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Heart palpitations, weakness, and feeling faint 1 month after taking diuretics.

23 year old female, 5'0" tall 100 pounds.

A month ago, I took over-the-counter diuretics (50mg of Pamabrom in each pill) for several days, following instructions on the package (although I broke a pill in half at one point), and have been feeling my heart racing and pounding almost everyday ever since. I'm still experiencing all this even 1 month after I stopped taking the diuretics. I can feel my heart pound even when my resting heart rate is in the 70s, but it feels even worse when it is 80bpm or above. It gets above 100bpm, as well. With the palpitations also comes with feeling very weak and like I could faint. Eating foods with potassium in it may make it worse, or just eating food in general. Sometimes drinking water somewhat helps, but it still happens even when I'm already drinking a lot of water (at least 80 ounces a day). No chest pain, headaches, or nausea. There have been a few days when I mostly felt fine (including the one day that I wore the holter monitor). But most days, when I am experiencing these symptoms, they are on and off for several hours at a time.

I saw cardiologists, who had me do wear an event monitor then a holter monitor. With both monitors, except for one time when my heart rate went past 130bpm and went up to 154 bpm (both of which I did not feel myself), they say that my heart rate/rhythm was within normal limits. I also had blood tests done to test my electrolytes, thyroid stimulating hormone, glucose, Vitamin B12, complete blood count, and they all came back normal (mean corpuscular hemoglobin was a little higher than normal). I also did an echocardiogram where they found no abnormalities. This is not due to anything anxiety related, either. These symptoms start even when I have been feeling calm. I do have history of a heart murmur, which I still have.

I was prescibed beta-blockers (2.5 mg bisoprolol) to take as needed. However, I took one dose 5 days ago and the next day, and for the few days after, I felt very dizzy and even weaker. Those feelings got worse when I tried to lie down to sleep at night. I also had this feeling in my legs as if I have sat on them for too long even though I did not sit on them at all. These reactions to the beta-blockers seem to be wearing off, though.

The doctors are not finding anything wrong with me, and they say that it is nothing life-threatening, but I can't function. I can't work or go to school or travel like this.
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Avatar universal
Why did you take the diuretics?  You say it was only several days, so it would be hard to see how that would cause permanent damage, but they do leach nutrients out of the body when you take them.  Don't know what's going on with you, and you've seen docs, so you've sort of been checked -- that thyroid test doesn't actually test your thyroid, so you haven't actually had a thyroid test yet.  That tests your adrenals.  Don't know why you're on beta blockers if there's no physiological reason to be on them.  Do your docs suspect anxiety?  You may have drained something while on the diuretic, and while it should have gone back to normal when you stopped, sometimes our bodies get stuck in symptoms.  Might be what happened, but who knows?
Helpful - 0
1081992 tn?1389903637
Hi, here's a way to look at your situation:
the one thing that's missing from your otherwise ultra thorough account is mention of blood pressure. The body can try to compensate for low BP by raising heart rate (reflex tachycardia), and/or increasing the force of heart muscle contractions ("I can feel my heart pound even when my resting heart rate is in the 70s").

For some reason your system is either:
(1 ) not contracting smooth muscle on the artery side as it should (which would raise BP),
(2) or else you have not enough blood (low circulatory volume) as in "Sometimes drinking water somewhat helps".
(3) or both

The famous high-veg high-fruit DASH Diet is said to lower BP because it has lots of potassium and also nitrates (which can relax artery muscle, just like nitroglycerin tablets do). So you'd possibly want the opposite - including taking sodium, which hypertension patients are advised to lessen.

Beta blockers get prescribed to lower heart rate, but can also then reduce heart muscle contraction force and some are vasodilators as well -- so those latter two effects can make things worse for you ("I felt very dizzy"). Going just from memory, ivabradine provides pure rate control without the other effects; I'd ask the cardios if it's available in the US yet. But taking a drug should probably only be seen as an intermediary step, until you get the underlying problem (probably minerals) sorted out.

There's also probably something going on in you in particular, which doesn't happen with most people - and that's why the usual things done by your docs hasn't panned out for you. You have the unusual swelling, posted about previously? (another possible blood vessel problem)

You also don't mention Orthostatic Intolerance. Do you get much worse dizziness/almost-fainting upon standing up?  


"blood tests done to test my electrolytes"
In serum, or in cells?


Hopefully, that gives some context.
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2 Comments
Thank you so much for such a thorough reply! My blood pressure is almost always 90-120/55-80. I also don’t get worse upon standing up. The blood tests I’ve done were labeled “CMP/TSH serum or plasma” and “CBC, w/ Auto diff.” Do you know what kind of specialist I should see regarding problems with my blood vessels? I still have the unusual swelling, which was why I tried the diuretics in the first place.
Also, what kinds of “mineral problems” could cause my symptoms?
1081992 tn?1389903637
As you likely know, 90/55 is pretty low - except that for somebody as petite as you, that can be normal. However, have you faithfully checked BP *during* bad spells? You might be lower then. I would also obsessively check BP many times throughout the next several days to see if there is any overt pattern, such as being lower in the mornings, or after certain foods (besides the mentioned K), or whatever.

"I also don’t get worse upon standing up."
That's a clue. But once again, be sure in case maybe sometimes you do - such as in and around dizzy periods. What can dilate blood vessels only sometimes? Immune system chemicals like histamine and prostaglandins can. (Do you ever get spells of flushing red?) Why might immune cells be sometimes inappropriately releasing immune chemicals? That's a huge topic.

"The blood tests I’ve done were labeled... serum or plasma"
The idea here is that the body will do everything it can to keep levels of vital substances in the bloodstream as normal as possible, and so to accomplish that might rob minerals from elsewhere (say, possibly from vascular smooth muscle cells, besides the bones). So a better test is said to be using levels in cells, such as the easily obtainable red blood cells.

"Do you know what kind of specialist I should see regarding problems with my blood vessels?"
Not yet. Let me check your other posts today or tomorrow, chances are they are related to this. This is all speculation, but that's what we have for the moment - especially since the normal avenues of investigation have been already done. You shouldn't be expected to just resign yourself to this problem, right?

'Also, what kinds of “mineral problems” could cause my symptoms?'
Oh, I'd just meant the electrolytes.
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4 Comments
I do check my blood pressure during bad spells, and it is usually around 105/70, the same as always. I don't notice any change in blood pressure between the times when my heart feels fine and when it doesn't, and I always check. I don't experience spells of flushing red, either. I also got heart palpitations soon after having refined wheat bread (not whole grain). I generally react fine to plain rice noodles. But I have been tested for a gluten allergy (and other common allergies), and I don't have any.

My only other posts are on the swelling that I've been having around my jaw and hands, for which I will be evaluated for TMJ (temporalmandibular jaw) disorder in a few days so I'll see how that goes. Other than that, I've also experienced flaky dry skin over the last 3 years, along with my hair texture becoming coarse and wiry. My acne has gotten worse, as well. I did take a blood test earlier this year where they found my iodine levels to be extremely low even though my TSH levels were normal and I don't have goiter. However, I saw an endocrinologist last month who said that my thyroid looks a little larger for my size, for which she's having me follow-up with her in 6 months. I am also seeing a naturopathic doctor (who is also an M.D.) who suspects at least most of my symptoms to be thyroid related. I'm surrently waiting for her to order more blood tests for me.

Do you know how I could get a blood test done that measures levels in cells?
One more thing about the blood pressure: There are a few times when my diastolic pressure would go over 80 (but never went over 90), but it usually goes back down to 80 or below soon after. I just measured my BP (108/82) and heart rate (74 bpm). I just measured it again (less than 3 mins later) and now it is 108/76, heart rate= 72 bpm.
“ (1 ) not contracting smooth muscle on the artery side as it should (which would raise BP),
(2) or else you have not enough blood (low circulatory volume) as in "Sometimes drinking water somewhat helps".
(3) or both“

How could I be tested for either of these and how are these two conditions treated?
Also, I’ve started to notice that my heart and other parts of my chest kinda sort of hurt for 1-3 seconds at a time no more than a few times a day. It’s hard to describe the pain.
1081992 tn?1389903637
Good morning. Let's zero in on this new one, which may call for another visit to the cardio.

"Also, I’ve started to notice that my heart and other parts of my chest kinda sort of hurt for 1-3 seconds at a time no more than a few times a day. It’s hard to describe the pain."

Did any doc mention variant angina aka Prinzmetal angina?

"Ventricular Tachycardia Associated Syncope in a Patient of Variant Angina without Chest Pain"  2016
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720840/

"The frequency of variant angina presenting as syncope is not uncommon, but only a few cases of variant angina without chest pain were reported."

Most other things have become moot (for now), since you are very thorough and do know that your BP was not going very low. But we now have a new possible explanation of blood not getting to the brain - artery spasm resulting in changes in heart pumping ability (VT).

Artery muscle spasm blocks blood flow, and generally is not detectable except when it is happening. When the artery eventually relaxes, tests done by cardios look normal. So perhaps the ideal thing at this point is to get the Holter again and capture what happens when you feel the new pain and/or pre syncope (almost fainting). You might have progressed from no-pain episodes. Please study that article carefully. Not to be alarmist, but the bad possibilities can be very bad - especially in cold weather.

You did have the one episode of tachycardia when you were previously wearing the Holter. Apparently that showed no ST elevation or anything else that might suggest spasm. So that argues against. But I'd think this still needs bringing up to the cardio.


Btw, is this new pain mostly in the mornings?
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1 Comments
Good morning! I’m not sure if this new pain is mostly in the mornings. It has happened in the afternoon and evening, as well. I did experience a few fainting/almost fainting spells 1-2 months before the palpitations started (the palpitations seemed to have been triggered by the diuretics), which was what I was referred to the cardiologist for in the first place. The first time I fainted at home while on my period, then I almost fainted the next two times I went out. Those happened while I was slowly walking around a store.

No doctor mentioned any kind of angina.
1081992 tn?1389903637
No swollen ankles for you, New, right?

"The first time I fainted at home while on my period"
and from your swelling post:
"[pain was] absolutely unbearable, where I wasn't able to lie down, but it went back to the usual degree of swelling the next day after getting my period"
The period aspect is out of my area. Can you illuminate me on how female hormones might be involved? Also, have your estrogen levels been checked? (low estrogen might lead to endothelial dysfunction, which might lead to artery spasm)

"my heart and other parts of my chest kinda sort of hurt for 1-3 seconds at a time no more than a few times a day. It’s hard to describe the pain."
maybe 'microvascular' heart disease... hard to detect, unlike with larger arteries... and probably often described in nebulous terms like that


What specialist to see? I had been thinking of an immunologist, but with such a myriad of problems and so may negative test results, not so much anymore. How about a Diagnostician, if any are nearby.


"I just measured my BP (108/82) and heart rate (74 bpm). I just measured it again (less than 3 mins later) and now it is 108/76, heart rate= 72 bpm."
Seems like normal variation, and some normal people are more labile than that. Some even take 2 out of 3 readings, as is done in BP research studies.


How to test for hypovolemia? Hypovolemia seems probably less likely since you don't get worse upon standing (orthostatic hypotension). Your creatinine didn't show dehydration, either; or you would have said so.    Btw, for extremes: there is such a thing as hypovolemic shock, usually from blood loss creating not enough blood. There is also septic shock from vessel over-dilation. Lying down should help in times when the brain doesn't get enough blood... yet you had a time when lying down made things worse.


And New: please try to take measures so that you don't pass out and end up hitting your head on something hard. An intracranial bleed would make the rest of this seem minor in comparison. I'd even mentally rehearse sitting or lying when in danger, at least to reduce the height to fall.
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2 Comments
Nope, no swollen ankles. And I honestly don't know how female hormones are involved, except that some women do retain extra fluid a week before or during their period. However, I retain fluid even when I'm not on nor nearing my period. My estrogen levels have not been checked, but they will be in a few days (along with progesterone, pregnenolone, ANA, HSCRP, cortisol, TPO/T3/T4/TSH, zinc, iodine, magnesium, folate, selenium)  and it will take about 10 days to get the results.

Is an internist the same as a diagnostician? I found a lot more results searching for Internists in my area.

When lying down made things worse for me, it was due to my reaction to the beta-blockers. I no longer feel dizzy and the effects of the beta-blockers seem to have subsided. However, I feel the pain in my heart/chest getting slightly worse and more frequent.

I'll be sure to sit or lie down when I really feel like I could faint.
The pain in those areas are dull and they come and go.
1081992 tn?1389903637
"Is an internist the same as a diagnostician?"
Nope, think of a diagnostician as a solver of mystery cases. It might be impossible to get an appt, though. We can figure out who else to see once your many test results are back. Just about every one I have thought of, you already are scheduled for.


"When lying down made things worse for me, it was due to my reaction to the beta-blockers."
Yep, I remembered that; but it's still seems paradoxical.

"However, I feel the pain in my heart/chest getting slightly worse and more frequent."
That is worrying me. Can you write to the cardio tonight to say mainly just that, and get replies?

Now I'd like to ask that you keep me updated on any developments, okay? I'd like to know that you turn out alright, rather than me being in perpetual suspense :)  I'll keep my fingers crossed for you to get completely healthy again.
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1 Comments
I’ll contact my cardiologist’s office when they open on Monday. I’ve just noticed the same kind of pain in the area right behind the lower half of my left rib cage and my stomach, too, even though there has been no change in my diet. I’m scheduled for a trip overseas in a month, so I’m hoping that I could have all of this resolved by then. The cardiologist has cleared me for exercise (and even recommended it), but I would  still like to be well before I leave for the trip.

And I’ll keep you updated! I can’t thank you enough for all of your help. This is a pretty scary experience for me so I really appreciate all the time you’ve taken to help me figure this out.
Avatar universal
Just to comfort you a bit, because the above exchange sounds pretty alarmist, blood pressure varies a lot by the individual, by the hour, by the day, etc.  I have always, at least so far, had blood pressure on the low side.  I say so far because I haven't had a physical for awhile and due to new injuries that are chronic at my age I'm not as athletic as I once was, so maybe that will end.  But most of these diagnostic tests aren't all that useful, because you are the only you and you're not having extreme episodes.  You also say you were tested for electrolytes and they're normal, but again, these vary by the hour, day, week, etc.  It's natural, we don't always eat the same or sweat the same or exercise the same amount.  As for your thyroid, TSH doesn't test the thyroid, it tests the adrenals.  While the thyroid and the adrenals are interconnected, there are 4 main hormones the thyroid excretes that must be measured if you want a complete analysis, and you want it done more than just once because, again, levels vary normally.  What you usually can get at best is a test of T3 and T4, and your doctor will do it for you if you ask.  But no doctor does it if you don't.  A holistic nutritionist will often test for this, as anyone can order the test as it's just sent out to a lab.  So if you suspect thyroid, ask for a complete test, not just Tsh.  For the rest, no idea and hope you find out soon.  Peace.
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By the way, heart tests are not reliable either.  I once had an EKG, which is pretty useless, but it showed my heart was pretty slow.  The verdict from the doc was, either my heart was so strong and healthy it didn't need to work very hard or I was destined for a pacemaker, and he had no idea which it was and wouldn't until something happened, such as happened to my brother who passed out one day and came home with a pacemaker.  The body is a pretty odd bird, and generalizations, while useful, don't necessarily apply to any particular individual.  Again, hope you get past this soon.
Thank you very much for your input. I'll be getting tested for T3, T4, TSH, as well as TPO/thyroglobulin antibodies. Would those together count as a complete thyroid test?
1081992 tn?1389903637
"because the above exchange sounds pretty alarmist, blood pressure varies a lot by the individual..."
I had already said explicitly, once she had posted her actual BP measurements, that they seem 'like normal variation'.

Or do you mean that a warning about people hitting their head is 'alarmist'? I know somebody in real life who was having dizzy spells of unknown origin, and I gave him the same warning. Maybe he thought that was 'alarmist', too - because one month later he was in intensive care with a brain bleed from a fall.

Or are you advising a patient who has had enough unusual heart behavior so that she had been referred to a cardiologist, that being concerned about **new** chest/heart pain is 'alarmist'? I didn't say she was in immediate danger (and didn't tell her to rush to the ER); I did say that her cardio needs to know about the new chest/heart pain - which is even more worrisome because it's getting worse and more frequent. It's not unheard of for docs to read and reply to emails via a portal even on a Saturday night.

"if you suspect thyroid, ask for a complete test, not just Tsh"
She had already outright said that she is getting some advanced thyroid testing 'in a few days'.

"I once had an EKG, which is pretty useless..."
The EKG is a foundation of modern medical science and it can tell a very lot. It is ordered countless times every hour of every single day by actual medical professionals. What evidence do you have for saying that it's useless? Anything from say, the American Heart Association or the American College of Cardiology?
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1081992 tn?1389903637
"I'll be getting tested for T3, T4, TSH, as well as TPO/thyroglobulin antibodies."
There are tests for Free T3 and T4, as well as T3 and T4 that are bound to proteins in the blood - being sort of in reserve while being in circulation. You can see if that's in your test order.

TSH doesn't come from the adrenals, it comes from the  pituitary.
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Yup, I'll be tested for free T3 and free T4.
I was just wondering if my heart pounding/palpitations, feeling weak and feeling faint could be hypovolemia/hypovolemic shock? I wondered if it could be simply a loss of a little too much blood. Just before these symptoms started, I took a blood test ordered by an endocrinologist (which came back normal) and I was almost done with my menstrual cycle. Then I took the diuretics for a few days before the onset of these symptoms. Could it be that I just lost a lot of blood volume? And would I be able to ask my primary care physician to test for it?
Hi Ken! So the blood test that I took on 12/16 found that my magnesium levels were low, so I was advised to take a bit of epsom salt/magnesium sulfate for it and it has been helping a lot. However, the heart racing and pounding have not completely gone away and I've been getting them the most after eating, especially when I eat complex carbs.

I also thought of something that I think may be relevant: Back in March 2019, I started to take Abilify to treat PTSD, but then in May 2019 I immediately switched to Risperidone since I didn't find the Abilify to be helpful and it made me extremely bored. I took Risperidone for a little over a month and stopped abruptly because I realized it wasn't helping and it made me constipated. But soon after I started taking Risperidone (within 1-2 weeks), I started to feel this extremely scared/anxious feeling in my heart. I would have to rub my chest to make it go away. That happened for a few times but I never linked it to the meds. This would happen a few times over the course of the next 2-3 months. After stopping the Risperidone, I still had this anxious feeling in my heart but sometimes my heart would feel physically depressed (I can't find a better way to describe it). These feelings would usually, if not always, happen in the morning then it would go away on its own, sometimes walking around and doing very light activity helped. In late July 2019 I started taking Sertraline, then stopped abruptly 2 months later. Shortly after I stopped taking the Sertraline (in the middle of September 2019), I experienced fainting (while I was also on my period), but I experienced almost fainting the week after my period was gone, as well as the week after that. Those two occasions where I almost fainted were the only times I left the house and I felt faint only after ~30 mins of light walking. I stopped fainting/feeling faint after that. Before the fainting spells, though, I also took an annual flu shot (I've taken it the year before in 2018, as well, and had no issues).

Do you think any of this could be related?
I forgot to mention: In late October 2019, I took over the counter Nexium for 2 weeks for the gastritis that I developed after taking ibuprofen to treat menstrual pain. I switched to acetaminophen for the menstrual pain as well as the pain for the gastritis.
1081992 tn?1389903637
"Do you think any of this could be related?"
Yes, I do think that most of it is related, and possibly all of it is related. I'll also take a step off the mainline med path and say that I think it's possible that you are very reactive, both physiologically and emotionally (which are intertwined). That would mean that when you read up on these med topics, you can't necessarily compare yourself to the averages -- and scientific studies are usually mostly about the averages. Since I don't want to give you any anxiety or stress, I'll point out that I am giving you a compliment here and not any criticism whatsoever :)

I see lots of side effects, e.g., for risperidone: heart rhythm problems, dehydration (low circulatory volume), etc. For the Zoloft, too much serotonin can be a problem, and stopping suddenly is a known a problem (hopefully you weaned). But please know that those drugs are outside my field. Hopefully you can be off them all forever.

Nexium is a PPI and so it reduces stomach acid. That means you don't absorb minerals so well (and some vitamins). So we're back to discussing low electrolytes.

Too much Mg can have an ultra powerful laxative effect -- by all means keep on faithfully with it, but just be wary of too much at once. Maybe switch to another form. As always, nothing is simple: Mg Oxide is perhaps least well absorbed, citrate is more expensive, IIRC glycinate is even more expensive but is said to be least laxative and best absorbed. All that goes on and on. Personally, I don't agree that people should buy the very expensive *brand* names, but that's a matter of opinion.

IIRC, the Mg sulfate can be absorbed somewhat through the skin. There is also a spray form called oil, which is not oil.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579607/
"Myth or Reality—Transdermal Magnesium?"

Sorry, I've got to run and can't be more detailed now.

Tomorrow starts your new year and your new improved health :)


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