Cardiac Related Questions

[Christine]

I hope someone has some ideas here--fortunately, as far as I know, there is nothing serious going on but I'm sort of curious. It seems that there are some knowledgeable "cardiac" people here, so I thought I'd throw this out.

I will also say that I will be seeing my GP on April 12th.

Yesterday, I had my follow up appointment with my gastroenterologist. A month ago I had an upper endoscopy and a colonoscopy to make sure I had no internal bleeding (I have iron deficiency).

I had some problems during the procedure in that they had to give me a LOT of drugs to knock me out and, even then, I woke up several times during the colonoscopy portion.

So yesterday the doctor tells me that in all the years he's done these procedures, I am the only patient who had the highest resting heart rate of 145 bpms. What he means by resting is that when I was supposedly sedated, my heart rate was at 145.

Now, prior to the procedure, before drugs, as I was waiting to go in, I was a nervous wreck. My pulse was at 120, and it was also around 120 right before the sedated me. Apparently it kept going up, even though I *was* feeling relaxed.

I do have a history of sinus tachycardia. This could be due to being on thyroid meds and having a lower than normal TSH. I've also had several EKGs, holter monitoring, and an echocardiogram. All showing normal heart, no arrythmias, just "sinus tachycardia" at times.

So--this kind of bothers me. The doctor says that it's just because of my anxiety. I know I have anxiety but have never had it do that and I've had many surgical procedures. I do know that they used a TON of Demerol during the procedure and some Versed. But mainly Demerol. I wonder if it was more the drug's fault. Or should I be going back to the cardiologist?

 

[safetymom]

I think just for peace of mind you should go back to the doctor.

 

[tiki tink]

My husband has both Tachy & Brady, so I can relate to the problem you had. I don't mean to make this into a post about me, but I want to let you know what happened. On 3/13 DH was hospitalized due to what they thought was Sinus Tachy, but they were wrong. He went almost a day & a half with a heart rate of 145-160 which anyone knows can cause irrepairable damage. He had to be transferred to a hospital in Orlando as Daytona couldn't do anything for him as he was born with Transposition of the Great Vessel and needs a pediatric cardiologist who's familiar with congenital abnormalities. As it was he's developed Atrial Flutter and we have to find out what to do next. What we learned when we saw an electrophysiologist is that you shouldn't be able to feel those beats running that high. Although the body reacts normally to certain stimulation causing the heart rate to increase, it shouldn't be so high when you're at rest or under anesthesia. How was your BP during the procedure? My DH also has recently had bouts of anxiety, but it could just be signs of the cardiac issue which appear as the Tachy. We've done the Holter monitors and now have an Event Monitor for this month just to see what's going on. The Event is good since you can have it a month at a time and it will record at the onset of any episode. I think that you should get to a cardiologist as soon as you can get in, just to have that peace of mind. If you ever want to chat, just PM or email me and I'm here for you

 

[Pea-n-Me]

Christine, I think I've mentioned to you in another thread before I think it's a good idea for you to keep in touch with a cardiologist.

But as far as this goes, have you googled the side effects and drug interactions of versed? Give it a try. You might also want to talk to an anasthesiologist or pharmacist to see if they have any thoughts about this incident - they should know your medical history and have your medication list in front of them. BTW, who was in the room at the time - the GI doc and a nurse? Was there an anesthesiologist/nurse anesthetist there? (I know when I had an endoscopy using conscious sedation, there wasn't.)

I guess in light of this incident I'd be cautious about future procedures. If I were you I'd get a copy of the notes from this episode and show them to people doing any procedures you might have at a later date. It's something for them to be aware of and prepared for, and your verbal explanation might not be enough for them to truly understand what happened.

 

[Mackey Mouse]

We are so thankful to have you on this board Pea-n-Me.......your responses are informative and so comforting.. thanks for giving such good advice and I am also going to look up the side effects of Versed....it does work wonders though as you do not remember feeling the procedures.. of course you do not remember much else for that day either.. LOL

 

[Christine]

Christine, I think I've mentioned to you in another thread before I think it's a good idea for you to keep in touch with a cardiologist.

But as far as this goes, have you googled the side effects and drug interactions of versed? Give it a try. You might also want to talk to an anasthesiologist or pharmacist to see if they have any thoughts about this incident - they should know your medical history and have your medication list in front of them. BTW, who was in the room at the time - the GI doc and a nurse? Was there an anesthesiologist/nurse anesthetist there? (I know when I had an endoscopy using conscious sedation, there wasn't.)

I guess in light of this incident I'd be cautious about future procedures. If I were you I'd get a copy of the notes from this episode and show them to people doing any procedures you might have at a later date. It's something for them to be aware of and prepared for, and your verbal explanation might not be enough for them to truly understand what happened.

Well, I just got back to this thread not realizing that more people had answered.

Pea-N-Me--at this particular hospital they did not have an anesthesolgist. There was a snowstorm that day and I was supposed to go to a hospital that used propofol as a anesthesia (with an anesthesiologist). However, they shut down due to the storm and my doctor sent me to another place. They just use Demerol with a little bit of Versed.

Now, in the past, I have had two breast surgeries (with an anesthesiologist using Versed and, I assume Propofol) and I've had no issues.

According to my GI doc, they just could not get me under and he had to use 3 times as much Demerol on me as any other patient he's ever sedated. I just know when I was on the table, I was at 120 bpm and I was starting to feel relaxed with the drugs. The nervousness was overwith. So, I'm thinking the drugs caused some sort of elevation. I did read that Demerol can cause this so who knows. As far as I know, my BP was fine.

I have an appointment with my GP on April 12th to review the gastro records and check my anemia. I'm going to mention this to him.

Edited to add: I found this on the internet regarding Demerol:

In its effects on the cardiovascular system, meperidine generally resembles morphine, including its ability to release histamine upon parenteral administration. Heart rate is unlikely to be significantly affected with i.m. administration but may increase, with i.v. administration.

I had a lot of this stuff apparently!

 

[Pea-n-Me]

Versed can have a "paradoxical effect" on heart rate - meaning opposite. http://www.rxlist.com/cgi/generic/versedinj_ad.htm

If this were my experience I'd want to talk it over with someone who specializes in administering sedation medications, knowing all the details of the case as well as my health history and what medications I'm taking. Of course, talk it over with your docs, too - but I'm not sure they'll have answers for you on this.

(I'm not posting this to scare people about versed - it's used the world over - but just to show that unusual things can happen.) http://www.askapatient.com/viewrating.asp?drug=18654&name=VERSED

FWIW - it doesn't have to be one drug or the other, either. It could be a combination, or the fact that you had to get extra demerol, etc. Each case is different even for the same person.

 

[Christine]

Versed can have a "paradoxical effect" on heart rate - meaning opposite. http://www.rxlist.com/cgi/generic/versedinj_ad.htm

If this were my experience I'd want to talk it over with someone who specializes in administering sedation medications, knowing all the details of the case as well as my health history and what medications I'm taking. Of course, talk it over with your docs, too - but I'm not sure they'll have answers for you on this.

(I'm not posting this to scare people about versed - it's used the world over - but just to show that unusual things can happen.) http://www.askapatient.com/viewrating.asp?drug=18654&name=VERSED

FWIW - it doesn't have to be one drug or the other, either. It could be a combination, or the fact that you had to get extra demerol, etc. Each case is different even for the same person.

Thanks so much for your response. I guess it's just "wishful" thinking on my part that this is easily explained by the drug.

I agree, my GP will probably just scratch his head. Quite honestly, I wouldn't even begin to know HOW to talk to an anesthesiologist.

I don't *have* a cardiologist. I was tested many years ago when my tachycardia started. Had an event monitor. I've had several EKGs and, last year, had an echocardiogram just to keep up with the tachycardia. Nothing has been found on any of these tests, though I know there is further testing that could be done.

 

[Pea-n-Me]

If you don't know an anesthesiologist, seek out a friendly, knowledgeable pharmacist where you buy your meds. If they don't work in a hospital, they may not be too experienced with the effects of IV versed or demerol but they certainly can look it up and will know basic things about the classes of drugs these fall under and interactions, etc. I talk to pharmacists a lot in the course of my work and find them to be a helpful lot.

I know we've talked previously about your baseline tachycardia, but feel free to PM if you ever want to brainstorm again. If I recall, you can't take a beta blocker because of your asthma, but you were on a calcium channel blocker to slow you down a bit. Are you still on that?

The issue with tachycardia is over time there is extra workload on the heart which can cause thickening of the muscle and later, less elasticity for pumping. It can also can lead to decreased exercise tolerance if your heart cannot fill properly because in going too fast, there's not enough time for blood to flow in in order to be pumped back out. Your heart is working overtime trying to keep up. Slowing things down allows for longer filling time and ultimately decreases the workload on your heart since your heart doesn't have to work as hard to fill and pump out what your body needs (ie demand). Even if you are on meds and you are still tachy, it's a good idea to be seen regularly by a cardiologist because medications often need to be adjusted/fine tuned. They'd want to see how you're doing these days if it was a while ago.

 

[Christine]

Here's what my issues are with the tachycardia. I don't have it all the time. Many years ago, I started with bouts of it, predominantly in the morning. Turns out, a lot of it was caused by GERD and sort of got under control when I began using Prilosec. My heart rate, just standing around the house would be about 120. This was back in 1998 and at that time I did the event monitoring and found there were no arrythmias.

Back in 2005, after my last breast surgery was over, I noticed that my heart was pounding a lot. This happened within the month of having surgery. Again I felt my pulse rate was high. I was also under a lot of stress/worry over the biopsies. It was at that time that I saw my GP. He referred me to a cardiologist for an echo. I was a nervous wreck for some reason while having the echo and during the whole test, my pulse was at 120.

On top of all this, I think I have hormonal issues. For the 2 weeks prior to my period, my heart rate is in the 80/90s when I'm doing stuff around the house (not bad)--sometimes it will be higher. Then, after I start my period, I am down in the 60s/70s and I never have any racing pulse.

Because of all this, it is hard for me to take Inderal (beta blocker) on a regular basis. On the days that I don't have a high heart rate, it will shoot my pulse down to the 40s.

My doctor tried me on a calcium channel blocker (verapamil) and I had an allergic reaction to it.

As if this wasn't enough, I also take Synthroid at a suppressive dose (my TSH is routinely about 0.3) due to thyroid cancer. I think that only makes things worse. Then there is the anemia (which I think is gone) but I am still very iron deficient at this point--which also contributes to a rapid pulse.

I have been exercising. Going about 3.5 mph on the treadmill and my pulse rarely goes over 135 (normally it stays at about 128). So exercise doesn't seem to make it worse.

The 145 bpm during the procedures was really odd because while I do have some noted tachycardia, it has NEVER gone that high.

 

[Pea-n-Me]

It's a complex situation with your history and medication issues, but a good team of docs should be able to sort it out and get it under control for you. Keep on them about it. Good luck.