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Having Heart Palpitation And Shortness Of Breath. Found Vitamin D And Iron Deficiency. Suggestion?

Posted on Sat, 6 Apr 2013

Question: Hello doc. I am 51, female, and had a complete heart work-up 2.5 years ago when I had heart palps, shortness of breath, etc. All came back fine but I later learned I was severely anemic (7.0 HGB) and low in Vitamin D (11 ng). I still struggle with mild anemia occasionally (big, whopping fibroid) but I can mostly manage it with iron pills. Lately, I've been feeling crappy, pressure in center of my chest, and my BP was high at doc's office when I felt bad (170/110) and I asked my family doc to check my D. This time, it was 4ng! An EKG also came back RBBB for the first time. What else should I be tested for? For a week, I've been taking 10,000 IUs of D a day. I feel overall bad. I know I mostly need fresh air and sunshine but what should I ask the doc to test me for? Just in case. Thank you for your time and your help.

Answered by Dr. Anantharamakrishnan (2 hours later)

Hi friend,
Welcome to Health Care Magic

Anaemia needs attention. It is most likely from Iron deficiency / and Iron deficiency is from blood loss from heavy periods. Yet, have serum Iron, Iron Binding Capcity and Ferritin estimated – to be sure.

Vitamin D deficiency is fairly common / easily correctable / need to follow up

BP is moderately elevated / this level needs treatment / treatment will be life long / hence the need to check on several occasions to make sure / Kidney function, electrolytes need evaluation / If it is episodic, adrenals should be checked for Pheochromocytoma...
Lipids should also be looked into at this age

RBBB is Right Bundle Branch Block. It is often an incidental finding. It may be from conduction defect in the right branch – very likely in you case because of age / it may be rate dependent / or volume overload in the right ventricle. EKG needs to be repeated.
Palpitation may be from anaemia / yet better be investigated further...
HOLTER (24 to 48 hour ambulatory monitoring) / ECHOcardiogram / TMT (Treadmill exercise ECG) / LABORATORY work-up (thyroid)– may all be necessary for further assessment and assistance.
The treating doctor may suggest them depending on need, based on his assessment of the situation.

To sum up, a few things need attention /further work up. / nothing alarming...

Take care
Wishing speedy recovery
God bless
Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (17 minutes later)

I am familiar with all the iron tests - ferritin etc. and I can keep up with that now. My BP returned to normal and only seemed to be high when I felt bad but I will ask my doc about a follow-up EKG and the other tests you mentioned. Thanks so much.

Answered by Dr. Anantharamakrishnan (2 hours later)

It is good that the BP became normal.
It could have been anxiety / sometimes the very act of seeing the doctor - "white coat hypertension"

All the best
Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar