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Episodes of extreme exhaution with HEPATITIS-C under control.

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I have suffered from periodic episodes of extreme exhaustion for 30 years old patient(my present age is 60). It was blamed on Hepatitis C, until I completed treatment recently achieving sustained viral response (cure). I don’t expect a diagnosis here, and I will see my cardiologist, plus other doctors if necessary, but I would like to preview some questions, which might help me refine questions for my doctor.

I am fairly fit for my age. Height 5'9". Weight 135 pounds. My body looks like a fit 30 year old, but sometimes I feel like 90 and near death. My diet is basically whole, natural foods, low cholesterol, almost no sugar, plenty of vegetable, but also some fish and poultry.

Blood pressure between 120/60 to 135/70 - at the lower end when I am exercising routinely. I take no meds (except for the Sovaldi/GS5816 for the Hep C, concluding 6 months ago). The only remarkable blood test out of range that I know of is blood platelets at 100.

In a nutshell, it seems like sometimes my heart functions smoothly and other times it is inefficient. I have had normal ECG, echocardiogram, stress test, and echo stress, during the course of this history (all within the past 4 years). I reportedly show a right branch bundle block on my ECG, although the doctor said it was nothing to be concerned about at this point (then being when symptoms of fatigue were assumed to be hepatitis C). My question is: Would RBBB symptoms be consistent with the manifestation as follows. For about half the time (sometimes more, sometimes less), I am able to function with enough energy for moderate activity. If I am physically active (e.g. cleaning or small construction), I wear out after 3-4 hours, and three days of that will completely exhaust me. However, I can walk vigorously, even run, on a treadmill for an hour, and that regenerates me (as long as that is my only significant exertion in the day). Working in heat is particularly exhausting (I live in Tucson, with temperatures up to 115 degrees - but others seem to manage better than I). The matter is, when I collapse into exhaustion, I become so weak, I can hardly get out of bed, or even sit up (feeble, but I don’t get dizzy). I feel my heart weak - dangerously weak, it seems. Even digestion and mental acuity is slow. This may last for days, at worst even weeks. At some point I begin to gain strength. Many times I have had a strange sensation that I feel a sudden jolt in my chest, and it seems as though suddenly, my heart is functioning smoothly. I usually find improvement steadily from that point, but sometimes it falls back, and I recover soon after. This could be imagination, but it has occurred many times, and the sudden effect is most interesting. This is why I wonder if there is an electrical “reconnection”. Alternately, I wonder if there could be a chemical threshhold (e.g. hormonal) that is reached at this point. But to the cardiac question, can RBBB turn on and off like this? Does it present symptoms this way? Can I have such a contrast of performance with RBBB, or does RBBB present as a constant condition?

Please respond with any insights you think are relevant.


Category: Cardiologist

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Category: Internal Medicine Specialist
Dr. E. Satish Kumar is online now

Expert:  Dr. E. Satish Kumar replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
I have gone through your case file, as per your history you feel comfortable in walking an hour or doing a tread mill shows that heart is in a healthy state.
You stress echo normal indicates heart to be healthy.
EKG showing RBBB usually does not indicate major problem as most people have it, it is assumed significant in certain conditions like a patient having heart attack develops new onset RBBB. In your case RBBB does not carry any significance and doesn't seem to be related to the symptoms your are having.Most of the times RBBB is detected during a routine check up and they are asymptomatic.
One thing i want you to do is Holter Monitoring and also have a consultation with Endocrinologist.
Regards
Dr Satish


Patient replied :

Thank you for your reply.
Can you move this question about the conditions I described, to an endocrinologist?
But before I leave you, I would like to ask also about something that may or may not be related. I did have an episode of chest pain about 10 days ago. I was sanding wood, out in the heat (about 110 here in the desert), although in the shade at least, but also wearing an N100 HEPA half-face mask respirator. I suspect the restricted airflow, while increasing demand, was a problem. Similar chest pain has happened before. Two years old patientago I went to the hospital to check it out, and all tests as I described earlier, were normal. After that, I engaged in a routine exercise regimen, and have not had such pain again, except maybe once or twice last year very briefly. I have not been doing aerobic exercising in the last month, though. Now, perhaps I had mistakenly downplayed that episode 10 days ago. I have been weaker since, but it is difficult to distinguish between what could be heart trouble versus the exhaustion I have had for over 30 years. But, I don’t feel right, even by those standards. I began on the treadmill, just walking, about 5 days ago. I usually get my heart rate up to 130-145. I only reach about 105 comfortably now, for about half an hour. I need to get it checked out. I hope this isn’t a case of closing the barn door after the house has run out. I wonder if it could have been a heart attack, leaving heart damage.
I am wondering if there is any imaging procedure that doesn’t require radiation injections or dye injections. The radiation is huge, and the dyes can cause kidney damage, I understand. If there is no alternative, I may be at (or after) a point of greater concern for heart evaluation. Please let me know.


Expert:  Dr. E. Satish Kumar replied 3 Days.

Dear Doctor, I understand your apprehension, as a negative TMT rules out a significant heart problem. But if you have chest pain on exertion and relieved by rest or sublingual nitroglycerine, then definitely heart problem has to be ruled out.
Coronary angiography is safe procedure , if done by a trained cardiologist has low radiation exposure and contrast requirement is 20 to 30 ml which doesn't effect normal kidney.
Other test is STRESS THALLIUM which will help in identifying ischaemia and the radiation exposure is minimal.
Other crude way of identifying of a healthy heart is if you can walk briskly 4 to 5km over 1 hr.

Regards
Dr Satish


Patient replied :

Dear, I understand your apprehension, as a negative TMT rules out a significant heart problem. But if you have chest pain on exertion and relieved by rest or sublingual nitroglycerine, then definitely heart problem has to be ruled out.
Coronary angiography is a safe procedure, if done by a trained cardiologist has low radiation exposure and contrast requirement is 20 to 30 ml which doesn't affect the normal kidney.
The other test is STRESS THALLIUM which will help in identifying ischaemia and the radiation exposure is minimal.
Another crude way of identifying of a healthy heart is if you can walk briskly 4 to 5km over 1 hr.

Regards
Dr Satish


Expert:  Dr. E. Satish Kumar replied 2 Days.

Dear, I understand your apprehension, as a negative TMT rules out a significant heart problem. But if you have chest pain on exertion and relieved by rest or sublingual nitroglycerine, then definitely heart problem has to be ruled out.
Coronary angiography is a safe procedure, if done by a trained cardiologist has low radiation exposure and contrast requirement is 20 to 30 ml which doesn't affect the normal kidney.
The other test is STRESS THALLIUM which will help in identifying ischaemia and the radiation exposure is minimal.
Another crude way of identifying of a healthy heart is if you can walk briskly 4 to 5km over 1 hr.

Regards
Dr Satish


Patient replied :

On the matter of referral, can you move this question to an endocrinologist, since indications suggest cardiology is not likely the source of concern?


Expert:  Dr. E. Satish Kumar replied 1 Day.

Hello,
Kindly note that you had chosen cardiologist as the specialist while initiating the query, and hence it was forwarded to him.
We assign one specialist for each specialist query.
If you want an endocrinology opinion, kindly post a new query, and it will be forwarded to the endocrinologist.
Best Regards,
InHouse Physician.


Dr. E. Satish Kumar
Category: Internal Medicine Specialist
Experience: 
Fellowship, Cardiology - Tamil Nadu Doctor M.G.R. Medical University - DNB, Cardiology, 2002 – 2005Training in Germany in Complicated AngioplastiesMedical School - Maharaja Krushna Chandra Gajapati Medical college, MBBBS MD, Int Medicine, 1989 – 1999.
Trained in Rota Abalation for treating Calcific coronary artery disease in Japan
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