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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Have Heart Palpitations. ECG Showed PVCs. Prescribed Carvedilol, Clopidogrel. Done With Thyroid And Blood Test. Concerned?

I have heart palpitations, my ECG showed PVCs. A GP prescribed carvedilol and clopidogrel and recommended to seek for a cardiologist and have a 2D echo to determine the cause. I was not able to find a cardio on time as cardiologists in our location are very few and come here only on schedule. I went to an internal med doctor, had a series of tests, blood (except Thyroid hormone levels), chest xray, EKG, urinalysis, thyroid ultrasound. Results I have high cholesterol, have thyroid nodules (probably cystic), still have PVCs (4x a minute), normal heart rate, chest xray showed heart in normal shape and size, healthy lungs. The Dr told me Im hypo (I thought I have had T level tests, I wondered how she came to that conclusion, judging the cholesterol level and presence of nodules in the thyroid alone. The Dr prescribed levothyroxine 100mcg a day and will increase to 150mcg after a month. Advised me to go back after 6 months to see if the nodules decreased in size. The carvedilol dose to continue 6.25mg 2x a day. But the problem, heart palpitations persisted (prolonged) and seemed to got even worse. I thought these as side effects of the drugs, the Dr also prescribed me to take rosuvastatin for the high level cholesterol. Just today, I decided to temporarily stop the medications and have had a blood test for the thyroid hormone levels (still waiting for the result, will be available tomorrow). I feel quite better when I stop though there are still mild palpitations. Btw I also have a fever and joint pains, also side effects of the drugs? I am taking rosuvastatin around 4 hours after taking in levothyroxine. i am suffering with this condition (heart palps) for more than 2 weeks now. I am considering to wait for our cardiologist to arrive 3 more weeks or travel to next city to see one and an endocrinologist. I just cant withstand the shortness of breath, cant sleep at nights Im scared.
Wed, 15 May 2013
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Cardiologist 's  Response
Dear Sir/ Madam
Thanks for your query to HCmagic.
1. It is not scientific and correct to start therapy with levothyroxine without knowing you blood levels of thyroid hormone.
2. After ECG, next step in management of PVCs is ECHO and if it is normal, there is nothing to worry. In such a scenario treatment is given only if patient has bothersome symptoms because of PVCs. Any reason for increased PVCs like tea/coffee/anti-asthma therapy/ hyperthyroidism {not hypo} should be looked into and dealt with. If required i would prefer a cardio-specific beta-blocker rather than carvedilol.
3. Rosuvastatin or any therapy for cholesterol should be started only after considering target LDL levels and actual profile. This requires details about yourself and detailed lipid profile.
Hope this helps. Feel free to discuss further.
Sincerely
sukhvinder singh
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Have Heart Palpitations. ECG Showed PVCs. Prescribed Carvedilol, Clopidogrel. Done With Thyroid And Blood Test. Concerned?

Dear Sir/ Madam Thanks for your query to HCmagic. 1. It is not scientific and correct to start therapy with levothyroxine without knowing you blood levels of thyroid hormone. 2. After ECG, next step in management of PVCs is ECHO and if it is normal, there is nothing to worry. In such a scenario treatment is given only if patient has bothersome symptoms because of PVCs. Any reason for increased PVCs like tea/coffee/anti-asthma therapy/ hyperthyroidism {not hypo} should be looked into and dealt with. If required i would prefer a cardio-specific beta-blocker rather than carvedilol. 3. Rosuvastatin or any therapy for cholesterol should be started only after considering target LDL levels and actual profile. This requires details about yourself and detailed lipid profile. Hope this helps. Feel free to discuss further. Sincerely sukhvinder singh