Q:
Hello…my husband is 36 year old white male that is 6’4″ tall and weighs about 350 which I know is a heart attack waiting to happen right there.He just starting working out & has lost about 7 lbs so far so hopefully it will help all this.So about 2 years ago he went in for a stress test & passed, but they gave him an at home monitor, but only for about a week.His heart will do what he calls as fluttering or skipping beats, but not often and of course not when he had the monitor.
He says it is like it gets off rythym and then it takes about 10-15 seconds for it to jump back into place, but it is enough to scare him.He started around 3 years ago with blood pressure problems so high that he got nose bleeds so he went on meds. He then stopped taking them about a year or so ago because of side effects & a couple of weeks ago the primary care dr put him on hydrochlorothiazide ,but only 25mg a day.She noticed on his visit that his legs were swelled through his pants. Since then we have noticed alot of swelling.He recently got an eye exam because he woke up and could not see out of one eye & they thought it was a macular hole & then they thought it was optic nerve swelling & then cat scratch fever & then I have no idea what or if they knew what it was.I am only mentioning this if it has relation somehow? He also has had alot of joint pain lately. He was diagnosed about 5 years ago with sleep apnea , but only started wearing his machine nightly about for the last year.As far as history..his dad has had triple bypass surgery & I believe he has had 3 or 4 heart attacks.He also has had strokes and has diabetes. So with all this combined with his weight, history, and family I know this is not good, but I thought maybe you could shed some light on this mystery heart skipping or fluttering? Also the swelling….if it is related at all? I know all this is over the computer so it is not the best way to diagnose anyone, but if you could maybe give me some ideas to give our dr that might help. He hates to go to the dr so when I get him there it has to count! Also if you know of any bloodwork or labs to ask for. Thank you in advance.
A:
His morbid obesity (his Body Mass Index, BMI=42), Hypertension, peripheral edema (swelling), palpitations, all confirm what you already know: a heart attack waiting to happen. Sleep apnea diabetes, positive family history for heart disease all contribute to this prognosis. Loosing 7 lbs is a very minor beginning of the 150 lbs he has to get rid off.
Diet, exercise, wight loss. Without that, nothing else will be effective. His palpitations probably will need to be re-evaluated.
You can read more here:
http://www.cardiac-risk-assessment.com/heart-information/obesity
http://www.cardiac-risk-assessment.com/heart-disease-treatment/diet-exercise-dis
Palpitations:
The first thing to find out is whether his heart is healthy otherwise, so he will need to have some blood tests (including Thyroid), an EKG and 24 hour monitoring. That will determine the basics.
You can read more about heart rhythm here:
http://www.cardiac-risk-assessment.com/ca-blog/palpitations/
http://www.cardiac-risk-assessment.com/ca-blog/palpitations-and-pvcs/
http://www.cardiac-risk-assessment.com/ca-blog/i-am-worried-about-v-tach-ventric
http://www.cardiac-risk-assessment.com/ca-blog/what-are-some-of-the-causes-of-pr
Calculate his risks:
http://www.cardiac-risk-assessment.com/app/risk-assessment.php
More about diet:
http://www.cardiac-risk-assessment.com/patients/diet/heart-healthy-food
Hope this helps,
Dr T
http://www.cardiac-risk-assessment.com/