(08-19-2015 10:52 PM)plnelson Wrote:
(08-19-2015 07:10 AM)DocWils Wrote: .
As for your case, I've heard of a few like it, and of course, seen a lot on such things in our textbooks, but I never encountered one in my cardio rotation (back when dinosaurs ruled the earth). Is ablation a possible solution for you, or is there some other cause besides faulty electricals in your heart? And has your doc tried to put you on Bilol to see if that smooths it out?
Not sure what Bilol is - there are various formulations of Bisoprolol which might be the same thing - that's a beta adrenergic blocker, and I take atenolol, which is another a beta adrenegic blocker. It helps with the PACs but over a certain dose it slows my heart down too much.
It is indeed Bisoprolol, I apologise, I tend to use the Swiss generic names for these, as that is how we prescribe them here, so I have it in my head that way. Atenolol is of the same family, slightly different, you can try one or the other and one will most likely work better for you than the other, but which depends largely on your body chemistry. You are correct that for most long term patients, a too high a dose (say, 10 mg) will push you into bradychardia and you will feel sluggish when moving or anything (actually, besides the sluggishness, there is nothing really wrong with a brady if it stays in the 50s and even high 40s when sleeping, but below that it becomes a real problem) - I usually suggest start with 2.5 mg/day and work up to 5 to see where your heart goes with it, and tail off again if you slow down too much, usually I consult with my cardiologist mate next door before I do so, but in my department mystery PVCs and the like are common, and this is usually a first line of attack, if only to see if it responds - I have tried it myself, as a matter of fact, so I can speak from personal experience as well. I didn't enjoy it at all, and it made the largely physical work I do rather difficult and slow (made me feel my age and then some, too), but I also found low doses sustainable. Have you asked if ablation is a possible route for you to take? Essentially, if this is all electrical in nature and not part of some other blockage or defect, in certain types of rhythm disruptions, finding the errant nerve in the heart and cauterising it fixes it. It will depend on the nature of your contraction type. Your cardiologist will be able to inform you better if that is an option and you need a surgeon who has done this a lot, because this is a bit of a black box operation (done via catheter, no open heart stuff, so relax on that part - no zipper club for you).
On the subject of pulse-oxs, someone over in the cardio lab said he likes the SPO PulseOx 7500 for overnights at home, but there were none for me to check out - in fact we don't have them any more in house, I found out. Of late we use the CMS 50F for home use, but I suspect that is because of the price as much as anything (here $400, in the US $100 - thing's ain't cheap here) - but there are few artefacts or noise when moving, and the monitor straps to your wrist. In house use of course, we have whole other systems, but it is not worth going into those as they are designed to hook up to the bedside monitors. A mate of mine at another clinic says he likes the ChoiceMed MD300W11 for send-homes, so you have a plethora of choices, all recommended by doctors.