Dumping after large meal

[medhelpmark1]

After a questionable ECG Dx of (asymptomatic--only 2 episodes of short term nocturnal SOB) "septal MI"w/ neg.(no CAD, but lack of fitness) stressed echocardio, a 63 yo WM with sporadic untreated asthma, chronic (30yr) use of desiccated thyroid, has his 30yr untreated essential HTN controlled w/3 meds.(B-block/ACEInh./Hctz). Now he has (3) EPISODES OF increasingly severe post-prandial SOB, thready pulse and diaphoresis with some mild queeziness on first 2 epis. after extreme food overindulgence at conferences--no chest pain, no abdl distention or tenderness, no palpitations, no H/O BG or lyte irreg. His initial ECG 2 yrs ago at time of first Dx & Tx of HTN showed incomplete RBBB (PH/O R conduction defect X 30yrs and LVH with ST "slur"  and he had PVCs almost every min.for 30yrs. since he was put on thyroid (1 1/2 gr.)(they disappeared as soon as dose reduced to 1 gr.!, 1 yr.ago). Are these episodes more likely examples of variant of angina, hypoglycemic, hypotensive or hypertensive vasovagal reaction, cardiogenic shock or some (albeit lowgrade/benign) paraneoplastic condition? How should he be worked up? What condition would be most common? Which would be most dangerous? Which most treatable?

[Cleveland Clinic]

I am sorry but I think this is beyond the scope of this forum. This is clearly someone in the field trying to get answers for a  patient of theirs. In your case I would ask that you use your clinical acumen to decide what is more likely causing the pain, and what diagnosis are more life threatening. The intersection of these two groups is where you should start your search by directing the physical exam, laboratory and any tests.
In this case I recommend stopping the desicated thyroid, and seeing if he is hypothyroid following this. If he is give him a quantifiable amount of thyroid replacement, and if he is not then you most likely are causing him to be hyperthyroid and place him in grave danger form coronary artery disease.

[erijon]

heartstrings is correct, members are allowed 2 questions to the expert forums every six months. This allows the doctors to provide this great service to more members.

Jon

[heartstrings_41]

This forum has a limited number of questions a day, and you asked pretty much the same question yesterday. Are you a student looking for answers to a test? If so, this is not the place for gathering info. Try posting this in the patient-to-patient community.