -cardiactec.

awesome pics nina! i'm jealous! looks like you had a blast, and what a beautiful place! definitely an "add" for one of my future vaca spots!

momtoguiliana, PSVT's should be treated if patients are symptomatic and interfering with daily life. there are very few types of PSVT's that are actually dangerous and that should be treated via radiofrequency ablation. The first approach generally is a non-invasive approach -- medications -- beta blockers. With me personally I have tried just about all beta blocker and none helped me. I was also highly symptomatic and my electrophysiologist's concern was that the PSVT might actually be making my POTS symptoms worse, or that my pots (sinus tach) was actually helping to trigger my PSVT (which came with a higher heart rate, and thus more symptoms). But yea, first line of therapy is generally beta blocker or a non-invasive approach. if you are still having problems then, generally they go invasive (EP). If the rhythm disturbances dont bother you, and the rhythm does not display a particular rhythm type that can be dangerous, than usually PSVT's are left alone. Also, Incessant PSVT's should be treated as this can cause tachyarrhythmic cardiomyopathy.

Hi ajw4055, Ablation basically is a type of cardiac catheterization procedure where catheters are inserted into the heart and abnormal conductive tissue is ablated (cauterized/burned) so the rhythm can no longer occur. In my particular case, I have a few things going on. I have a SINUS tachycardia due to POTS and also had a PSVT (specifically an atrial tachycardia). I didnt have my sinus node ablated, but had an atrial tachycardia ablated (abnormal tissue in the atria. PSVT's is not a POTS rhythm. SINUS TACHYCARDIA IS a pots rhythm. PSVT's are very different from sinus tachycardia (thus POTS and/or IST) in that the mechanism of action AND cause is very different. PSVT's are mainly caused from tissue/cells that have abnormal conducting capabilities that occur outside the normal electrical/conductive pathways of the heart. the sinus node is the pacemaker of the heart and IS part of the normal electrical conductive pathway of the heart, thus, a sinus tachycardia is a variant of normal because the rhythm is originating from within the normal electrical pathway of the heart. Sinus tachycardia causes, unlike PSVTs which occur from abnormal conductive tissue/extra electrical pathways/etc) is triggered from many things -- fever, anxiety, medications, caffeine, autonomic dysfunction, exercise). A PSVT (such as an atrial tachycardia like what I had) arises from outside the normal electrical pathway of the heart so ablating this does not cause disruption of any autonomic innervation (thus cant make pots worse). Ablating a PSVT in someone who also has POTS (sinus tachycardia) does not make a pots patient worse because you are not disrupting the sinus node with a PSVT ablation (with the exception of an SA nodal reentrant type tachycardia). the sinus node with pots presents a sinus tachycardia and the sinus tachycardia is somewhat of a "defense" mechanism for various things, but mainly to prevent blood pressure from plummeting out (a compensation method of the heart beating faster to preserve perfusion or blood flow to the brain - to keep you from passing out). so those who have had sinus node modification/ablation who have autonomic dysfunction run into problems because the ablation takes away this compensatory action of the heart to preserve blood pressure - and then they drop their pressure, having higher incident of dizzy spells, passing out, etc. with PSVT ablation, you eliminate or destroy abnormal conducting tissue and do not effect autonomic innervation.