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Don't know what happen...

I post a question in another group but didn't had an answer...

I'm a man of 37 yo, weight 165 pounds for a height of 6'. I don't exercise since 2010, stop smoking recently, disable from work, was active in the past but since a while I experience a lot of heart related symptoms and want to know if its normal or not?

Right now I'm taking 30 mg of propranolol daily..

First off I had a lot of heart tests done in the last 3 years and the only things that my cardio Doc find is that I'm having exercise intolerance, low ejection fraction of 45 (tested last year and probably lower now), dysautonomia and pots...

My symptoms are chronic and worse over time, they are mainly irregular heart rate (always high at rest and sit in the morning around 120 and as soon as I walk around the house and take my shower it can run as high than 160...), it can also suddenly fall to 60 and jump to 120 again for no reason, I have chest pain at rest who don't seem to be worse when I'm active, I'm almost bedbound and some day my energy is so low that I can't get up at all, in general all I can do in a day is to wake up and take a shower, get dress and sit on the couch all day long cause I feel very tired physically and have no resistance or tolerance for normal task like cleaning the house or just take a small walk. That low energy start 4 months ago (I mean being almost bedbound) and little things like taking a shower bring symptoms like high heart rate, lack of breath, dizziness, clammy hands and feet, headache, jaw pain and left arm pain, panic attacks from the high heart rate, depersonalisation feeling...

Strangely I can't sweat, so can't go out when it's hot cause I feel like I will pass out with the very high pulse rate, nausea, hot head feeling, clammy hands and hot skin but no sweating...

Have a lot of bowel problems as well, very slow transit time and constipation, in fact nothing can move my bowel and always need to use A LOT of glycerin suppositories to have a bowel movement but no bowel movement happen even if I wait 6 days, and in my case it's dangerous to wait that long since I had a gastric by-pass surgery to loose weight 12 years ago and I have short intestine... Before I had all those heart related symptoms I had liquid stools all the time up to 8 times a day!!!

Overall I feel like I will die from a heart attack all the time!!! I now fear going out of my house cause its triggering more heart symptoms and make me panic and feel very anxious...

I also wake up in the middle of the night (1 night on 2) with strong chest and back pain, lack of breath, and tachycardia...when it's happening I take 10mg of propranolol and 1 mg of clonazepam and pray that I will not die in my bed...did go to the ER 3 times on the middle of the night because of that but all the tests came back normal so I was release from the hospital with no explanation at all...

Is it possible that my low ejection fraction of 45 is now even lower and that I'm having congestive heart failure? I mean I have no energy at all and wheezing sound in my lungs when I breath, I'm so worried...

Also the nitro did nothing for my chest pain and only put me in a very low blood pressure stage...

My usual blood pressure is about 110/70, when I really need to get out of my house it can go higher into the 130/90...the dystolic increase more...

My cardio Doc wanted that I start exercise slowly with the help of a personal trainer but I can't exercise at all...I did try for some days but was soooo tired and exhausted after that I wasn't able to continue..

I will have a holter monitor 24 h test this week but I'm sure the cardio Doc will say its normal as usual..

I will see my regular Doc this and I wonder if I should ask to try another beta blocker that I never try (tried almost all of them...) like the Coreg or the bystolic? Should I ask for more tests? Ask to try an Ace inhibitor ?

I'm so tired to feel exhausted all the time...also I can't stand anymore those symptoms.

Any kind of answer will be welcome -;)

Thanks!
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612876 tn?1355514495
"the only things that my cardio Doc find is that I'm having exercise intolerance, low ejection fraction of 45 (tested last year and probably lower now), dysautonomia and pots.."

The things you list here that your cardiologist has diagnosed are more than enough to account for your symptoms! Dysautonomia and POTS can be very severe, disabling conditions! Maybe your doctors have not fully informed you of the full range and extent of symptoms they can cause, but it definitely covers what you describe here. Add to that the low ejection fraction and of course you feel like rubbish!

Has your cardiologist sent you to any other specialists to do testing to try to identify the root cause of your dysautonomia? Have you been tested for autoimmune diseases, paraneoplastic syndromes, neuromuscular conditions, endocrine disorders, etc., etc.? Now that your functional cardiology problems are established, that's the next step. In the mean time, a graduated exercise program that focuses on the legs is beneficial; most people find something like recumbent bicycle best for starters and may only be able to tolerate five minutes at a time to begin with! Taking on too much at the outset is a big reason for discouragement with exercise programs!

to meet you and welcome to our forum!
Helpful - 0
875426 tn?1325528416
Welcome!

I haven't tried it yet, but a doctor gave me samples of Bystolic because it's supposed to not lower blood pressure very much while it is supposed to slow heart rate, provided the dosage is low enough.  

1. Did the doctor mention Digoxin to you?  

2. Do you not have a diagnosis of I.S.T. (inappropriate sinus tachycardia) as well, since you also have tachycardia while at rest?

3. Did they rule out pheochromocytoma for you with your tachycardia is happening even in the night?  Did they do the sensitive fasting plasma free metanephrines blood test?  

4. Did they also ruled out:
a)  iron deficiency with your fatigue, tachycardia even at rest and headaches,
b) vitamin B 12 deficiency with your fatigue, and
c) hyperthyroidism (hyperactive thyroid) with the tachycardia and panic?

5. Your ejection fraction is concerning to me.  What did the cardiologist say about this?  

6. Your blood pressures along with your panic attacks suggest to me you might have the hyperadrenergic form of P.O.T.S. (you mentioned you had P.O.T.S.).  With that form, the blood pressure can be a nice normal low with rest, but spike when a person is upright.  Have they checked your catecholamine levels, including doing a standing norepinephrine test?

Your numbers remind me of some I recorded some years back of my own blood pressure.  I think my diastolic may have even topped 100 before.  But I don't have the ejection fraction you do... that is something the cardiologist really needs to properly go over with you to address your concerns.

When I was diagnosed with P.O.T.S. and started having chest pains, I was afraid of heart attack.  It was a comfort to me to have a cousin who had P.O.T.S. too tell me that this is a normal symptom of P.O.T.S..   Your heart rate is not higher than it would be as a target rate for someone who was exercising, so that might be a comfort too- it has been for my own tachycardia situation.

Here are a couple of threads about lack of sweating you may find of interest:

http://www.medhelp.org/posts/Dysautonomia-Autonomic-Dysfunction/sweatingPerspire/show/1351378

http://www.medhelp.org/posts/Exercise--Fitness/lack-of-sweating/show/400331

7. Your stopping smoking is commendable and an excellent step for your health.  And while I think it definitely was the right step to take, you might consider how that may be affecting you as well- possibly could cause increased nervousness and slowed metabolism, which can lead to weight gain, for example.  Have you discussed this with your doctor?  



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