Dr. Muhammad Majid Hanif
Cardiology
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Patient's Query
Hello doctor,
I was diagnosed with high BP (160/105 mmHg) one year ago with HR above 100 bpm. Current BP is normal (115/78 mmHg this morning), HR is 40 to 48 bpm during sleep, 48 to 55 bpm at rest. HR increased to 130 bpm only when exercising. Now no longer drinking alcohol for the past one year and has lost 33 pounds since diagnosis. Also started to exercise for one month. I have been taking Atenolol 50 mg per day and Madiplot 5 mg per day (half tablet) for just under a year. It was prescribed for hypertension and elevated heart rate. It has controlled my heart rate and blood pressure very well, but I am acutely aware of palpitations feeling in my chest these past few days. I have a strong awareness of my heart beating and can feel a strong pulse in my chest if I cup my hand and neck. I can also feel my heart beating when I lay on the bed, through my chest and ears. My heart is beating slowly (due to Atenolol), but I feel like it is beating too hard. This feeling is not constant. It seems worse in the afternoon and evening and is not really present this morning. I have my suspicions as it might be the calcium channel blocker that I have not yet taken for today. I would like to know if the medicine is to blame and whether I should adjust the dose. Kindly give your opinion.
Hello,
Welcome to icliniq.com.
I am very concerned and can well understand your worries. I appreciate you lost weight and have also started exercising for a month now. I would add here, you want to keep the good work up just like that, and most probably you would feel much more relaxed and better. Well, for palpitations, there may be a lot of different reasons. It can be unrelated to the heart also. Can you please share with me your latest blood work reports, especially the complete metabolic profile that includes fasting lipid profile and fasting blood sugar levels, HbA1c (hemoglobin A1c), thyroid function tests, and cortisol levels? Please also share readings of blood pressure and heart rate for at least a week. Do not take spices. Stop smoking, if any. Good to be sober, as you mentioned already.
Please get back with the result for appropriate treatment.
Patient's Query
Hello doctor,
Sorry for the long delay in replying. I did attend the hospital for some checks which took some time due to the COVID-19 situation and would appreciate it if you could look over the results. My sugar and lipid levels are normal (HDL a little low) thyroid function was tested as usual. Cortisol was not available. I was advised at the hospital to reduce my hypertension medicine. I have tapered and stopped both over a month and now my blood pressure is still normal (125/80 mmHg). I am working on diet and exercise to keep this in check instead of medication. I was told my palpitations feeling was nothing to worry about but I am just a little worried about being able to feel my heartbeat across most of the left side of my chest when I touch it. Today it is very noticeable. I have attached my most recent EKG which I would appreciate if you could look over.
Hello,
Welcome back to icliniq.com.
I have gone through your reports, all seems good. EKG sinus bradycardia (heart rate less than 60 per minute), no other significant changes. It can be due to Atenolol. With this heart rate you are having palpitations sometimes can be due to panic or anxiety because your all blood workup is also normal. You can go for an echocardiogram and TMT to rule out any other cardiac cause. Consult a psychiatrist if its anxiety or panic which is causing palpitations.
Patient's Query
Hello doctor,
I have actually stopped my blood pressure medicine for three weeks now. I believe it was too strong for me because now my BP is still normal (under 125/85 mmHg) and is about 60 to 80 at rest or light activity. I notice my EKG had flagged ST elevation which I was not sure how worrying that is. I would like to get a new EKG soon since I stopped the medicine but I do not want to visit a hospital right now during this COVID-19 wave.
Hello,
Welcome back to icliniq.com.
There are no ST elevations (error by machine), your doctor also mentioned on EKG no ST-T changes. The only rate is 57 per minute (the normal range is 60 to 100 per minute).
I hope this has helped you. Thank you.
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Cardiology
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