###Input :I (22F) found out I have a pulmonary embolism on november 2nd. It is in the posterior basilar segmental pulmonary artery of the right lower lobe. Its acute (d-dimer at 1,170), I wasnt really concerned honestly. I have been in and out of hospitals my whole life (Im not very lucky when it comes to my health) and ive gotten to the point that I dont stress out whenever I get diagnosed with something new. The ER doctor suspects it was caused by my BCP (combined) along with post-covid stuff (I had covid in july/august of this year).I work as a phlebotomist and recently added an MA type position to my job role at a preventive cardiology office. So I am in the medical field but I dont know a lot about medical stuff - moreso just what I learn from patient situations and what I hear around the office.The first day back at work, a lot of co-workers were extremely concerned and worried about me, some said things like im so glad youre alive!. I appreciated all of the kind words from everyone but it got me a little nervous about how serious this is??Should I take this more seriously? And be more aware of my symptoms? I can take my vitals daily at work and do little things like that. I am so lucky that this happened while working at a cardiology office as the doctors there are keeping an eye on me and basically just told me to monitor my d-dimer at the office and refill my own prescription for eliquis etc etc. Obviously giving them the blood work results if there is anything concerning.The only thing I have changed in my life is that Im constantly wearing a mask in public as I really dont want to risk getting sick right now. When I started eliquis while I was in the 2 weeks of 10mg twice daily, I sneezed and got a nose bleed (I havent had a nose bleed in a good 10+ years so thats not normal for me), so I really dont want to be constantly coughing or sneezing. I used to try to wear a mask out in public whenever I remembered to bring a mask with me and I avoided large crowds as I am immunocompromised anyway, but I wasnt extremely strict with it. Ive also been wearing compression socks since I started this recent BCP.Should I be more careful in other places? Is this something I should be really worried about? I feel like Im doing enough but the comments I get whenever I mention my PE to someone kind of scare me.Medical info : 22 Female 5ft8 ~155lbs White. Diagnosed with psoriatic arthritis at age 2 (arthritis, psoriasis, and uveitis). PCOS, endometriosis, and a septate uterus (the main reason Im on BC). Hypermobility (probable EDS). Frequent concussions (recently got a referral to see a neurologist for this). Guillan-barr episode in October 2020 due to an insect bite on my neck. Paralyzed from the neck down, was in the ICU for a week for precautionary reasons but never needed a ventilator. GB isnt reoccurring and not on any medications for it. ADHD (along with depression and anxiety) and PTSD.Humira bi-weekly for uveitis. Eliquis 5mg twice daily. Falmina (BCP). Prazosin for PTSD (nightmares). Cymbalta for depression. Vyvanse for ADHD (not taking currently due to concussion and PE. Vyvanse makes me extremely tired and Im already tired from my PE so I dont want to make myself even more tired). Pred-forte eye drops for uveitis (SIG changes constantly, currently on twice daily in both eyes).Extremely light drinker (last drink I had was sometime in September). Occasional marijuana use for humira side effects and pain (~4 nights a month). ###Output :PEs are like car wrecks. Some are horrible and kill you instantly, more often they are a semi big deal, and a lot of the time they happen and are lame but you werent really at risk of dying on the spot. But regardless, if you tell someone youre in a wreck theyll gasp and ask if you were ok.Sounds like you had a small subsegmental PE which as you said couldve been provoked by your medication. Take your eliquis which will prevent new clot formation and your old clot will dissolve with time


###Input :male/ 37 years old/ 230lbs/ 6 feet tall/ non-smokerI've had chest pain since my late-20s. For about 12 years, I've had high cholesterol due to a rather poor diet. My total cholesterol is "borderline" high according to the ranges, at around 230 mg/dL, my LDL is usually around 160 mg/dL and my HDL is around 50 mg/dL. My blood pressure is always pretty good at around 115/78.Due to the chest pain not going away, I was sent to a cardiologist who did a whole cardiology workout: echocardiogram, loop monitor, EKG and a calcium CT scoring test. Everything came back fine and my calcium score then was "Zero" , which the cardiologist said is a perfect exam.Since then, I've been diagnosed with a hiatal hernia and anxiety. I've started Zoloft, which has made my chest pain 85% better. I still get it at times, and my doctors are convinced it's my hiatal hernia creating pressure in my chest and/or pushing on my vagus nerve.Fast forward 6-7 years to today, I just really started getting my diet in gear about 2 weeks ago but just at that time before I started, I wanted to get a baseline blood work to compare. My cholesterol was the same as it usually was for the last 12 years but my primary care physician said my C Reactive Protein is 5.5 mg/L , whereas when I had it drawn years ago , it was around 3.0 mg/L. He said "you really need to focus on lowering your cholesterol. That CRP could be due to your arteries starting to narrow and atherosclerosis starting to happen.". Would the calcium score test from 6 years ago change that much in that time?I am not "fat" and have really wide shoulders so I carry my weight differently but I know I should definitely lose weight and eat better, which I definitely have been. Hearing that my CRP is now high, I am worried that there is now narrowing in my heart. Should I go back to my cardiologist and see if I can have a repeat calcium scoring test or even a CTCA? ###Output :More than anything you need treatment for your cholesterol. Are you on a statin? Poor diet does not by itself lead to an LDL of 160 in a 37 year old.


###Input :thank you. I am not on a statin. My doctor said given the fact that I got my LDL down to 118 a few years ago when I tried eating more fish (salmon), he said I can do try the diet route again if I stick to it. He also knows I don't exercise much due to the pressure I feel from the hiatal hernia. ###Output :It is worth considering. While you are young your elevated lipids and hsCRP are enough to at least consider it


###Input :79M approx.. 6 195 lbs. asthma (we have no idea what meds he is on or prescribed at ER)My FIL (79M) was taken via ambulance to a small local community hospital on Tuesday and diagnosed in the ER with having had a TIA due to Afib. Heart issues is something that was unknown to them previously so he was not previously on any meds for that. My husband got up there in time to interact with the doctor at discharge and specifically heard the doctor tell FIL and MIL that he needed to take the meds he was being prescribed and see cardiology and neurology as soon as possible. This was a small local community hospital outside of San Diego but they are in an area with a large senior population where they probably see this a lot. My husband felt the instructions were clear and relayed succinctly.Because my own father has a long and fantastic experience with both cardiology and neurology at the large very well respected university medical center my husband asked me if I could make appointments for his father there as we figured inlaws were overwhelmed among other issues. I was surprisingly able to secure him appointments for this Monday and Tuesday respectively (6 days post ER visit). Husband told MIL that evening that appointments were secured for FIL at the university hospital.Now today my husband learns that MIL took FIL to their GP yesterday (day after he was released and before specialist visits) to their GP (whom my husband refers to as Dr. Quack due to his negligent care of his aunt resulting in her subsequent death due to melanoma so we may be biased here and this is why we are asking) told him he didnt need coumadin that he was just stressed and he just needed some Xanax to relax. So FIL told my husband today that he stopped the meds that ER doc overprescribed and am just taking the Xanax. I FEEL GREAT! FTR we have no idea what the other meds were and now they wont tell us.MIL is exploding at my husband and accusing him of a lot of wildly ridiculous things and FIL is trying to keep the peace and just shutting down. As a bit of background there are A LOT of issues with MIL and her behavior and this is pretty standard. Husbands basic rule is that we just need to prevent her from harming others and just tune her out otherwise. So our question is will this change of meds harm FIL and husband needs to intervene more strongly or is this something standard? TIATLDR: is it medically acceptable for a GP to remove someone from blood thinner (Coumadin?) less than 48 hours after a TIA and replace with Xanax even before they have seen cardiology or neurology?Edited to clarify timing ###Output :Everything here is just odd. No way of knowing what's what without the hospital records. Please be sure to take them with you to the neurologist and cardiologist.


###Input :Thank you for responding. Right now they are saying he is not going to cardiology and neurology because GP told him he doesn't need it. (again husband and I do NOT trust this GP and believe the ER). Husband had me call the university and make sure the appointments cannot be cancelled unless they call my husband's number. Our question is will he be fine like this until Monday or should husband intervene with the nuclear option and go collect FIL when MIL is out and take him to urgent care? ###Output :Unless FIL is cognitively incompetent, they should be able to make their own decisions. They have all the information from the ER and GP to go on. This is a complicated situation and your question is not answerable without more detailed/nuanced information and discussion of pros/cons. Being on Coumadin is either a necessity or a huge liability (quite often both) depending on factors we do not know here on Reddit.


###Input :34 female 5'9" 230lbsNon drinker, light smoker but almost completely quit since the heart problems started. Had covid 6 weeks ago with no complications. No history of heart problems or high BP.It started less than 2 weeks ago with drops and spikes ranging from 90/60 to 180/110Now it's sustained high BP and elevated HR. I did go to the ER Monday just to make sure it wasn't something acute as there is accompanying chest pain but the entire time I was at the ER my BP was very low as was my HR.I have a cardiology appointment next Friday but every day since Monday I've been waking up with systolic in the 150s. I feel physically panicked all the time and it's starting to affect my sleep. I've already doubled my propranolol from 40 to 80, I take klonopin and prazosin daily as well, and I've added clonidine and antihistamines to also try to keep it lowered. Even taking all of those at once it barely makes a difference.I have a good life right now i can't think of any stressors other than being in love, but I feel like I can't do anything or be there for anyone because my body is fucking panicking 24-7 nowI can't do this much longer. It's obviously not an emergency but I feel awful not at all being in control of my body. It's like something flipped the fight or flight switch and it's stuck on high. This does not reflect my mental state at all. ###Output :How regularly are you taking the clonidine? That frequently causes rebound hypertension.


###Input :Age: 8Height/weight: Average, not sure exactly but last i was told, she's within normal rangeFemaleCaucasian/ HispanicNo previous medical history, no prior surgeriesnon-smoking householdWe all had covid in December 26th. It was rough but we all recovered. Me and my husband were vaccinated. My kids weren't because their clinic wasn't providing the vaccines yet.I'm going to try to be thorough as possible because it's just so much going on with her and i don't know where to start and her symptoms are all over the place... Last summer she was in someone's house that had a rabbit. The rabbit was filthy and it scratched the top part of her hand. Her hand began looking infected because even though i washed it and put neosporin on it, kids are kids and she couldn't keep it clean and soon it began looking red. She got a fever roughly around that time and was complaining of headaches and that her "throat feels tight". I took her to her clinic and they drew blood to test her for "rabbit scratch fever" It came back negative..They figured she just caught a virus and nothing became of it. The scratch eventually healed with an ointment they gave her. That same summer she..again...being a kid, didn't listen to me and was rolling in grass in her grandmother's yard which we have found ticks in. She ended up with a tick in her head which by the time we noticed it amongst her hair was engorged. I pried it off her. My daughter again, began complaining of headaches and her body hurting, "tight" throat. I took her to the ER and had her get tested for lyme disease it came back negative..It's now almost a year later and her headaches "tight throat" and body pain just come and go sporadically. I would chalk it up to growing pains which is what everyone was telling me. Her doctor never seems concerned...But sometimes the headaches are so intense she will cry and lay down and ask for a cold towel for her head...she's 8. And now on top of it all she's got new symptoms. She came to me about a week ago saying her butt felt weird like it had "dots". I tell her to show me and all over her butt and upper thigh area she is covered in what look to be pimples. Its so odd. My mind automatically went to "bed bugs!" So i checked the beds from top to bottom but found nothing. She still has trouble sleeping some nights and comes to sleep on our bed so if it was bed bugs why is she the only one with the dots? I'm checking her daily and it's as if she's got a new "pimple" everyday...again, she's 8...wth..Another new symptom she has is she's been getting heart palpitations. One minute she's playing on the floor or on the sofa, and the next she will come to me saying her heart is beating rapidly. I put my head on her heart and i feel her heart beating quickly. It scares her and i have to scoop her up and hold her for a while. She has also started hypervenilating when she's upset. Something she's NEVER done in her life. We aren't strict with her and she's a happy child, why would she start doing that? She says she can't help it.I took her to her doctor roughly two-three weeks ago because i had enough, i told her doctor everything from the summer to now. From the body pain to the heart pain and showed him her butt pimples and asked him to please help because we are at our wits end. He checked her out and said her heart sounds fine to him. He also was dismissive towards her skin problem. He did however notice the lymph nodes around her neck were really swollen. He ordered her to get blood work done and it came back last week. She has covid anti-bodies in her blood. She tested negative again for lyme (im guessing he just wanted to double check in case the other one was a false negative) and showed what he thinks might be her in "Recovering" state of cat scratch fever? ...ok? We have cats so i guess that's possible. He sounded so unsure with himself. Sighing a lot and kept going "eh...i don't really know what to tell you..." and stumped with her blood work. He sent her a prescription for Azithromycin just to be safe. She has to take this every day after dinner.Thing is, she's still complaining about her various symptoms. And it's been days since she got the medicine and now she's more frequently telling me her hearts beating quickly. So im afraid to continue giving her the medicine in case that's whats causing the palpitations. I have sent various messages to her doctor two days ago but he isn't calling me back. I'm tired of waiting for him and already went ahead and made her an appointment for both pediatric cardiology and dermatology. I also found a new pediatrician because i've had it with this guy. Both appointments are next week. But until then i'm just a bundle of nerves. I hate when she comes to me saying her heart hurts or her head hurts. Can anyone here please tell me whats wrong with my baby girl?Edit: were at the ER now. She started complaining of heart pain and palpitations and Im done waiting. Will update depending on what they say ###Output :Time for a new doctor. Its not typical for 8 year olds to get heart palpitations


###Input :Yes, but I was just told by a pediatric cardiologist that this is happening with children who had Covid and were t vaccinated. Im going through similar with my 8 year old.Edit: werent vaccinated, not were.The reason I stated what I did and kind of barged in here to comment was just to bring light to this issue.Theyre monitoring her for now. They had to her a holter monitor for a few days, then some testing. She was fainting and her lips were turning blue when she would have her palpitations. I also have them and get dizzy but never blue finger tips or blue lips.I hope all ends up okay. I know how scary this is for both of you. ###Output :How long does it last? If it lasts 15+ minutes, it might be worth your peace of mind to get her on a monitor in the ER. If its only a few minutes then she probably needs a holter monitor or evaluation with a pediatric cardiologist.


###Input :29F, non-smoker with history of NSVT. Diagnosed in 2011. NSVT was then changed to PSVT in patient records without my knowledge until recently.Diagnosis would present with palps, lightheadedness and tunnel vision. It occurs randomly with no clear trigger.I had a new holter applied for rapid pounding heart with dizziness and angina.Holter findings were reported normal with low burden PVC and sinus tachycardia. (sinus tachycardia is expected culprit for rapid heart and associated symptoms)However, VT was also noted?https://imgur.com/a/S2rMmmEThe comment states AIVR. And Im just curious if this is actually AIVR or PSVT? Or something else entirely.I do have an appointment with Cardiology in a few weeks. ###Output :Characterized as AIVR because rate is <110 with widened QRS.PSVT is usually in the setting of tachycardia so rate goes from normal to very high. Had a few more beats (like those shown) at a faster rate happened, it may have been called PSVT.


###Input :That makes sense, thank you!Do you know if PSVT and AIVR have a habit of appearing hand in hand? ###Output :Not typically. My best guess is this was a small run of soon to be PVST that corrected before becoming tachycardic.


###Input :29M 62 181lbs Hypertension (20mg olmesartan qd) and recently recovered from mild COVID infection, otherwise no significant medical hx. I do also take melatonin nightly and use an occasional ginger root supplement.I was on a beach trip over the weekend and we stopped to grab some brunch around 10am before my girlfriend and I drove back home. I drank a cup of coffee at brunch, and felt a skipped beat kind of feeling, so I took an Apple Watch ECG. To my surprise, I noticed that I was popping anywhere from 2-10 PVCs/minute, which I have no history of.I rode it out on the way home and tried to forget about it. I took a few more random Apple Watch ECGs, and the frequent PVCs have been consistent all day. Finally a little after we got home, I decided to go to urgent care just to get seen. They did an ECG, which didnt capture any PVCs on the 10 second strip of lead II. But the NP said she auscultated a few after they took the ECG. Confirmed on my Apple Watch theyre still happening.The NP basically told me shed give me a cardiology referral and to do nothing in the meantime, but to go to the ER immediately if I started having any chest pain or SOB. She basically said that there was nothing she could do in the urgent care setting and that I need a further cardiology work up.Is this solid advice? Am I safe? Or do I need to go to the ER? Besides the initial skipped beat feeling, I havent been symptomatic at all.I will also say, I had a good bit of alcohol this weekend, more so than usual. Could it be alcohol and caffeine?12 lead ECG from urgent careApple Watch strip with PVCs ###Output :Yup wait to follow up with cardiologist. ER if SOB or chest pain. Caffeine and alcohol can certainly contribute


###Input :40M 5'8 160 pounds. As part of my team of doctors (3 cardiologists, primary care doc, endocrinologist, neurologist, etc.), we've been hunting down some autonomic issues that I have been having. I haven't had blood work in a couple of years because I have been pending Disability since last year and had a work injury the year before that. My autonomic issues worsened over that time.If TLDR, can a Cardiology office request the same type/amount of blood work as a primary care doc, for instance?I don't have a primary care doctor presently because I had a good one and he moved away back to his home state a while ago. Most primary care doctors are unfamiliar with specific autonomic dysfunction conditions, so my third cardiologist is the specialist in autonomic issues. They want to do blood work. Of course, I'm asking their office what kind of blood work they can do, as well. But since it may be days before they can get around to that general question, this is a two-part question:I'm wondering if any doc can explain the difference between which offices (primary care, cardiology, endocrinology, etc.) can do what types of blood work and if they are 'limited' in what types they can request.Also, is that that limitation solely based on the provider themselves being medically unable to request beyond specific blood work related to their specialty or is it just because they're not familiar with other blood values? For instance, I asked my neurologist one time about blood work values from a cardiology tilt table test and he said he "didn't know how to read those blood gas levels". So that told me that of course that's not his specialty, and I knew that, but he was the one who asked about blood work to begin with. ###Output :Any doctor can order any kind of blood work, but the limitation as you've found is the ability to properly interpret it.


###Input :Im 20F with a long standing family history of heart failure. Ive had intermittent chest pains due to chronic Tachycardia but last night it was unbearable and I went to the ER because I thought I might be having a heart attack. I waited approximately 2 hours after initial onset to leave work bc another manager needed to be present. My mistake but I eventually shut down the store out of fear and went. My ECG was flagged abnormal for nonspecific T wave abnormalities on the inferior leads. But thats always on my ECG. However the hr recorded was 72. My avg resting hr is 98. Could I have had a cardiac event that ended before I got to the hospital? negative D Dimer low average Lactase and high PT (12) and PTT (54) INR 1.1. Chest X Ray clear. Should I push for a cardiology referral given family history? or was it likely a fluke? ###Output :>Should I push for a cardiology referral given family history?No, they would probably decline the referral given your normal investigations.>Could I have had a cardiac event that ended before I got to the hospital?Incredibly unlikely.Also:>Ive had intermittent chest pains due to chronic TachycardiaI doubt these two things are related.


###Input :34, male, 5'9", 260lbsnon-smoker, rarely consumes alcohol (1 or 2 a month, if at all), tried a friend's THC vape once, no other recreational drug use.medications: effexor 150mg, concerta 54mg, advair 2 puffs daily, albuterol rescue inhaler as neededhealth conditions: anxiety, depression, ADHD, moderate asthma (all very well controlled on current meds)medical history: knee surgery 2012, initial 2 COVID vaccines March and April 2021 + booster November 2012, had COVID February 2022.Background of Current IssueHad a mild case of COVID-19 in February. Main symptoms were swollen lymph nodes on the left side on my neck and armpit and frequent heart palpitations.Symptoms went away until April, when I started having sudden heart palpitations randomly throughout the day. When the palpitations end, my the same neck and armpit lymph nodes swell up painfully for several hours.Symptoms got bad enough that I thought I was dying and went to the ER. Not dying, just something that can happen post-covid. Minor abnormalities on ECG, Doctor explained why they weren't concerning in my case.After a couple months of reducing caffeine intake as much as possible ( about 2 cups of coffee before work, no more canned coffees or caffeinated tea at work), it seemed to have gone away.About two days ago, it came back. Didn't recognize the symptoms for what they were and went to the ER again. Slightly different abnormal but not concerning ECG. Blood pressure was high, went back down to normal by the time I was discharged. Negative COVID-19 test. Same left side lymph nodes painfully swollen.My Question for AskDocs:I plan to see a cardiologist about the heart palpitations since they have been so frequent after coming back.Is there any other specialty that might be able to help me? Or would making sure my heart is okay be enough? ###Output :Cardiology will handle the palpitations.Without seeing your ekgs I can't tell you much more. There are many causes of palpitations, if the ER discharged you then the palpitations we're probably due to PACs or PVCs which can be treated by your PCP or cardiologist to reduce your symptoms, but like I said, can't say much more without the ekgs or more info.


###Input :Age: 21. Weight: 160. Gender: male. Height: 5'7". Diagnosed with asthma.I had a cardiology appointment today. I was told that I had a heart murmur and I had a bunch of tests scheduled..the soonest being A WEEK OUT. With my echo being months out. Seems like a heart murmur could easily kill me. What's up. ###Output :Many heart murmurs are caused by non-life threatening things. Unless you are having signs or symptoms of life threatening things (passing out, chest pain, severe shortness of breath, etc) doctors will investigate things in an outpatient setting. For example, most cancer work ups (arguably more life-threatening) are done in an outpatient setting.


###Input :Mandatory info: 30M, 6'3", 185lbs, white, near syncope with heart pains for the past week, EKG abnormality. Don't smoke or use any recreational drugs, have used Ambien (5-10mg) to treat insomnia intermittently for the past 3 years. No preexisting conditions.Last week I had back-to-back instances of severe chest pain, followed by a hot flash / sweating and dizziness that persisted for about 60s. This occurred at the airport, and resulted in me getting transferred to the ED for evaluation. Paramedics conducted a few EKGs, and I heard them say there appeared something anomalous with "B3". At the ED, had an additional EKG, chest x-ray, and ultrasound with no acute findings. No bloodwork done. Cleared to fly, completed my work travel, returned home with a PCP appointment scheduled for this morning. The intermittent pain / palpitations / weakness / dizziness has persisted since the first episode.At PCP visit today, another EKG was done and compared to my past EKGs done at that office. My primary found an anomaly in Lead 3 (which I assume is what I misheard the medics identify), and ordered bloodwork (troponin and lipid panel, amongst others). Gave me an urgent referral for cardiology, wants me to get a Holter monitor and stress test at a minimum.My question for all you wonderful people: what is the pathophysiology that leads to an anomalous Lead 3 finding on an EKG? How worried should I be? ###Output :Impossible to say without seeing the ECG and exploring. Lead 3 (in conjunction with others) corresponds to the inferior portion of the heart. But there are many things that could be showing in this lead on your ECG.


###Input :F30. Ive had these transient episodes of PSVT for some years now, following an Epstein Barr infection when I was 22. Ive had a cardiology referral before, with a 3 day monitor. It caught nothing, so they diagnosed me with Anxiety and sent me away with a low dose of Propanolol if I wanted it.These heart episodes are making my life a living hell. They are destroying my relationships and my ability to function in my daily life. I used to work, but now I dont. Ive had to give up my job because I couldnt cope with the interrupted sleep (they specifically wake me up from a sound sleep, usually around 3am). This is obviously very frustrating for both myself and my partner.Went to ER with chest pain after the last episode, and the ER doc wanted to get me a 21 day heart monitor - which would definitely catch it as my episodes appear in clusters, a few times a month. There appears to be a hormonal component to it.Ive completely cut out caffeine but the effect that has had on it has been minimal.Now, the NHS is saying that they will refer me to cardiology when my anemia is sorted. But, its never sorted - at least, not without iron infusion therapy (I have IBS and dont tolerate oral tablets well).I did have an iron infusion months ago, which picked my Hb levels to no longer anemic - but didnt get the referral then either. On the contrary, I heard nothing from my GP, for months, and now Im back to being anemic again - its so hard to maintain my iron levels without routine IV iron, and the only time I get it is if Im in hospital for another reason (last time was Gynae related).Im beginning to lose hope that this will ever be resolved and worry that Im just going to drop dead of an unidentified cardiology issue.Is there any way I can get the cardiology appointment and have my cardiologist take me seriously instead of attributing it to anemia like last time, because my resting HR is 60bpm, these SVT episodes are a very distinct and immediate jump to a hr of about 170-200bpm, and they arent anxiety related at all. They also definitely arent anemia related because even when I am no longer anemic, I still get them. Twice monthly, around the times I ovulate and right before my period. Predictable as clockwork.I just want them to stop because they make me afraid to sleep at night and as a result I have developed pretty terrible insomnia, and depression due to the constant fear of wondering if something is severely wrong with me. ###Output :I dont understand why you had to give up your job if they only happen twice a month like you say? Do the beta blockers work?


###Input :I was training as a student nurse, but the stress from this has been too much for me to cope with tbh.Im reluctant to take BB because my resting heart rate sits at 60bpm, and tbh theres nothing wrong with my resting hr. I would prefer to have an ablation than take daily unnecessary medication for the rest of my life? ###Output :Im sure the cardiologist assessed your pulse before giving you beta blockers, have you tried them?


###Input :That was when I was 25, and Im 30 now, so its been a while since my last cardiology review (during which time these episodes have gotten more frequent and last longer) and the cardiologist hadnt ever actually seen an ecg tracing of this issue, which I think is a pretty important piece of diagnostic information. Id personally advocate for my patients that abnormal ecgs are reviewed, so why not mine?Ill ask my GP about trying a low dose BB, but I dont expect it to do a great deal other than lower my BP a smidgen. ###Output :Id be surprised if a cardiologist ordered a 3 day monitor without reviewing an ECG first.If I was you Id go back and take the beta blockers, give them a go. If they fail then go back and say I did what you said doc whats the next steps. The outcome will either be finding a treatment that works in primary care or youll be referred back to cardiology.


###Input :I have also been having infrequent runs of (possibly) SVT, which also seem to be hormone related, although Sods Law they have never appeared when hooked up to hospital machines, only a 6 lead home device.I also have a resting HR of 50-60 but have found beta blockers insanely useful. I take a super low dose of bisoprolol and it seems to be just enough to stop my heart going into these fast rhythms but not so much that my heart feels too slow. I was sceptical at first too, but Im glad I gave it a go. I drink a tin of coke each day and take stimulant medication and I will only get a brief run of SVT once in a blue moon. Whenever Ive stopped the beta blocker the issue has come back so it must be doing something.I hope you manage to get to the bottom of things and find a solution! ###Output :Meds are helpful as mentioned and usually pretty well-tolerated unless you have AV block or hypotension.Depending on frequency, length of the episodes and preference cardiologists generally use either chronic preventive therapy with a beta-blocker or calcium channel blocker, or pill-in-the-pocket with flecainide or beta-blocker. If you have a favorite vagal maneuver those can sometimes work too.These are very rarely life-threatening. Ablation is effective but can't help you negotiate the NHS system. Fixing the iron deficiency will also help. Our hematologists do have some patients with chronic iron deficiency anemia who can't catch up with oral supplements who have scheduled IV infusions, but only after every possible source of ongoing blood loss or iron malabsoprtion is addressed (celiac, heavy menses etc).


###Input :40M 5'18 160 pounds. Over the past few years, some weird symptoms either developed or got worse. I was lightheaded back in 2018 and a neurologist found nothing wrong with me. Late December, symptoms sent me to the ER with elevated blood pressure, white blood cell counts at 14.5, stomach and intestinal pain, rapid heartbeat, etc. My heart rate and blood pressure rapidly fluctuate. My heart rate varies by at least 20 beats per minute from the base line. So I'm sitting and the base is 70, it will go 72, 75, 78, 80, 82, 85, 87, 90...88, 86, 84, 83, 0, 78, 75, 72, 70 and sometimes do that whole course twice in a minute. I am not known to have ever had Covid and I am presently fully vaccinated, as well.Over the past few years, I've been seen by primary care, neurology, gastroenterology, endocrinology, had head/abdominal scans with nothing noted, saw 3 cardiologists, wore 2 Holters for a month, had lots of blood work and such. Stress Echo via treadmill showed a healthy and strong heart.Diagnosis of Postural Orthostatic Tachycardia Syndrome by primary care, neurology and cardiology. Dysautonomia/autonomic dysfunction got thrown vaguely into the mix, as well. Tilt table test would have been negative for POTS. I didn't faint or have the rapid rise in heart rate. They gave my sublingual nitroglycerin and I fainted within a short time. BP went down to 97/56 and pulse to 40, possibly only because of the nitro. I am lightheaded 24/7. Even just lying on the bed at night, I feel little sharp "zaps" of lightheadedness. I'm familiar with BPPV and it's not that. The POTS no longer applies - I am rarely tachycardic. Also, my blood pressure is now more so low on a daily basis. For instance, earlier today it was 99/57 after a meal that was quite heavy in salt. I seem to always crave salt and can't seem to get enough of it. I am completely exhausted every day, have no energy and my entire body is hyperreflexic.I have hundreds of tiny little red bumps all over my upper and lower back and the backs of my arms. They do not itch. Back in 2020 an EGD showed an inflamed stomach lining with negative biospies. 6 months of Prisolec 40mg twice daily at that time didn't help. He put me back on the 40mg twice daily again. It was after that point that I ended up chasing the POTS/autonomic dysfunction stuff and had not seen the gastro doc since because I later lost my job due to a work injury. I just saw my gastro doc again recently. After reviewing my symptoms, he asked if I have ever seen an allergist. Then when I told him about the horrific lower colon pain that I get at times, constipation on average of 2-3 days at a time due to inflammation preventing a bowel movement, the feeling of inflammation and severe burning/clawing pain for hours even after a bowel movement and such...he feels that I may have something else going on in my colon. He brought up Crohn's and said it was sneaky sometimes. I showed him photos of my pie crust-like tongue that seems to swell at times and I get canker sores in various areas of the mouth and have for a long time. I showed him a photo that looked like I was pregnant - considerable lower colon swelling and abdominal bloating. Also, what makes me think some of my other symptoms like the low blood pressure and such may be related is because when I press on my lower colon area or rub it, my ears immediately ring and at times I get nauseous. There's no way that's a coincidence given how often it happens.I'm always hungry for big meals even after I just ate a big meal recently. I get considerable postprandial hypotension. I haven't worked in 2 years, pending Disability. Gastro doc requested CBC, Comprehensive Metabolic and Thyroid/TSH panels. All within normal range except the thyroid panel:T3 UPTAKE 24 Reference Range: 22-35 %T4 (THYROXINE), TOTAL 10.9 High Reference Range: 4.9-10.5 mcg/dLFREE T4 INDEX (T7) 2.6 Reference Range: 1.4-3.8TSH 2.25 Reference Range: 0.40-4.50 mIU/LThe only flag was the T4 Thyroxine and it's only 0.4mcg/dL higher than the highest normal reference range. All other blood work was fine. This reference range seems normal and also what is 'normal' seems to vary considerably depending on what source you compare it against.Severe burning/clawing sensation in the lower colon just below the navel. Worse at night, but moderate pain 24/7. Full-body malaise, jitteriness and rare spikes in blood pressure with full-body tremors as if freezing cold for 15-20 minutes. I get even more colon pain during this time and at times feel feverish. I have had unexplained blood pooling in my hands and feet since I was a teenager. Heavy nausea immediately after lightly pressing or lightly rubbing the lower colon area below the belly and middle abdomen. No vomiting. Frequent bright yellow or greenish stools with some worm-like mucus in them. No visible bleeding. Upper body jolt-like 'tics' that feel at times as if they are originating from the lower abdominal area and cause my upper body to jump randomly in certain movements. With the lightheadedness, it feels like even when I'm sitting or lying down an djust move one arm or leg, I get a brain "zap" of lightheadedness. What in the world could cause that?I'm trying to get a colonoscopy to see for sure. Due to low income, the Colorectal Cancer Alliance has me on a list for funding for a colonoscopy locally when it becomes available, quoting possibly in February when more programs open.What are my chances of Crohn's/IBD with the above issues going on? Could it also be the cause of my blood pressure and heart rate fluctuations? I'm puzzled at the normal white blood cell counts given that my lower colon was absolutely hurting/inflamed during the blood draw. ###Output :There's nothing here that suggests IBD, though that doesn't mean you can't have it.It's possible that you have IBD but your symptoms are pretty vague and not classically IBD


###Input :28YO female, healthy and an avid lifter. Referred to cardiology for heart palpitations and fast heart rate. Placed on 7 day heart monitor. Was told that I am in ST majority of the day. There were some skipped beats as well. Placed on toporol for management. Cardiologist said borderline concerned, due to how high my HR is. Said if it gets worse, things would change. These strips are from the Holter monitor report. ###Output :ST = Sinus Tachycardia. It means the heart is working down the normal electrical system, but its going faster than normal. Often there is an underlying cause (and not a primary problem with the heart), but sometimes peoples hearts just go fast and we need to slow them down with medications like your toprol.


###Input :Age: 36 years old Gender: Female Height: 5'4" Weight 160lbs Location: USA Smoking: Never Meds: xyzal 5 mg daily for chronic idiopathic urticaria and angioedema 200mg Zoloft (serteraline)I recently gave birth. I had pre-eclampsia with high blood pressure, protein in my urine, headache and chest pain. I was given an ECG, EKG, and chest x-ray while in the hospital. I was discharged a couple days later and they put a zio heart monitor on me for 2 weeks.This past Friday I had a follow up appointment with a cardiologist after my monitor results, the other tests, and one more ECG. The cardiologist told me (in a relatively relaxed and casual way) that I have a long QT interval and that can increase the risk of sudden cardiac death. She referred me to a geneticist who I'm waiting on for an appointment.At the time my brain stopped working when she said death but now I'm trying to gauge what is.me.being overly health anxious and what is justified worry. I am emailing the doctor but I suspect it willl take awhile for a response since it is the weekend.But given that I have no history of drinking, smoking, drugs, eating disorders, or any vitamin imbalances. How worried should I be?? Like should ainbe saying my goodbyes?! Or do I just ignore it and my life will be relatively normal??? I haven't had any fainting spells and I don't THINK either side of .y family has a history of SCD. But on both sides there is cardio history -- my maternal grandfather died of a heart attack and my maternal uncle has had a couple I think? My paternal uncle has had a heart attack and I think my paternal grandfather died from one as well? But that one I am really unsure about.Is this the sort of thing that everyone has and is NBD?? Or is this the sort of thing where I need to 100% commit to completely devoting myself to Cheerios and heart healthy choices if I want to live???I really appreciate any help or advice you can give. I really know SO LITTLE about cardiology it's like I don't even know what I don't know. ###Output :I'm sorry you're going through this. I don't think you need to say you're goodbyes at this point. There are varying degrees of prolonged QT intervals. Without actually knowing how prolonged it is it's hard to really guess. Depending on how prolonged it is it may be nothing to worry about but it sounds like you're in good hands with seeing a cardiologist and moving forward with workup.


###Input :Thank you for your reply.I feel so ignorant about how hearts work I feel like my brain can't even comprehend the risk or understand. I'm not a particularly stupid person but this is all just beyond my capacity. ###Output :Don't feel that way! It's a complex organ and no one would expect you to fully understand. You should reach out to your cardiologist and just see if they can explain it better to you, that may be helpful before seeing the geneticist and answer some of your questions.


###Input :F49, 55, 143 lbsI had a severe allergic reaction and I almost died on Tuesday. I got stung 2-3 times by a yellow jacket while cutting the grass. I came inside to get some Benadryl and saw all these black spots (probably 4 minutes later). Then I was profusely diaphoretic, dry heaves, had copious amount of phlegm from my mouth and nose, couldnt breathe, weakness and was blacking out. It was so so fast.My husband (hero #1) happened to be coming from the airport so he called 911 and My 13 year old gave me one of her epipens in the thigh (she is anaphylactic to shellfish and buckwheat). First responders came (maybe 4.5 minutes) and I couldnt open my eyes, they put me on a blood pressure monitor and then it was alarming, so they turned the alarm off. Then advanced life support I think or Ems literally picked me up and ran me out to the ambulance. I think I blacked out and woke up and I barely remember the ambulance ride with sirens and lights and them laying on the horn. I could hear them saying we got gotta get her pressure up, we got nothing here. I remember trying to talk to them and my tongue wouldn't work. When I was conscious and realized the lights and sirens were on, i saw the seriousness. When I heard them say ETA 3-5 and BP of 40/20 - I 'm like , that's not compatible with life. The paramedics worked on me the entire time. At hospital had me in a trauma room and called all staff over loudspeaker. Thankfully they got my pressure up and gave me another epipen and steroids and Benadryl. The epipen and lack of blood flow gave me some cardiac issues and Im following up with cardiology.That said, I dont feel right. Im weak. I keep waking up with nightmares about not being able to breathe and I keep replaying the incident in my head. I have little appetite. Do you think I would benefit from some counseling? Did I almost die? I feel like I certainly came close. Would I be a candidate for venom therapy? I feel like this if my only chance at a normal life.Is there any way I have some sort of Mast Cell Disorder for this to come on so suddenly? ###Output :Sounds like a pretty traumatic experience and I'm sorry you had to go through that. It is normal not to feel completely yourself this quickly after such an event, and it may take some time to feel back to normal again.Medically, it is good that you have recovered. I must emphasize you need to have an epi-pen with you at all times in the event you do have another sting at some point. The strength will come back. It's hard to tell how bad off you are, but can say a BP of 40/20 is pretty bad.Counseling is up to you. It sounds like you are having an acute stress reaction to a traumatic experience (think PTSD, but happening essentially immediately after). This may improve on its own, or may need some help to get through.


###Input :Sorry to hear about how much has happened to you in such quick progression  I can imagine it was and continues to be very jarringBased on your description and recollection of the events, you went into severe anaphylactic shock which likely would have been fatal had your husband/daughter/EMS not been around. Will reiterate what has been said already to keep an epipen on you at all times moving forwardOnly other thing Id add to whats been said is you likely may be a candidate for venom therapy. However, it sounds like theres still quite a few things going on so take it one day at a time. Once everything else has settled, you may want to consider connecting with an allergist to receive venom testing  in Canada the 5 main sting tests we do are on honeybees, wasps, yellow hornets, yellowjackets, and white faced hornets. If you test positive for a stinging insect, venom immunotherapy can be 98% effective for the rest of your lifetime. That being said, its not cheap, and it can take 3-5 years of injections at the very leastWishing you all the best in your recovery! ###Output :In reference to your last sentence - your mast cells must work normally for you to get anaphylactic shock in the first place, the issue is that your immune system is sensitised to the venom in the sting. Given that there is no definite way that you can guarantee avoidance of the same allergen in the future you should be referred to an immunologist for consideration of a desensitisation program


###Input :Could a Physician clarify as to why Cardiology have told GP to omit Ramipril until blood tests and ECG have taken place.34 year old male BP 160/110 (Schizophrenia/Meds Olanzapine/Valproic Acid/Citalopram)GP prescribed Ramipril 1.25mg, he started to take though 6 days later a call from the surgery saying omit Ramipril until above has been done. Booked for 2 weeks time, but has left (my son) with no BP moderation. Very worried as seems so high! ###Output :Your doctor will likely be able to answer this question in much more detail, but often before starting an ACE inhibitor (which ramipril is one) it's important to make sure a patient has normal/stable kidney function and potassium. A blood pressure of 160/110 isn't imminently dangerous, no reason to make hasty decisions.


###Input :Im a 40(F), 410 and 113 pounds. I was diagnosed with hypertension in 2018, its been u fee control with Lisinopril HCTZ 20-12.5 with no issues. I was diagnosed with ADHD in December 2019 and put on methylphenidate 20 mg(2 in the morning and 1 at 1:00 pm). I always checked my blood pressure around lunch to make sure it was t too high, I never had an issue. I was diagnosed with Hashimotos last October and started seeing a functional medicine doctor last December. I was put on NP Thyroid 30 mg, moved up to 60, then doubled to 120 by June. I have had labs drawn every 3 months since December. I felt really good until around the beginning of August. My TSH was <.02 but T3 and T4 were in range so she reduced my medication to 105 mg a day.Since I was checking my BP for it being to high, I didnt realize it was going down. I happened to miss my afternoon dose of the methylphenidate and my nephrologist commented is was a little low. This was the last week of August. I had some scans done by my cardiologist the next week. I mentioned my fatigue and she suggested I stop the methylphenidate for a few days to see if that helped and to follow up with her in 2 weeks. The next few days my BP just completely went down, I ended up in the ER twice because of it. The did CT scans the first time I went and I had kidney stones. The second time I went, they though it was a kidney infection. I went back in the methylphenidate because it kept my BP up. I followed up with my cardiologist. She said everything was fine cardiology wise and to continue to take the methylphenidate without the lisinopril until I could find out the cause for the drop.At this point a reached out to my thyroid doctor to see if anything thyroid related could cause this and she said no because usually signs of over medication is high blood pressure. She said to let her know what the urologist and nephrologist said.I made an appointment with my urologist and he did a cystoscopy and ureteroscopy based off the CT from the ER visit but he found nothing wrong and no stones. The nephrologist also found nothing wrong.So last Wednesday, I finally get her to run my TSH, Free T3 and Free T4. I got the results back yesterday. My T4 is in range. TSH is <.01. T3 is 5.3. I ask about T3 thyrotoxicosis and again she says that would cause high BP. She wants me to not take my thyroid meds for 2 days then go down to 90 mg.This has been going on for 2 months. The constant up and down with my BP has me struggling. My vision is getting blurry. Im exhausted. Do I wait it out to see if what she says or should I go to the ER? ###Output :With hyperthyroidism, hypertension is definitely more common, but this is not always the case. In acute crises of hyperthyroidism, blood pressure can also be lowered, particularly diastolic. In general, I'm pretty sure the problem here is the interaction between the various medications you are taking. The thyroid medication is largely overdosed considering that TSH value, and has been increased quite randomly over the various months. Also, I am not a fan of NP thyroid, since adjusting the dosage is difficult with that medication. Until the TSH is in range, we can't be 100% sure thyroid is not responsible. Look for an endocrinologist.


###Input :Thank you. I was taking Jaimiess birth control until mid-July. The functional medicine doctor kept suggesting I get off of it to help get my hormone levels up since I was only on it to lighten my periods. From what I read, the estrogen acts as an inhibitor for the thyroid medicine, which would explain why the dosage needed to be increased so much before it started working. Then I went off the birth control and the thyroid meds just went wild. I asked her if that could possibly be a factor but she said no. I am now also wondering if my hypertension was caused by the birth control. Hypertension runs in my family so I just assumed that was the reason. I had no idea birth control could cause that. Im looking for an endocrinologist but the 6 Ive called, with good reviews, are at least 3 months out. Im debating if I should go back on the pill so I can get my BP back up for now, then come off of it under the supervision of an endocrinologist. My cardiologist said, shed rather it be high(obviously not too high) that can brought down with meds, than it be too low. I just know I cannot continue with the methylphenidate like I have. Again, thank you for your response. ###Output :Estrogen has an effect on thyroid function by altering the hormone-binding protein, but generally the problem is when you stop therapy or go through menopause. It is also true that the pill can increase blood pressure, but not so much that you go from hypertension to hypotension. The effect of the pill is modest. I think if therapies are the culprits, it depends more on the triad thyroid hormone-antihypertensive - ADHD meds . I don't think it's a good idea to start hormone therapy again just to control blood pressure, honestly.


###Input :My son 3 years old recently diagnosed with autism. He was sitting near me suddenly he started to cry but with very low energy. I looked at him and his face was blue. I quickly grabbed him and he fainted I put some cold water on his face and ran to the balcony to get some fresh air. Then his face turned to very white and he started to open his eyes then he fainted again, on my way out of the building he woke up and slowly got some energy back. I arrived at the ER Almost 30 minutes after this happened, they did blood gases tests and blood counts then after an hour they said all is good but I need to see a cardiology to make sure nothing is wrong with his heart. I took a look at the test results and I think there is something wrong and the tests were not ok. I uploaded a screenshot of the tests. TAM KAN SAYIMI = FULL BLOOD COUNT (Count or percentage) KAN GAZLERI = BLOOD GASES. What should I do now? TestsEdit: Now (after 7 hours in the ER) they gave him the 3rd "fever shot" in his serum. The heartbeat is now stable in 160s after being stable at 180s but it sky rocketed twice to 241 and 250 bpm and when he cries it goes to 200s until he comes doen. They say it may be a flu infection. ###Output :I believe one of those is chloride. It's a hair above reference range and is fine.The other two are oxygenated vs. deoxygenated hemoglobin. They appear to be applying arterial reference range values to a venous sample, making them look very aberrant. These are also fine.Lactate being slightly elevated is super common in kids also. Nursing often struggle to get good samples with limited tourniquet use, and the lactate is frequently a tad elevated.


###Input :Looking for clarification, are you recommending a tighter tourniquet to ensure a more accurate lactate level? I am a nurse... ###Output :No. Limiting tourniquet use as much a possible is best for lactate.


###Input :Okay thats traditionally been my understanding. I just wanted to make sure there wasnt some other thought process. Thank you. ###Output :No. Nothing in these labs is spooky.Has he had any gastrointestinal symptoms?"Toddler doing weird shit and passing out" is sometimes from intussusception, and we have a low threshold to do US looking for this.


###Input :37F, 5'7, 128lbs, Caucasian. Primary complaint is increased resting heart rate, palpitations at night that wake me as I'm trying to fall asleep and fatigue.Symptoms started 06/15/2022 with one severe episode of diarrhea. After that I was feeling very fatigued. On 06/22/2022 I was very dizzy and almost fainted, my heart rate was elevated (120-140) and I had tingling/numbness in my hands and feet. Went to the ED. Only thing they found was a Potassium of 2.6, they said my ECG was "inline with my low Potassium". They gave me IV Potassium, Magnesium and saline. Got my Potassium up to 3.8 and sent me home.Three days later I had a similar episode and went back to the ER (I thought maybe my Potassium was low again or that maybe it was my heart). They did another ECG and said my heart was fine. Potassium was fine. No other abnormalities. ER doc said maybe viral or Thyroid.In the weeks after my ER visit I was still feeling very weak and my heart rate was still elevated (80's laying, 90's sitting, 110 standing). I was still dizzy. My stomach was destroyed, I couldn't eat without getting severe reflux and I just wasn't hungry. I thought it could be POTS. My symptoms were worse in the morning and in the evenings I felt almost normal.Symptoms slowly started to improve as I started breathing/meditation exercises and started getting back into training and eating. (I lost almost 10 pounds during this because I just couldn't eat).I then started to experience adrenaline surges where my heart would race, I would feel very jittery, nauseous and I would have to pee many times. At first the surges happened only in the morning, but later started happening at night. Only one a day. The surges would leave me very tired. I had very poor exercise tolerance.I saw my PCP and we ran many tests, CBC, BMP, Full Thyroid Panel, T3 and antibodies, H.Pylori, AM cortisol, Catecholamines, PTH, Heavy metals, MTHFR, DHEA serum, ACTH plasma, celiac panel, Homocysteine, CRP, 25 hour Urine Catecholamines and Metanephrines, Folate RBC and serum and B12. The only "abnormal" tests are below:Alkaline Phosphatase low 32 (this has always been low for me).High epinephrine 67 (I was having a "surge" that morning, I am not afraid of blood draws).Heterozygous C665C MTHFRHigh am Cortisol 21.2 (I was having a "surge" that morning, I am not afraid of blood draws).DHEA 686 (she said it was normal but it seems high for me based on my age).24 hour urine Normetanephrine 122 lowFolate RBC 1248 (for context)Folate serum >20 (for context)B12 852 (for context)Background information: When this all started, my husband and I were trying to conceive and I had been taking 800mcg of Methylfolate to prevent neural tube defects since May. The day I ended up in the ER was the day I got my period. I thought that maybe, based on my MTHFR mutation, I had a bad reaction/poor tolerance to the Methylfolate so I stopped taking it 2 weeks ago. My symptoms seemed to align with too much Methylfolate, based on other peoples reports.My biggest complaint now is the palpitations at night. I keep getting jolted awake several times as I am falling asleep. This lasts an hour until I fall asleep until morning. Palpitations are felt when I am lying on my side and sometimes when I lie flat on my back. I have headaches off and on and still feel like something isn't right, like my body cannot relax. I also get this feeling of pressure in my head. I don't have any shortness of breath except for when I am jolted awake at night.I am not an anxious person thought I am certain these issues have caused worries. I am active (strength training three times a week, assault bike workouts and lots of walking/hiking/paddleboarding). I do Olympic lifting for fun but haven't gotten back to that yet. I eat paleo-ish, low carb, Weston A. Price though I am trying to incorporate more carbs into my diet. I take Magnesium Glycinate at night, probiotics, Vitamin D and Cod Liver Oil. I practice good sleep hygiene. I don't lead a stressful life. I have a cardiology appointment at the end of August.Any input would be greatly appreciated as I have already spent so much money on all this, I need to be efficient with my resources.Im thinking that something really messed me up, maybe the Methylfolate combined with a stomach bug? I had COVID in January, maybe that has something to do with it. Will this likely resolve on its own?Thanks in advance! ###Output :I dont think methyl folate has anything to do with your symptoms. My hypothesis is that the first occurrence sensitised you and made you more introspective. Fear of something can cause tachycardia and introspection can make you notice your heart beat, where you previously wouldnt have noticed it.Relaxation exercises, especially breathing exercises and a distraction from your own thoughts via audio book or podcast might be helpful. 24h ECG could objectify your symptoms, but Im not sure thats a good idea. Maybe try it for a week or so and get back to me, if it doesnt help? Cant promise Ill immediately respond, but I check up on Reddit regularly :)


###Input :Fair enough. I am and have been meditating and doing breathwork. I will continue. Any hypothesis on why the first occurrence happened in the first place? ###Output :Hm, maybe its not really anything about your body changing, but your perception of it having changed. Concentrate on your belly button, for example. Normally, we dont really consciously feel the pulse there, but if you concentrate on it long enough, it will feel really strong. Its there all the time, but we only notice it, if we actively look for it.


###Input :I understand what you are saying, I just don't know that it's true. But, I will go with that theory and see what happens. Thank you for taking the time to reply to my post. ###Output :Neither of us know if its true. I only have your explanation of everything happening to you, there is no blood work, no images, no test results available to me here. Im trying to give you a direction to work in and my opinion based on the information given. There is a reason this isnt designed as an actual treatment or doctors visit, here :) That said, I hope you get well soon!


###Input :Well, here's my week update. I am definitely continuing to feel better. I told myself that whatever seems to be happening to me is not something that I need to worry about. I am continuing to do my breathing/meditation exercises 1-3 times a day. I am exercising daily (strength training, pushing the sled and riding the assault bike, usually 10 minute TABATA). I drink water with liquid IV daily, am eating well and sleeping well. I sauna every other day. My resting heart rate is still consistently elevated, about 100 - 110 standing. I used to be around the 70 range standing. I've only had one adrenaline surge in the last week. I do think that changing my state of mind has helped me avoid any extra stress but I do still feel like im not my usual energetic self. Like my body is working harder. ###Output :First of all,thats great to hear. In addition to that, a physical stress response, where your body constantly readies for fight or flight will sap energy from you. Are your palpitations still there?Your cardiology appointment isnt far now, that will hopefully help with stress, too, or maybe allow for more specific advice.


###Input :I'm(M17) 176cm(5'9) and 48kg(105 lb), my BMI is 15.5 and I'm REALLY skinny, everytime somebody sees me they get either scared or concerned, and at the beginning i said i was fine but now I really feel like I need help. We contacted many different doctors in my city(I live in Italy) and nobody knows what my problem is.. we(my family and I) did many exams looking for problems with metabolism and we got nothing, we were thinking to get my self hospitalized (as you know, it's free in Italy xD) but they asked us a kind of "hint" of what medical department(like "cardiology" i don't know if it's correct in English) i should go in, and our doctor told us he'd inform himself but didn't tell us anything.So my questions are, what could be my problem, what department should I get hospitalized in and in general what should I do?Any answer is appreciated and I'll try to answer every question ###Output :"You're not eating enough food" is the answer about 98% of the time.


###Input :Add a couple of glasses of sustagen/ensure and a few spoonfuls of peanut butter to your daily intake (in addition to everything you already eat), if you still havent gained any weight after a few months then I would see a gastroenterologist to check for malabsorption.Well, I'm not the 98% I eat enought I'm quantity and i get all the nutrients i would need, yet i can't gain any weight nor muscle. We've been struggling with his problem for a while and it's getting always worse.. i grew 10cm in about 1 year and a half while not gaining any weight, i actually lost weight. I get it that many people jump to that conclusion, but I'm 100% sure it's not that ###Output :How many calories per day are you eating?What brand of food scale are you using?


###Input :Don't know exactly, but I can estimate about 2.6k calories a day, altough some days it may be Less and some a lot more ###Output :Also, you can't say it's "100% not that" when you haven't ever measured your calorie intake.It's like saying your checking account is getting lower and lower and you don't know why, but you've also not looked at the math for your income vs. expenditures."You're not earning enough money for how much you spend."Nah, can't be that! I'm certain."Have you actually looked at you budget?"Nope.Unless you have some malabsorption disorder where you can't absorb nutrients (these people have constant diarrhea, gas, belly pain, and even oil in their stool), you just aren't eating enough calories.That's not enough.Young men, especially active young men, typically need 3,000-4,000 kcal to gain weight.Anything in the low or mid 2,000s isn't going to cause weight gain.This isn't a medical mystery. Eat more food and workout. You need r/gainit, not an inpatient stay (assuming no eating disorder).


###Input :Yes, but I don't think it should cause this much weight loss either, as well as the fast loss of muscle.I'll try eating even more as you told me.. even tho I'm still skeptical about it, as me and my brother eat pretty much the same things yet he's alright(skinny but not on the same level as me) ###Output :That's literally the only answer. If you've been evaluated for metabolic disorders, malignancy, etc, the only thing that will make you gain weight is eating more calories.Even moreTo clarify, mid 2,000s is not a lot of food for a teenage boy. If that's an accurate estimate at all, is not surprising you're not gaining weight. You're not eating a lot to start with.Eating the same amount of food won't make you gain weightEating less food won't make you gain weight.You must eat more food.


###Input :If I feel heart flutters about once a day, and cardiology tests come back normal, at what point do I need a medicine to prevent strokes? In other words, when, if ever, would it be time to go on Plavix or Eliquis?(Female, 55, no drugs, overweight, normal blood pressure, normal cholesterol) ###Output :The sensation of flutters versus having atrial flutter / fibrillation is different. Unless you actually were diagnosed with it, you do not need medicine for stroke prevention.


###Input :35F, 145lbs, 511 dont smoke, drink rarely. Generally consider myself healthy, however mid last year I underwent double jaw surgery and have since not taken part in any form of exercise and feel very unfit, but I still eat a well balance diet for the most part!After surgery however I lost over 20lbs in around 2 months and then gained it all back in the following 4 I had a hard time psychologically during recovery for a plethora of varied reasons and also unexpectedly became a carer for a relative who developed dementia whilst I was still recovering, this took a toll on mental health and I fell into a bit of a depression, I was prescribed Sertraline 50mg in late September 2022 however my mental health has VASTLY improved, it is my physical health that is bothersome.I also have a history of IBS and GERD (diagnosed over 10 years ago so is my normal but has slowly gotten a little worse over time).I reached out with no urgency to doctors for a health check as my generally sense of physical health felt at an all time low. I wanted to reassess IBS and GERD with focus on regular urgent diarrhoea (occasionally up to 6x a day), and regular nausea. Additionally I find myself easily very short of breath, dizzy and nauseous, and ultimately I feel weak. The disconcerting feeling this brings means I avoid any physical activity (historically I have enjoyed being more active). I noted that my heart rate has been falling lower and lower in the last 8 months since surgery and I am not physically fit at the moment. I feel slow. Maybe I am just getting old I was given a battery of tests and most of my bloods are generally fine, I have some deficiencies eg. Folate (which I queried as I dont drink and enjoy my greens) but was advised that some people are built different and need more vits or nutrients than others and I just need to take supplements  I assume this may cause some of my symptoms such as diarrhoea?I also had a 24hr Holter monitor and results came through yesterday. I havent seen them but doc noted 357 counts of bradycardia with lows of 37bpm. Coupled with my nausea and dizziness, I have an urgent referral to cardiology (although that still means in 3 months).However when I read up on Bradycardia, it doesnt seem to be a concerning issue? I dont have the full results but is it only the coupling of my nausea etc that makes it more concerning. Unsure if relevant, but despite low heart rate I often have slightly high blood pressure.Tldr: is bradycardia with nausea and dizziness worthy of urgent cardiology referral? Can heart issues cause additional symptoms such as regular diarrhoea?Also not sure if relevant, but I had a persistent rash and redness and deep itch in left breast for last 2 months, ultrasound shows I have lots of benign cysts and a fibroadenoma, they (radiologist and consultant) seemed unconcerned but did biopsy due to my age and I will get results soon, the lack of concern from consultant means I have little concern also (my mother has fibroadenomas that have never caused any issues), but thought I would add everything that ails me! Ha! In case there is some magical connection to it all.Thanks! ###Output :What is your normal heart rate? Was it sinus bradycardia? How long were these episodes in duration?. Also would be helpful to know any medications other than the SSRI and whether you have sleep apnea, have had Lyme or chagas disease or are hypothyroid.To he honest I would also be surprised if it is sinus bradycardia that it is causing your symptoms rather than vice versa. Nausea and bowel movements are an excellent way to temporarily lower your heart rate. Most often it is just a normal variant, and if it is sinus bradycardia almost never requires a pacemaker. Wouldnt get too overwrought.The downside is i there is no magical connection here to any issue other than maybe being a symptom of nausea, which isnt that magical.


###Input :Thanks for response! I take no other medication, however I did take antibiotics and omeprazole briefly post surgery last year. I cannot see the detailed results, ###Output :okay then what i said above i guess.


###Input :I have zero other health issue than those noted in my post, when I was very young I had migraines and I have always had dodgy joints (again Im getting older and runs in the family) and that is about it.I have never had any ailments you noted. When first diagnosed with IBS I was given lansoprazole in case I had an ulcer. But generally I have been in good health most of my life and taken little medication. Its just a bit cloudy all at once now I have reached my mid 30s  Blood tests historically are fine only regular things to note: I consistently have high bilirubin in liver blood tests but as the rest are fine this is usually noted as Gilberts syndrome? And again, not an issue. Cholesterol is teetering on high side but still currently in normal range. High but normal MCV in last few blood tests (~100)Im more concerned that I am not in need of an urgent referral and wasting time? But secondarily would like to know why I feel so rotten, and if it could relate to heart at all? It would be great if I could actually see the results and notes - I should call and ask for them and see if they will share! ###Output :I suspect that this is not cardiac related and it is incidental. But with your symptom of dizziness and bradycardia and your GP's concern followup is prudent and not a waste of time. "urgent" and "three months" don't seem to belong together.You certainly have symptomatic gastrointestinal disease, diagnosed IBS but some of the symptoms sounds like gastroparesis. I would continue to followup with gastroenterology for workup and treatment.


###Input :Hey guys,Today I had a pulmonary function test performed and results are mostly normal, which I expected. The only abnormal result is my FEF25-75%. The final value was 2.04, 64% of the expected reference value.I didn't have a bronchio dilator test performed due to palpitations, which I take beta-blockers for. Still being studied in cardiology.I didn't expect much to come out of this, because my GP suspects it might be exercise induced asthma. I wasn't feeling particularly bad when I had the test performed either.I experience chest tightness, wheezing, sob, air-way burning feeling and it hurts when I try to take a deep breathe. If I talk too much or laugh, I also get chest pain and cough.I have been prescribed Atrovent/Ipratropium bromide and it's so far the only thing that has helped me. It has taken me from barely being able to walk 40-50min, to walking 40-90min (usually 40-60) depending on the day without collapsing. ###Output :The FEF25-75 is the forced expiratory flow throughout the middle of your expiration. When we fully exhale our lungs are left with some air leftover (called residual volume, or RV on your PFT). This RV is there because as we exhale our small airways close down as the intrathoracic pressure rises above the intra-bronchiolar pressure -- it's a normal part of expiration. A lower FEF25-75 is thought to reflect early small airway closure, which could be a component of asthma (as asthma affects small airways).You'll notice I use a bunch of hedgy language (lots of "could" and "thought to"). PFT guidelines recommend against using FEF25-75 to diagnose or treat anything. The data just isn't very strong. The American Thoracic Society recommends not even putting the FEF25-75 on the PFT report. All that said, the FEF25-75 isn't entirely worthless, it just has to be interpreted with caution. If you have the right symptoms, a reduced FEF25-75, and a positive clinical response to bronchodilators it can be very reasonable to suspect asthma.If you have a great response to the inhaler, great, there's your answer. If not, it would be a reasonable time to seek an evaluation by a pulmonologist. Your goal should be feeling normal. All-too-often asthmatics will talk about having daily symptoms, which is a real shame. They either need more aggressive treatment or a different diagnosis altogether.


###Input :23F, 51 and 115 pounds, Asian. depression, anxiety, ptsd, adhd, taking 20mg adderall, 57.5mg paroxetine, 50mg welbutrin. i drank weekly in college but since ive left, i barely have. no weed either.I crashed my car a while back into a pole, but I have no idea how it happened - my memory is blank from me just driving on the road to me being in front of a pole, where i tried to break before i crashed. i dont know why theres a gap in the memory, but my pcp is suggesting i may have passed out or have had absence seizures, but she feels its neurological and not cardiological which is why Im seeing a neurologist in a week. i am just wondering if there are any ideas of what it could be / if i have any disorder. i know i didnt fall asleep as i have a pretty routine sleep schedule, but i just want any ideas of what could have happened to soothe my nerves. the car crash left me with a broken ankle and a friction burn, but nothing else. thank you in advance. ###Output :You need to be evaluated for potential seizures - that's why you're scheduled to see a neurologist. If nothing found there, probably worth getting some kind of cardiac workup.


###Input :Age: 28Sex: Non-binary/Female (she/they with a uterus)Height: 59Weight: 145Race: White/EuropeanDuration of complaint: N/A, 3-weeksLocation: New England USAAny existing relevant medical issues: Depression and anxietyCurrent medications: Wellbutrin (daily 150mg), Xanax (as needed, usually ~0.25mg/month)Hi Docs,This is a question about my spouse (she/they) in their late 20s and physically healthy. She has a panic disorder thats especially bad in medical settingse.g., took 0.5mg Xanax before their recent echocardiogram, but was still hyperventilating and crying throughout.Three weeks ago she was having some chest tightness, which we thought was from a workout we did the prior day, but wanted to go to urgent care just in case. Urgent care gave her an EKG (her first one), which had an inverted T wave in one lead (EditI think it was actually in two leads, EKG reveals sinus tachycardia at a rate of 117, T wave inversions inferiorly and laterally.). Along with the tachycardia (which always happens in medical offices, but goes back down to ~70bpm after) and they sent us (in our car, not ambulance) to the ER.ER did blood panel CBC/diff, some hormones, D-dimer in case clot, etc, all looked normal except for neutrophils at 82% (reference 48-76), then checked for fluid in the heart cavity with an ultrasound. ER wasnt concerned and sent us home with a cardiology f/u.Cardiology NP was worried about potential inflammation (e.g. myocarditis, as Ive heard has been a more common than usual in young women lately from covid, which we dont think weve had yet) so did an echo and a few more blood tests, including a sediment test, all of which looked normal.No chest pain or tightness or swelling other complaints since the ER incident.I dont have the full EKG, but herere the values they released to us from one lead:PR interval: 123ms QRS: 78ms QT: 318ms QTC: 443ms P Axis: 65 degrees R Axis: 69 degrees T Axis: -4 axis (was -36 at previous visit)Cardiology NP is concerned about the inverted T wave and wanted a cardiac MRI after the echocardiogram, but to me the T wave seems like an unconcerning variation in the absence of other symptoms. If I was the patient Id be fine with the MRI but, given how psychologically difficult an MRI would be for my spouse, Im not sure its necessary and want to encourage her to talk to her primary care doctor about her options.Based on the (of course incomplete) picture Im giving here, does my interpretation sound reasonable, or am I missing something?Thank you! ###Output :Inverted T-waves in V1 and V2 are normal.


###Input :Thank you! Yeah I just went back into the ER notes to check. It looks like it was two leads, not sure which ones (Thinking back, I think they circled the top right cornerlead 4?)From the ER Chart: EKG reveals sinus tachycardia at a rate of 117, T wave inversions inferiorly and laterally. ###Output :Would need to be able to see the EKG to tell more info.Are they still having symptoms?Could provide more info with: Troponin lab value D dimer lab Echo report


###Input :Thanks for the responseAh, that makes sensebummer that they dont provide the full EKG, I shouldve taken a picture. Ill update this post if I somehow get it.Theyre not having any symptoms anymore, aside from the anxiety.Troponin is <6 ng/L. D-dimer is <270 ng/mL.Echo summary: The left ventricular cavity size and wall thickness are normal. Left ventricular systolic function is normal. There are no segmental left ventricular wall motion abnormalities noted. The estimated ejection fraction is 60% The right ventricular size is normal. The right ventricular systolic function is normal. Normal valve structure and function.Reason for exam: eval in ED with CP x 4 days, EKG showed TWI inferolateral leads, trop <6, Dimer wnl, no history of Covid. Persistent tachycardia. Abnormal EKG Palpitations ###Output :Thank you. So labs and the echo are normal. TWI is not an indication for cardiac MRI. TWI in inferolateral leads can even be due to things like lead misplacement.I think it would be in your partners best interest to ask the ordering NP how the cardiac MRI would impact their care. If it's positive for myocarditis, what will they do to treat it? (The answer is probably nothing). If it is negative for myocarditis, what will they do to treat it? (Also nothing) Secondly, it could be in their best interest to discuss this test and their care with a physician.Gotta give you a disclaimer: My assessment and recommendations are based on the information provided and I have not seen the EKG, taken a history from the patient, or performed a physical exam. I don't want to sow mistrust and am not attempting to disagree with other medical personnel, since the ordering NP has performed all of these assessments.


###Input :40M, 5'10", 210 lbs, Caucasian, California.5mg Bisoprolol for arrhythmia, 160mg fenofibrate for high trigs, 300mg gapapentin for chronic thoracic spinal painHello. I'll try to keep this as short as possible as I know you're all busy.TL:DR - https://imgur.com/a/m5lprmBWondering if anyone can offer an opinion on this ECG from my implanted loop recorder. The loop recorder was inserted 1.5 years ago to investigate a an episode of sustained arrhythmia + syncope. I have a history of AVRT (ablated in 2006, possibly WPW, but that wasn't made fully clear to me). It seems something didn't go quite right during the ablation and the AVRT was eliminated but I developed frequent PVCs that were not present before the procedure. I have some documented NSVT from holter monitors and 30 day loop recorders over the past 10 years.My loop recorder seems to not be programmed to detect much of anything on its own. I think I would have to literally be in v-fib for it to automatically flag an event for review. After about a year of it literally capturing nothing despite having symptoms, I requested a patient trigger device that I can use to force the device to record and upload an event. Since I have started using the trigger, I have been able to capture several episodes such as this: https://imgur.com/a/m5lprmBWhen I look at this, my untrained sees a salvo of PVCs, which I guess technically defines NSVT. I have asked my doctor for an opinion on these events and every time his response is basically "Doesn't look like anything to me".What he doesn't seem to understand or appreciate is I find these episodes to be physically very uncomfortable and honestly, highly distressing, like hand over heart, feeling like I'm going to die sort of vibes. I admit that's probably a bit dramatic and an overreaction, but my cardiac history and long road to a diagnosis has trained me to think this way. Additionally, I am dealing with Kaiser Permanente in California and unfortunately, they have a rather abysmal reputation for cardiology and electrophysiology is basically non-existent.I realize there's people out there that have PVCs and other palpitations and barely notice them, but for some reason when I experience them, its like I'm getting punched in the chest.My hope is that someone out there can give me a reason why I should NOT be worried about these events. My doctor seems to be very, very, unconcerned by them, and maybe he's right to think that, but an explanation would be nice and if there's a way to be less frightened by these episodes, I think that should be considered therapeutic and part of the plan for care in this situation.Thanks for reading. ###Output :So first things first I dont see clear P waves and you seem to be slightly irregular. Do you have a history of AFib? Secondly the beats that you point out are wide but also irregular. This makes it less likely that they are PVCs/NSVT and more likely to be AFib with aberrant conduction if you have AFib to begin with. Since you have AVRT and have had ablation, its not unusual to have some aberrancy when the rate changes since you have an abnormal electrical conduction system thats also been burned. While this isnt life threatening in any way, increasing your bisoprolol dose would probably help keep the rates better controlled and decrease your symptoms. You can also get a cardioversion/ablation if you are actually in AFib


###Input :No history of AFib.I think the lack of visible p waves may have more to do with how the ecg is rendered with this recorder (very small), plus this is a screenshot of the report's summary, so maybe the actual report renders the morphology with better detail (I don't ever have access to that). For comparison, I have a 6 lead Kardia ecg device that is much clearer and shows clear p waves.This isn't the first time I've gotten a recommendation to increase the bisoprolol dosage but im a bit concerned about the long term side effects of that. I've already been on it for over a decade and I'm 40 now. However, after this recent episode, I think it's probably best for my sanity.Follow-up question. Does your opinion change knowing that I have never been diagnosed with afib, despite several doctors reviewing my strips in the past? ###Output :I think the answer no matter what is to increase bisoprolol.


###Input :Now I am off them in the past few weeks I have noticed mild chest pain and fluid retention in my legs. I have always carried weight in my legs but recently I have been needing to pee quickly after lying down at night. I can speed the process up by lying on the ground and putting my legs up against the wall to let it drain down them. I always get a lot of fluid when I pee when I do this, lots more that I should do. I know fluid retention can be dangerous with heart problems and Im getting quite concerned. I have a GP phone appointment next Friday but Im concerned Im not pushing for the right things fast enough.I also suffer from what I have always assumed was IBSI have been tested for Celiac, thyroid problems, absorption levels and all the standard things you would be tested for on the NHSI know that the heart problems could be caused by the low levels in my blood, but what is causing my levels to be low in the first place. Im really worried and really at a loss. Thanks ###Output :The history isnt convincing for anything heart failure related causing your fluid retention.What is far more likely is that its a side effect of your contraceptive pill. Fluid retention is listed as a common or very common side effect of your particular medication.


###Input :The history isnt convincing for anything heart failure related causing your fluid retention.What is far more likely is that its a side effect of your contraceptive pill. Fluid retention is listed as a common or very common side effect of your particular medication. ###Output :Often, but not always. Your physiology changes over time so sometimes you may start to see side effects that you previously didnt.


###Input :Cross from /AskCardiologyDetails to previously deleted post, dad had heart attack but refuses medical adviceI previously posted and deleted due to lack of details. My dad (56M) had a cardiac event two weeks ago that he refused to explain. Yesterday he invited me to dinner to explain his situation. He looks TERRIBLE, he is gray with the blackest bags under his eyes. He explained he was working out and suddenly had SVT bad enough to where he lost feeling in his body, his left arm turned blue and he collapsed (didnt lose consciousness) and couldnt get up for a couple hours. As a nurse, he 100% believes he had a heart attack. He stated he has been feeling ill for 6 months, had this event, and has not felt normal since. His cholesterol and triglycerides are insanely high and he knows he has hereditary atherosclerosis. He is very anti-doctor/pharmaceutical and is relying on a diet of nitrous oxide-rich foods and Willow bark to clear is arteries of plaque. He looks like a corpse and Im afraid he will die soon without medical attention. If he did have a heart attack, whats his outlook without treatment?Edit: he is not on any medications, works out twice a day, his father had triple bypass at 70. ###Output :Ok man, I'll be pretty straightforward - lack of attention to this could kill your father.The thing you worry about after a heart attack is that part of the heart muscle doesn't work well. You can get heart failure pretty easily when one wall of the heart isn't contracting. If he looks bad to you, keep gently encouraging him to get checked out. Use words like "I'm worried about you" and "I don't want to lose you." Don't push. Encourage and focus on your concern for him.It isn't clear it was a heart attack, but something bad happened. An arrhythmia, exacerbation of undiagnosed heart failure, a heart attack, some other vascular event are all on the table and need proper testing to sort out.


###Input :hanks for your response, I did ask that he see a doctor but he is very stubborn and just accepts if its my time then oh well. So Im not expecting much here unfortunately. ###Output :Ugh. Im sorry. So hard to watch a parent do that. Be persistent. Enlist other family members. Avoidant behavior is very common. Especially for healthcare workers.


###Input :Im 34, female, 5 ft. And currently depending on the day between 209 and 223 lbs ( its weird, Ill get to that.)Day 1 Normal bp: 90/60. Weight 184 pounds 5/29/21.So back in June, I was working in a facility housing homeless individuals. During my shift, I smelled what I thought it was an electrical fire or fumes coming through or exhaust system. I discovered that folks were either cooking or smoking methamphetamine in the facility, but couldnt do more then create an incident report and narrow down where this happened.I coughed a bit, Had a headache, went outside to clear my head. Didnt think anything of it. By the end of my shift It felt weird to breathe. Like I was stuffed up. Within 48 hours I was wheezing coughing and very fatigued. COVID negative. Started azithromycin and prednisone 7 day taper.By day 4 post incident I could feel It wasnt helping. Went to the hospital. 02 was in the high 70s, I was coughing so hard. Confused. BP elevated for me 120/70s. Admitted for 4 days. 3 COVID tests (2 pcr, 1 rapid) negative. No fever this whole time. Nothing came up in sputum tests or blood work other than what they explained as inflammation.According to docs notes: patient was admitted to the hospital originally for suspicious of pneumonia based on the chest x-ray reading. In speaking to the patient, her symptom is more consistent with a asthma/COPD attack and lack the usual signs symptoms of infectious pneumonia including fever, productive cough, leukocytosis, and known sick contact. Instead, her symptom was brought about by inhaling smoke at her workplace. Patient has a history of childhood asthma for which she managed at home with rescue inhaler, patient did not have any asthma issues as an adult until exposure at her work.Therefore, after admission, she was treated for an asthma/COPD exacerbation. Antibiotics initiated on admission ( levaquin, azithromycin)to a more appropriate diagnosis. She responded well to bronchodilators, nebulizer, and oral steroid. So I finish the azithromycin, prednisone and have duoneb, and albuterol to help.CT scan showed glass opacities, right side of lungs was worse. 5th PCR test negative for COVID.06/13-I go back to the doctor 6/13. I feel worse. They tell me to give it time.06/24- return to work on light duty. No more than 4 hours a day of walking.07/03-7/23- doctors are still saying give it time. My lungs sound clear. I quit my job with the county to work from home.07/29- go into urgent care because I feel like I cant breathe. Exacerbation of symptoms. They talk about referral to pulmonologist but nothing yet. More prednisone dosepak7/30-8/15- using flutter, spirometer, albuterol and duoneb still as directed. Flutter/ spirometer every hour. Albuterol every 8 hours.Hospital admission 8/16-8/21 doctors notes*Called by nursing due to worsening hypoxia. Patient was admitted for presumed asthma exacerbation with high suspicion for COVID-19 infection. She was initially on room air with SPO2 of 90%. Since her admission, her oxygen needs has been gradually increasing. She is currently on 15 LPM oxygen mask with SPO2 95%. She is becoming more tachypneic with respiratory rate up to 36.Due to lactic acidosis of 3.9 on presentation, patient was started on normal saline at 125 mL/h. She was also started on dexamethasone for presumed asthma exacerbation with possible COVID-19 infection. She is on albuterol MDI inhaler every 4 hours and every 2 hours as needed.Vital signs: Temperature 98.7, pulse of 107, respiratory rate 36, blood pressure 114/74, SPO2 95% on oxymask.On physical exam, patient is alert and oriented. She shows signs of mild respiratory distress with increased work of breathing and tachypnea. She has decreased breath sounds with mild crackles expiratory right greater than the left. No active wheezing.Laboratory studies show white count of 18.3, hemoglobin 14.7, platelets 277. Chemistry panel within normal limits with potassium of 3.9. Magnesium low at 1.7. Lactic acid improving to 2.2 from 3.9. Procalcitonin less than 0.05. D-dimer 0.41.CTA with PE protocol per my review shows no filling defects consistent with pulmonary embolism. There are mild diffuse patchy interstitial bilaterally concerning for COVID-19 infection versus asthma related pneumonitis. No pleural effusions or focal consolidations.Acute hypoxemic respiratory failureLactic acidosisHigh suspicion for COVID-19 infection. Progressive worsening with administration of IV fluids. Improving lactic acid.Plan: -Discontinue IV fluids. -Furosemide 40 mg IV once. -Continue dexamethasone 6 mg by mouth daily for 10 days. -Continue albuterol scheduled and as needed. -Magnesium sulfate 4 g IV once to assist with treatment of possible asthma exacerbation. -Check ABG. -Continue levofloxacin. -Follow-up COVID-19 testing results. Continue precautions for now. -Escalate to high flow oxygen to decrease work of breathing.Patient is critically ill. The patient continues to have: Acute hypoxemic respiratory failure the vital organ system that is affected is the: Respiratory system If untreated there is a high chance of deterioration into: Respiratory failure, cardiac arrest, and eventually death. The critical care that I am providing today is: I performed an extensive data review and discussed care with patient. I have stopped IV fluids and started diuresis with furosemide 40 mg IV. I started magnesium sulfate IV for treatment of presumed asthma exacerbation. I have escalated oxygen needs to high flow oxygen.I get discharged from this hospital stay with 2L oxygen constantly. I get to see my doctor for follow up 9/8. They tell me again to get better first. Then well look at respiratory therapy and pulmonologist and physical therapy long term. I talk to them about my weight gain and my puffy face. They say its common with steroids. I can self monitor for oxygen use.9/17 develop vertigo, confusion, nausea and vomiting. Diagnosed with colitis. COVID negative. Urgent care visit. No longer on oxygen but still exhausted.9/25- diagnosis sinusitis, vertigo from left ear infection. Lungs clear. COVID negative10/5- vertigo doesnt go away. Given meclizine. COVID negative10/17- patient noted to have slightly elevated blood pressure likely circumstantial secondary to presenting complaint (152/90). Referred to primary care physician for further evaluation.Medical Decision Making: CT temporal bones show some fluid within the left mastoid. Slight elevation of white count. Patient also has an abnormal dilatation of the right lateral ventricle on CT of her head. This is concerning in light of her ongoing nausea vomiting and vertigo over the last several weeks. Discussed with pharmacy and placed on antibiotics to cover for possible mastoiditis and discussed with hospitalist for admission for further evaluation and treatment of this ongoing vertigo and abnormal CT head. Admitted in guarded condition.10/17- COVID positive. Test results received after discharge. 10/18. 10/21 tests negative for COVIDWeight gain from June to October 21 is from 184 pounds to 222.October 27- pcp follow up after quarantine. Currently 231 pounds. BP is 148/86.Doc notes History of Pneumonia, RecurrentRecurrent pneumonias with recurrent hospitalizations Exposure to methamphetamine at work at shelter - ended up with ground glass opacities on imaging. Tested multiple times for covid, negative at that time. Has had persistent fatigue, lightheadedness, loss of energy Positive for Covid 10 days agoWeight GainGained 30 pounds since September. Has had recurrent doses of steroids with recent infections. Orthopnea Has had decreased appetite and is not eating much at all. When she does eat a lot, feels need to vomit.HypoxiaDesaturations throughout hospitalizations, was discharged on home oxygen which she was able to wean down, but does still have hypoxia when she sleeps and exertion. Concerned for sleep apnea.VertigoRecurrent episodes of vertigo especially after recent illnesses Reports that she is occasionally awoken by vertigo and hot flash symptoms. Repeat evaluations for the same - does have history of CP, recent finding of R ventricle enlargement on MRI. Some benefit with Meclizine, but has had abnormal associated symptoms including confusion, word finding difficulty. Continued to say istory of pneumonia, recurrent Suspicion for initial covid infection with negative test causing initial ground glass opacities As these are consistent with many other etiologies and she has significant other symptoms (fatigue, weight gain, hair loss, vertigo with normal TSH) will consider other etiologies ANA, RF, anti-CCP for evaluationWeight gain TSH normal in the past, so has never reflexed to T4 and T3 - will measure these Autoimmune evaluation as elsewhereHypoxia Pulmonology evaluation,possible covid long-hauler symptoms, possible other causes of groundglass opacities Sleep study and general PFTsCurrently taking : Claritin albuterol Flonase every day. Meclizine as needed. I think they help.I KNOW THIS IS A LOT. I m sorry thank you for even reading this but I wanted to be thorough.How can I advocate for myself further? What can I ask about? Any additional testing you would suggest? I dont feel like a person anymore. If I eat, clean my kitchen and walk the kids to school it takes everything I have. ###Output :This is a hell of a history. From the right ventricular dilatation, hypoxia, and continued GGOs on CT scan Id say that the cause is probably the lungs. The pulmonologist is going to be your best friend here. PFTs are going to be helpful