Paging the DFW Docs

[idrivea4banger]

Please please please let me know what you find out about this. I have the exact same thing happening to me. I have had reflux and heart palpitations for years and they can never find anything with the EKG or stress test. Does your heart just all of a sudden start racing? I can sometimes get mine to right itself by taking in a really deep breath and holding it. My girlfriend says it sounds like my heart stops beating for a couple beats and then just beats slow and very hard for a few minutes.

U haz the aidz.

[davbrucas]

Please please please let me know what you find out about this. I have the exact same thing happening to me. I have had reflux and heart palpitations for years and they can never find anything with the EKG or stress test. Does your heart just all of a sudden start racing? I can sometimes get mine to right itself by taking in a really deep breath and holding it. My girlfriend says it sounds like my heart stops beating for a couple beats and then just beats slow and very hard for a few minutes.

Classic description/symptoms of paroxysmal supraventricular tachycardia.

[idrivea4banger]

Classic description/symptoms of paroxysmal supraventricular tachycardia.

In engrish???

[Kenny_Stang]

Dr.Dave, i'll have to scan and send u the full test reults on Sunday. Dont have them with me right now. I've been to the ER three times in the past year to year and a half due to this... It's never painful but very unnerving... My heart does race on its own, normally though it feels like i'll skip a beat or have 2 - 3 beats where should only be one. This can happen once, or last for 15 mins. My avg BP is 117/78 avg heart rate is 73. Ive had my heart racing in the upper 90s when just laying down. I had my gallbladder removed last year, my liver and billirubin where high then too but doc chalked it up to the gallbladder. I do take a beta blocker and an ace inhibitor. See a cardiologist twice a year. Might need to look at seeing a gastro doc maybe...

[davbrucas]

In engrish???

Read about it on wikipedia.

[Stephen]

Read about it on wikipedia.

http://en.wikipedia.org/wiki/Supraventricular_tachycardia

[LS1Goat]

Classic description/symptoms of paroxysmal supraventricular tachycardia.

.

Please please please let me know what you find out about this. I have the exact same thing happening to me. I have had reflux and heart palpitations for years and they can never find anything with the EKG or stress test. Does your heart just all of a sudden start racing? I can sometimes get mine to right itself by taking in a really deep breath and holding it. My girlfriend says it sounds like my heart stops beating for a couple beats and then just beats slow and very hard for a few minutes.

Holding your breath is called a Valsalva maneuver. Bearing down like your defecating, holding your breath, shoving your face in ice cold water, aggressive coughing, etc.. All will slow down the heart rate by affecting the Vegas nerve. It's not necessarily PSVT. There are many underlying conditions that can cause Tachycardia. I've had patients that had extremely low blood sugar experience paroxysmal tach, thus mitigated by administration of oral glucose or orange juice, if the they are A/O x 4. Caffeine or even a Panic Attack can be the culprit.

If you can stop Tach with Valsalva techniques and it doesn't happen often, then I wouldn't worry about it. Especially, without chest pain, shortness of breath, disorientation, etc...

True PSVT arrhythmia I've treated cannot be successfully (permanently) mitigated by traditional Valsalva maneuvers. They require Adenosine or Cardio pacing.

Also, sometimes perfectly healthy people with throw off a PVC every once in a while. I had to wear a Halter monitor for 24 hours once. It happens..and it's usually benign and quite common.

[davbrucas]

.



Holding your breath is called a Valsalva maneuver. Bearing down like your defecating, holding your breath, shoving your face in ice cold water, aggressive coughing, etc.. All will slow down the heart rate by affecting the Vegas nerve. It's not necessarily PSVT. There are many underlying conditions that can cause Tachycardia. I've had patients that had extremely low blood sugar experience paroxysmal tach, thus mitigated by administration of oral glucose or orange juice, if the they are A/O x 4. Caffeine or even a Panic Attack can be the culprit.

If you can stop Tach with Valsalva techniques and it doesn't happen often, then I wouldn't worry about it. Especially, without chest pain, shortness of breath, disorientation, etc...

True PSVT arrhythmia I've treated cannot be successfully (permanently) mitigated by traditional Valsalva maneuvers. They require Adenosine or Cardio pacing.

Also, sometimes perfectly healthy people with throw off a PVC every once in a while. I had to wear a Halter monitor for 24 hours once. It happens..and it's usually benign and quite common.

FYI...
There is no Vegas nerve. Any tachyarrhythmia originating above the ventricular system is SVT. There are several types of SVT but the most common in young, otherwise healthy patients is AVNRT/AVRT. Still above the ventricles. The causative agents you listed all can cause SVT. Its still SVT regardless of the causes you listed. The nature of the arrhythmia makes it susceptible to vagal maneuvers like valsalva...which slow conduction thru the AV node and oftentimes breaks the reentrant cycle...but not all the time and it usually comes back but what you said about it not being true psvt if you can break it with vagal maneuvers is not true. What do you think adenosine does? Slows conduction thru the AV node...same thing vagal maneuvers do. Yes, its easier to just put the patient on a rhythm strip and push the adenosine and see what the underlying rhythm is vs trying to get the patient to valsalva or performing carotid massage or whatever. Its a must to make sure there are no delta waves in the underlying rhythm. Giving a patient with WPW a longer acting AV nodal blocker like diltiazem can be disasterous. Also, cardiac pacing has no place in the treatment of psvt. (cardioversion is different from pacing in case you didnt know)
I am surprised that the OP hasnt been given a Holter Moniter to figure at what this is.
Once again Tim, you try hard to one up me and your schpiel may impress those that dont understand this stuff, but I can tell that you know enough to hold a conversation but your ignorance of the info is glaring to me. Maybe you should google this stuff to freshen your grasp on the info before coming behind me and attempting to downplay what I say. I do this for a living. You do not and have not for years. I would say stick to what you know but you apparently forgot some of your training. The dangerous part about you being a medic is you are confident but your fund of knowledge is lacking. This can lead to harm to the patient...and somehow I dont think I am the first to tell you this. I am sorry if this offends you, but I have had years of reading your medical posts to be able to make this observation.

[idrivea4banger]

Ahh fuck the drunk medic chimed in. Dr. Dave, I don't wiki that's too much work. Is that the advice you give your patient??

[LS1Goat]

FYI...
There is no Vegas nerve. Any tachyarrhythmia originating above the ventricular system is SVT. There are several types of SVT but the most common in young, otherwise healthy patients is AVNRT/AVRT. Still above the ventricles. The causative agents you listed all can cause SVT. Its still SVT regardless of the causes you listed. The nature of the arrhythmia makes it susceptible to vagal maneuvers like valsalva...which slow conduction thru the AV node and oftentimes breaks the reentrant cycle...but not all the time and it usually comes back but what you said about it not being true psvt if you can break it with vagal maneuvers is not true. What do you think adenosine does? Slows conduction thru the AV node...same thing vagal maneuvers do. Yes, its easier to just put the patient on a rhythm strip and push the adenosine and see what the underlying rhythm is vs trying to get the patient to valsalva or performing carotid massage or whatever. Its a must to make sure there are no delta waves in the underlying rhythm. Giving a patient with WPW a longer acting AV nodal blocker like diltiazem can be disasterous. Also, cardiac pacing has no place in the treatment of psvt. (cardioversion is different from pacing in case you didnt know)
I am surprised that the OP hasnt been given a Holter Moniter to figure at what this is.
Once again Tim, you try hard to one up me and your schpiel may impress those that dont understand this stuff, but I can tell that you know enough to hold a conversation but your ignorance of the info is glaring to me. Maybe you should google this stuff to freshen your grasp on the info before coming behind me and attempting to downplay what I say. I do this for a living. You do not and have not for years. I would say stick to what you know but you apparently forgot some of your training. The dangerous part about you being a medic is you are confident but your fund of knowledge is lacking. This can lead to harm to the patient...and somehow I dont think I am the first to tell you this. I am sorry if this offends you, but I have had years of reading your medical posts to be able to make this observation.

ah..i mispelledd a word because i've drank a bit tonight...lol your poor guy. to be that sanctimonious must really suck. and lack of knowledge my ass. standards of practice are delineated by our medical director. this varies from state to state/county by county. i think it's your ignorance of EMS that is egregious and obvious based on your usual assumptions and condemnations of my medically related posts. i was an excellent paramedic back in the day. i left/resigned due to PTSD from a lot of rough calls, as i felt it was clouding my judgment and therefore would be irresponsible to continue. and i got tired of the mandatory PTSD counseling sometimes required based on volume or repeated in short interval calls like SIDs.

you know nothing about me. you make assumptions about people you've never even met. like when you went back and forth a couple of pages about that wounded vet another member was trying to generate some money for. i realize you did donate, but you had to make an issue that your experiences and how you can go on and continue to work..not asking for hand outs..blah blah...you were highly disrespectful to another vet in that thread. and i believed at one point subsequent to your previous threads you issues somewhat of an apology? so, why don't you stop being a prick all the time. or at least concede the fact that you can an ass to people and bit your tongue. there is a lot BS posted on here that i don't agree with. i make remarks in probably 2/3 of the posts i read. people don't like my late night drunk posts. then ignore them. just keep scrolling down. and i hate to be the bearer of bad news, but you're not omniscient. and i liked the comment you also made in that post regarding deciding not to deconstruct the pathology in someone's post...lol You are arrogant, conceited, and have a pseudo-god complex. That last personality trait can manifest itself automatically over time when you are in the medical field and you have someone's life in your hands. i get that part, but seriously, you are flat out conceited. doesn't mean i don't respect you for your military service or being a practicing M.D. try taking a moment of pause and look in the mirror. looking at your "pathology" i wonder sometimes if you get stuck in the bathroom, if there is a mirror present. you and narcissus would get along quite nicely

i finished at the first of my class, dave. and after just a couple of years was approached to become a supervisor/field training based on my excellent audits and reviews.

i'm sure things have changed over the years since i was in the business, so it's logical to assume some of my learned treatment methodology differs in some way to present day. however, that's a concept you can't understand. i.e. logical reasoning and exercising common sense. and i don't prevaricate about this stuff. a lot of you folks out there don't understand the differences and emphasis on patient care in a pre-hospital environment. it cracks me. go ahead and continue to disparage me, if it makes you feel better.

[LS1Goat]

Ahh fuck the drunk medic chimed in. Dr. Dave, I don't wiki that's too much work. Is that the advice you give your patient??

I never use wiki nor google. I have a degree in Emergency Medical Management. Finished first in my class. I was also field medic and saw a lot of shit that would give your pansy ass white knuckles. I was also a BTLS teaching aid for a short period before I quite. Invited to do so for my academic performance.

You know nothing about me. You're just as much of a pretentious individual as Dave is.

As much as it must be palliative measure in your small mind to impugn everything I say, it doesn't change the facts. It doesn't mean anything, but illustrate your ignorance.

And yea, I get a little fucked up on the ETOH every once in a while. So do millions of other people. However, I can still put a roof over my head and keep my head above water. Get the hell out of here with your BS assumptions. Dr. Dave is an ER doc. He's never worked in EMS. He has a hard time grasping that my responses are per my training under the curriculum at the time. And a lot has probably changed over the years. Example: We were once suggested to use Hydrogen Peroxide to sterilize dog bites. Now you do not do that as the Standards of Practice changed and are constantly evolving. I would explain the answer to why that is, but you and the Doc would probably claim I was making shit up. And now he's correcting me because of a misspelled word. Even though Valsalva is a huge portion of the didactic portion of ACLS, but he doesn't know that because he didn't go through a Paramedic ACLS program.

So, there is absolutely no way I could know these things as a state and National Registry Paramedic and former teaching aid. You people are complete and utter morons. If not, then just grossly misinformed about EMS.

I guess this Diploma on the wall was just a joke. Bummer, I guess the secrets out. We played scrabble and poker to pass the time, not Emergency Medicine.

[davbrucas]

Tim, get some help for your depression and alcoholism. Sooner or later you are going to reach a hurdle that you cannot overcome and your family is going to suffer the consequences. You are intelligent. Use that intelligence. I suggest going to PA school and using/cultivating your medical knowledge instead of wasting yourself in IT and killing your mind with ETOH. Tim, it isnt pretentiousness if it is the truth. You tell me that I should look in the mirror...it's time for you to face your demons and put them behind you. If you like, I can shoot BrianC a PM and have him come do some of his chants and rituals to get those demons out of you if you like!

[davbrucas]

Ahh fuck the drunk medic chimed in. Dr. Dave, I don't wiki that's too much work. Is that the advice you give your patient??

I just didnt want to type it out when you could just google it instead. But actually, I do often print out some info for a patient about their condition for them to read later because no matter how much counseling you give them they wont remember it when they leave.

[LS1Goat]

Tim, get some help for your depression and alcoholism. Sooner or later you are going to reach a hurdle that you cannot overcome and your family is going to suffer the consequences. You are intelligent. Use that intelligence. I suggest going to PA school and using/cultivating your medical knowledge instead of wasting yourself in IT and killing your mind with ETOH. Tim, it isnt pretentiousness if it is the truth. You tell me that I should look in the mirror...it's time for you to face your demons and put them behind you. If you like, I can shoot BrianC a PM and have him come do some of his chants and rituals to get those demons out of you if you like!

Damn.... I really need to stop drinking myself into a stupor. I barely even remember making the two above post. Wife came in and angrily woke my ass up this morning on the coach. I had the laptop still sitting on my lap in sleep mode, and a big wad of Copenhagen in my mouth. And it burnt the ever loving shit out of my gum line and cheek. Feels like sandpaper against the tongue. By my calculations I had the dip in for about 6 hours passed the hell out with fingers on the keyboard...lol I'm laughing because I know I'm in trouble. Trying to make light of it. You're right about getting help part regarding alcoholism. I'm not in denial about that, which might be a first step. I have some interesting alcohol related problems that are very disconcerting. One of them being blackouts. Major short term memory loss. Another is I feel sick when I'm sober, but feel great as long as I have some alcohol in me. This is getting ridiculous. I read what I post when I'm sober and even I'm in awe. My best friend jokingly refers to me as Dr. Jekyll and Mr. Hyde in regards to alcohol. And judging by post sober vs. sideways drunk, I'm starting to see the "demons" you speak of.

[LS1Goat]

To the OP - Sorry for my drunken BS rants. Or should I say futile and unnecessary need to prove something to a stranger(s) that don't know me and have never met me.

Your lab results don't look bad. They most likely would have contacted via phone if there was an are of concern. Usually, when you get a report in the mail without a walk in or phone consultation, that means all is OK or within normal parameters. Bilirubin is on the high side, but that also can be genetic and also benign in some people. If the Dr. was truly concerned you would have received call for a follow up appt. Hell, I bet if I had a panel done my ranges would be off the table considering how much alcohol I consume.

I'm sure Dave could give you a detailed list of probably causes for this, but he might also agree that no phone calls or requested follow up associated with test results sent by mail is no cause for concern. Especially, if you are asymptomatic. This is a litigious nation we live in. And anyone(competent) in the medical field operates under CYA mentality.