Heart & Cardiology/Bradycardia & PVCs

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Question
I apologize for the length but will try to give you a complete picture.

BACKGROUND:

I have a history (over the past 7-8 years) of PVCs.  The doctors have made 2 ablation attempts but in the first attempt, couldn't recreate the PVCs and in the 2nd, couldn't identify a good spot to try.  I have von willebrand's disease (factor 8 deficiency) and in both attempts, I had to stay in the hospital overnight while they controlled the bleeding.  I have declined further ablation attempts.

On September 27th I was rear ended while sitting at a light.  I went to an urgent care center with a mild headache and neck pain.  I was diagnosed with whiplash.  Three days later I rear ended someone, it was my first accident ever in my 32 year driving career.

Late last week my primary care doctor sent me directly to the ER because my speech was slurred and my walk was kind of staggery.  My family had been commenting that I sounded like I had been drinking (I hadn't).  I was also extremely exhausted and having trouble completing basic tasks because I was so tired  I had just seen the doctor the week before for a UTI so she was concerned about the change in a week's period of time.  

I spent 2 nights in the hospital and they were not able to find anything.  I had a brain MRI (2 non-significant lesions), EEG (might be called EMG?), EKG, echo.  They found a small amount of fluid around my heart and everything else was normal (I slept through the test where they attached the things to my head but I vaguely recall at one point lights flashing at me before falling back to sleep). I have 2 half sisters with epilepsy.  I was released with a recommendation for PT to help me gain balance and strength.

While in the hospital, my heart rate ranged in the upper 40s to 50s (I am in no way athletic).  I had been on diltizem 180 and losartan potassium 25 mg. once a day.  They took me off the diltizem and my heart rate went up to the 60s.  My BP eventually got to the range of 140ish/upper 80s.  My pressure stayed pretty stable until yesterday.

Yesterday while sitting in my home office, I had an episode where I suddenly felt exhausted again, light headed.  I also had more trouble with my balance (I thought I had been improving). My mother and sister visited me shortly afterwards and were very concerned because they thought I was staggering again, euphoric behavior (I laughed so hard at them that I fell and had to be helped up).  My BP and HR were fine (I have a machine and have checked it against my cardiologist's machine).

This morning I woke up really off balance again and now my BP is up and my HR down again.  Latest BP 160/109; HR 58 and my arrhythmia monitor light is lit.  Yesterday the visiting nurse visited and got a BP of 146/100 with a HR of 44.  I'm also having problems (for the past week or so) with slow speech or where I just can't get the word out or I just completely lose my train of thought (it's not often, just when I start talking a lot).

I'm 48 years old, weigh 155 lbs (bariatric sleeve procedure in February of this year - I've lost 85 lbs so far), don't smoke and have had high blood pressure (familial) since I was 24 years old.


QUESTION:

Tomorrow I see my PCP again since getting out of the hospital and I'm really not sure what to ask her. I don't know what's relevant to tell her (I have not done a good job of communicating in the past) and I don't want to waste her time.  What should I tell her?

I have a cardiologist (she cut my diltizem from 240 last month because my HR was too low) but she didn't schedule a follow up for another 4 months.  I also have a problem with low potassium (hospitalized 4 years ago with potassium of 1.8 and no measurable magnesium).  I had been seeing her for PVCs but no testing was done until I decided to go to ER.  I reminded her of potassium issue (it now ranges between 2.8 - 3.4 usually) before she lowered the diltizem and added the losartan.  The losartan was to replace doxyzosin 8 mg. (2x daily) and hydrodizide.  Should I continue with this cardiologist or how should I talk to her about being so laid back (or am I over-reacting?).

Before I left the hospital the doctor said I have a bradycardia (which is the first I've ever heard of that).  Can PVCs cause a bradycardia?  Can it go away on it's own?

Is there anything else I should be asking about?

Answer
Hi Rhonda,
Your situation is beyond the scope of what I can answer from afar. I'd be concerned you may have some metabolic changes related to your bariatric surgery and rapid weight loss. You should ask your doctor for a blood test called metabolic profile and a cardiology consult.
Hope this helps,
Dr T
http://www.cardiachealth.org/

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