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Suggest Treatment For Heart Palpitations

Posted on Thu, 30 Mar 2017

Question: Hi, My name is XXXXXXX I had a history of palpitations, I had done a thorough check with a cardiologist 2 years back with ECG,Echo and Treadmill test.Cardiologist has confirmed its due to stress and anxiety and advised takingBetacap 20mg and Iam using it for 2 years.Last 2 weeks Iam under severe stress due to my work and had gone to a local cardioligist.He took an ECG and said there are minute changes in ECG and suspected lateral ischemia.BP was 140/100 and was severly tensed while taking ECG.

He advised the below:

1.Serrta /Alaprazol for anxiety

2.Metaprolol 25 mg twice morning and night

3.Rosuvas Gold - night ( i had slight increase in my LDL levels).

I was already taking Rosuvas 5mg and adilip for my LDL problems.

When i checked with my primary cardiologist he says nothing tor worry about ECG and asked me do a Echo later after
a month once my stress levels are low.

Can you suggest if this is ok.

Answered by Dr. Sagar Makode (31 minutes later)

Brief Answer:
See the description

Detailed Answer:
hello,
I guess you don't have any chest pain or heaviness.
There are certain changes in the ecg but they are considered normal, and not amounting to any significant heart problem esp if you don't have any symptoms. If you have any previous ecg to compare that would be a great help. So overall, there is less probability that you would be having any significant heart issues and no need to worry.
But, Just to rule out for sure, we need stress test like treadmill test or stress echo which would make picture Crystal clear. Echo will be normal in such early cases, as we are not expecting any serious abnormality. Any way you get echo as well.
So you continue medicine which you are receiving and get one stress test done.
You should also have a healthy lifestyle like avoiding fatty, oily and high calorie diet. Have low salt diet and monitor blood pressure regularly thrice a day for one week then once or twice a week. If bp is persistently more than 140/90 mmhg, then you should be on medicines for it. Regular exercises like brisk walking, jogging according your capacity atleast 30 min a day and 5 days a week. Lots of green leafy vegetables, fruits, fish once or twice a week, avoid meat. Avoid smoking and alcohol if any. There shouldn't abdominal fat deposition or obesity. You need to take care of anxiety, use relaxation techniques like deep breathing, yoga, meditation etc.
Get your sugars tested once if not tested earlier..
Get back if you have any doubts.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Sagar Makode (55 minutes later)

Hello Sir,

Thanks for your inputs.It was extremely helpful.

I dont have any chest pain or heaviness.

Can I continue with Rosuvas 5 mg or do i need to take rosuvastatin/aspirin combination?If so kindly suggest one.

My sugars - fasting 95.

Thanks, XXXXXXX

Answered by Dr. Sagar Makode (6 minutes later)

Brief Answer:
Continue combination till stress test

Detailed Answer:
you continue aspirin and rosuvastatin combination till results of stress test are available. There is no harm of low dose aspirin, say 75 mg.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Sagar Makode (6 minutes later)

Sir,

Thanks for confirmation.

Can you suggest any medication with aspirin and rosuvastatin combination, which I can take.

Thanks so much.

Regards,
XXXX

Answered by Dr. Sagar Makode (12 minutes later)

Brief Answer:
See the description

Detailed Answer:
tab Roseday A,
tab Rosulip Asp
tab Rosuvas Asp
tab Unistar
tab Arvast A,
tab Razel A,
Any of the above which is available in descending order. You can ask local chemist shop regarding availability.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sagar Makode (20 hours later)

Sir, many thanks.

Just three more questions please.

1.Taking aspirin - is that required in the long term or a shorter duration.Also is there any harmful side effects of it please.

2.As Iam taking Adilip 45 along with Rosuvas -A, do I need to stop taking Adilip tablets.

3.I have been asked to travel to US for a short business trip ( one week) is there any precautionary medicine that to take along..

Thanks so much doctor for your advise.

Answered by Dr. Sagar Makode (1 hour later)

Brief Answer:
Long term aspirin needed in heart conditions

Detailed Answer:
Hello,

In established heart disease patients, Aspirin is to be taken on long term basis. In you we will continue probably till stress test is done, if test is normal then we can stop iy. It has got some side effects but not very significant because we are taking it in a low dose. It can cause gastritis and bleeding in gastrointestinal tract in some patients, but very very rarely life threatening. One will have black, sticky, foul smelling stools for many days, and that's how it will be diagnosed. So don't worry much about side effects.

Secondly, adilip can be discontinued and infact it's usually given if one is having very high triglycerides level, not controlled with rosuvastatin alone. So you can stop it certainly.

Here, we are not suspecting any significant heart disease in you, so overall no need to worry much. Still you can keep tab Sorbitrate 5 mg Along with you which you ll have to take sublingually if you are having chest pain. Similarly, if you have severe chest pain at any moment and suspected to be a heart attack, then you should immediately have aspirin 325 mg chewed, that is 4 tablets of 75 mg or 2 of 150 mg, rosuvastatin 40 mg, and tab clopidogrel 300 mg if available. If possible all these chewed. Along with these one should also have tab Sorbitrate 5 mg sublingually ever 5-10 min till three doses. Most probably, you ll not require any of these things, still you should be ready with it.

I hope you this will help you, feel free to ask if you have any doubts.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Sagar Makode (42 minutes later)

Thanks so much for your inputs much appreciated.

I was totally feeling normal for my US visit until last week post this stress and tests.

Can I take lonazepam 0.25 for my severe anxiety, caused during my flight travel.
This should calm down my nerves i think.

But sir, you are the best to advise here.

Thanks XXXXXXX

Answered by Dr. Sagar Makode (29 minutes later)

Brief Answer:
See the description

Detailed Answer:
Thanks
You can have it. No contraindication.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Sagar Makode (2 days later)

Hi,

I just had my lipid profile tests done..below are results:
Cholesterol-Total 121 mg/dL

Triglycerides 189 mg/dL

HDL Cholesterol 28 mg/dL

Non HDL Cholesterol 93.0 mg/dL

LDL Cholesterol 55.2 mg/dL

Can you help with your inference.
Thanks

Answered by Dr. Sagar Makode (1 hour later)

Brief Answer:
its good

Detailed Answer:
hi,
Lipid profile is very good, slightly deranged triglycerides but overall good. Continue healthy lifestyle and also continue med especially till your tests are done. The worst and problematic cholesterol is LDL which is very much under control, so our target is achieved, we just need to maintain it.

All the best.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Sagar Makode (9 days later)

Hi XXXXXXX

Iam taking up my echo and TMT tests on Saturday.Do i need to stop taking Betacap TR 40, before TMT tests.

Kindly suggest,

Thanks.

Answered by Dr. Sagar Makode (6 minutes later)

Brief Answer:
Yes, you need to stop

Detailed Answer:
hi,
For tmt, you need to stop betacap 3 days prior to tmt in order to establish a diagnosis. Otherwise, you won't achieve maximum heart rate and study will be inconclusive. For echo, no such need. All the best.

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj