Managing Heart Palpitations: Medication Interactions and Health Tips

Medication consultation. Heart rate issues. Drug interactions?

Hello, doctor.
I have been experiencing heart palpitations for the past two weeks.
On the first day, I had two episodes of palpitations before bed, and the next evening, I experienced several more episodes.
I went to the emergency room, received IV fluids, and my electrocardiogram was normal, so I was sent home.
I felt fine for the next two days, but a week later, the palpitations became constant and very uncomfortable.
I then consulted a cardiologist who suggested that I have mitral valve prolapse.
He prescribed medication for me to take for a month and asked me to return for a follow-up (Sotalol three times a day and half a tablet of Amiodarone twice a day) and arranged for an echocardiogram.
During the echocardiogram, the doctor observed my ongoing palpitations and informed me that I have mitral valve prolapse, regurgitation, mild incomplete backflow, and premature ventricular contractions (which are the main cause of my discomfort).
He emphasized the importance of taking the medication, as not doing so could lead to heart failure in the long term.
However, after researching online, I decided to only take Sotalol and not combine it with Amiodarone.
Is this acceptable?
Additionally, after taking Sotalol for two days, I noticed an improvement in the frequency of palpitations, but on the second night, about an hour after taking the medication at 9 PM, I began to feel chest pain that persisted and prevented me from sleeping.
I also experienced fluctuating body temperature, feeling cold and hot, and it wasn't until around 6 AM that the pain subsided.
At 9 AM, I took Sotalol again, and after about half an hour, the chest pain returned.
Should I continue taking Sotalol? Would you recommend an earlier follow-up appointment?
Furthermore, I want to mention that I drink traditional Chinese medicine every night (with a one-hour interval from the Western medication) primarily for relaxation and emotional relief.
Could this potentially interact with the Western medication? Lastly, could my heart issues be related to my high cholesterol levels? (My mother recently consulted a doctor about similar symptoms.) I am considering a full health check-up; do you have any recommendations for specific tests related to my heart issues? Thank you.

Bei, 30~39 year old female. Ask Date: 2022/12/09

Dr. Li Shengkai reply Cardiology

Hello, based on your description, the treatment and management provided by your physician are logical.
Your condition is commonly seen in patients with mitral valve prolapse or autonomic nervous system disorders.
It is recommended to continue taking the medications prescribed by your doctor and to adjust your lifestyle to manage stress appropriately; if you experience any discomfort, you should return for an earlier consultation or even visit the emergency department if necessary.
Since it is unclear what traditional Chinese medicine you are taking, it is advisable to consult with a Chinese medicine practitioner regarding potential interactions.
If there is a suspicion of cardiovascular issues, you may consider undergoing a coronary artery calcium score test or a stress electrocardiogram, or more advanced nuclear medicine tests (such as a myocardial perfusion study); if arrhythmia is suspected, a 24-hour Holter monitor can be performed.
Routine blood tests can also help assess for issues with blood glucose and lipids, which are risk factors for cardiovascular disease and should be managed long-term.

Reply Date: 2022/12/09

More Info

Managing heart palpitations can be a complex issue, especially when there are underlying conditions such as mitral valve prolapse (MVP) and other cardiovascular concerns. Based on your description, it seems you have experienced significant discomfort due to palpitations, which have been exacerbated by your existing heart condition. Here’s a comprehensive approach to managing your situation, including medication interactions, health tips, and recommendations for further evaluation.

Understanding Your Condition
Mitral valve prolapse is a common heart valve disorder that can lead to various symptoms, including palpitations, chest pain, and anxiety. The regurgitation (backflow) of blood through the valve can cause the heart to work harder, potentially leading to symptoms like those you are experiencing. The early ventricular contractions (premature ventricular contractions or PVCs) you mentioned can also contribute to the sensation of palpitations and discomfort.

Medication Management
You were prescribed two medications: Sotalol (生達心律錠) and Atenolol (安柏寧). Sotalol is an antiarrhythmic medication that helps to regulate heart rhythm, while Atenolol is a beta-blocker that can reduce heart rate and lower blood pressure. It is crucial to follow your physician's recommendations regarding medication, especially since they have assessed your condition and deemed it necessary for your heart health.

1. Adherence to Prescriptions: It is generally not advisable to alter your medication regimen without consulting your healthcare provider. If you are experiencing side effects, such as chest pain after taking Sotalol, it is essential to report this to your doctor immediately. They may need to adjust your dosage or consider alternative medications.

2. Potential Interactions: You mentioned taking traditional Chinese medicine (TCM) at night. While many herbal remedies can be beneficial, some may interact with Western medications. It is crucial to inform your healthcare provider about all supplements and medications you are taking to avoid potential interactions.

Health Tips
1. Lifestyle Modifications:
- Diet: A heart-healthy diet low in saturated fats, cholesterol, and sodium can help manage cholesterol levels and overall heart health. Incorporate fruits, vegetables, whole grains, and lean proteins.

- Exercise: Regular physical activity can improve cardiovascular health and help manage stress. However, consult your doctor before starting any new exercise regimen, especially given your symptoms.

- Stress Management: Techniques such as mindfulness, yoga, or meditation can help reduce anxiety and stress, which may contribute to palpitations.

2. Monitoring Symptoms: Keep a diary of your symptoms, noting when they occur, their duration, and any potential triggers. This information can be valuable for your healthcare provider in managing your condition.

Recommended Evaluations
Given your symptoms and history, a comprehensive evaluation is warranted. Here are some tests you might consider discussing with your healthcare provider:
1. Echocardiogram: This ultrasound of the heart can assess the structure and function of your heart valves and chambers, providing insight into the severity of your mitral valve prolapse and any regurgitation.

2. Holter Monitor: This portable device records your heart's rhythm for 24-48 hours, which can help identify the frequency and nature of your palpitations.

3. Stress Test: This test evaluates how your heart performs under physical stress and can help identify any ischemic changes.

4. Lipid Profile: Since you mentioned concerns about high cholesterol, a lipid panel can provide information on your cholesterol levels and help guide dietary and medication choices.

Conclusion
In summary, managing heart palpitations, especially in the context of mitral valve prolapse, requires careful attention to medication, lifestyle changes, and regular follow-up with your healthcare provider. If you experience worsening symptoms, such as persistent chest pain or significant changes in your health, do not hesitate to seek medical attention promptly. Your health is paramount, and proactive management can help you maintain a better quality of life.

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