The GERD & Hairy Tongue Connection: It’s Not Your Imagination
There certainly is a connection between GERD and “hairy” tongue; this is a real condition that is not imagined. (more…)
Can Borderline QT Prolongation Be Caused By Computer Error?
An abnormal QTc interval from computer error?
Before you panic when your cardiologist points out that your EKG shows a prolonged QT interval or “borderline QTc interval,” first ask your doctor if the EKG results were determined the old-fashioned way rather than by a computer.
I asked an esteemed electrophysiologist (heart rhythm doctor) if a computer error could miscalculate the QTc and yield an abnormal result suggestive of a long QT interval.
“Absolutely. That’s why QT interval is manually measured,” says Andrea Natale, MD, cardiac electrophysiologist and executive medical director of the Texas Cardiac Arrhythmia Institute at St. David’s Medical Center.
Or rather, it should be manually measured. For example, an HMO system that schedules the highest number of cardiology appointments possible in a given day will likely rely upon a computer to calculate QT interval.
The computer calculation takes a lot faster than the manual version. This allows more patients to be squeezed in.
Dr. Natale adds, “Lead misplacement can result in a false positive. Additionally, the software can read the interval incorrectly when the T wave is relatively smaller.”
So what should you do if your doctor says, “I see that your QTc is abnormally prolonged”?
Well first of all, your doctor will want to get your electrolytes checked. Electrolyte deficiency can prolong the QT interval.
The cardiologist will review your meds if you’re on any, as certain medications can prolong the QT interval.
In my case, when I saw a cardiologist for a routine heart wellness exam, a lead misplacement was the apparent reason for the computer printout stating, “Borderline prolonged QTc interval.”
At the time, I knew nothing about QT intervals. I asked what this could potentially mean.
My doctor said it could mean possible fainting or ventricular fibrillation (which I knew). I couldn’t believe what I was hearing.
He knew I wasn’t on meds, wasn’t anorexic (a potential cause of long QT interval), and didn’t have hypothyroidism or heart disease (two more possible causes).
Yet he never mentioned the possibility of computer error or lead misplacement! Ironically, I was to learn that several past EKGs never yielded this odd result.
Three days later I had a repeat EKG with a different nurse, and I noticed that this nurse didn’t place a lead on my foot as did the previous one.
In fact, I realized right then and there that nobody had ever placed a lead on my foot except the nurse before this one.
Needless to say, the QT interval on the repeat EKG turned out normal.
Don’t panic if your computer-generated EKG spits out a QT prolongation finding – especially if you’ve done enough intense exercise over the past 20 years to have had a thousand cardiac arrests if you DID have long QT syndrome!
Genetic long QT syndrome is rare, but quite typically, when someone is diagnosed, they’ve had a history of fainting. However, in some cases the first symptom is cardiac arrest.
But then again, almost always, the patient knows of immediate and extended family members who either have a history of unexplained fainting or sudden unexplained death.
If you don’t have any risk factors for acquired long QT syndrome (e.g., anorexia nervosa or use of drugs such as antidepressants and antihistamines); have no family history of fainting or sudden cardiac arrest episodes; and have been a gym rat for many years without incident – and your computer EKG comes back positive for QT prolongation – do not panic, and request a manual calculation.
Computer Measurements of Qtc Fraught with Errors
“Computer-derived measurements are fraught with errors, particularly in patients with complex T-wave and U-wave arrangements,” states a report in The British Journal of Sports Medicine (Johnson et al, March 2014).
The BJSM report continues, “As such, physicians-in-training should be taught that the computer’s QTc cannot be relied upon when a diagnosis of LQTS is in question and, must be verified manually.”
Dr. Natale’s
greatest reward is restoring his patients to a life free of cardiac arrhythmia. He pioneered a circumferential ultrasound vein-ablation system to correct atrial fibrillation and performed the procedure on the world’s first five patients.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/megaflopp
PVCs for Two Minutes Straight: Does this Mean Heart Problem?
Have you ever experienced a bunch of PVCs for literally two minutes nonstop and feared that a heart attack or cardiac arrest was looming? (more…)
How Many PVCs Mean Occasional vs. Frequent per Hour or Day?
If you’re having so many PVCs that you measure their frequency by the hour, this may have you fearful that you’re afflicted with frequent PVCs.
Per hour, per day, how many premature ventricular contractions you have will vary when compared to others who believe they too suffer from “frequent” or “a lot” of these annoying – and sometimes very scary – heartbeat sensations.
But thinking that you have frequent or a lot of PVCs can be a very subjective interpretation.
Electrophysiologist’s Answer
So I asked an electrophysiologist the big question. Just how many PVCs per day or hour must one have in order for the condition to be considered frequent as opposed to occasional?
“Frequent PVCs are defined as having 15,000 or more per day, whereas five to ten PVCs per hour (or less) are considered occasional,” says Andrea Natale, MD, cardiac electrophysiologist and executive medical director of the Texas Cardiac Arrhythmia Institute at St. David’s Medical Center.
So, 15,000 PVCs per day = on average, 625 per hour, if you include the hours during sleep.
Frequent PVCs, then, would mean, on average, 10.4 of these “skipped” or “extra” beats every minute.
Keep in mind that someone may go many minutes or even a few hours without having a single premature ventricular contraction, but then over 2,000 occur in just the next hour alone.
Thus, the 24-hour tally won’t be evenly spread out among 24 hours.
This is why the concept of frequent vs. occasional is measured per day rather than per hour.
Five to 10 PVCs per hour, on the other hand, are, as Dr. Natale says, considered an occasional occurrence.
This will be surprising to many people who have health anxiety over their PVCs, because from their frightened point of view, five to 10 “flutters” per hour seems excessive.
But imagine having 10 PER MINUTE.
According to the math, occasional PVCs means 120 to 240 per day. If you’ve documented a lot more than this, but also a lot less than 15,000, you’re somewhere in the range of moderate frequency.
High frequency would mean you’d be feeling your heart jumping, thumping, fluttering or skipping nearly constantly every waking moment (10.4 or more per minute) or for large chunks of time out of the day.
Hopefully, this math will put things in perspective for you. But there’s a little more to consider.
“The prevalence of PVCs increases with age,” says Dr. Natale, “with less than one percent of ambulatory ECG recordings demonstrating PVCs in those younger than 11 years of age, compared with more than 69 percent in those 75 years of age or older.”
Dr. Natale’s greatest reward is restoring his patients to a life free of cardiac arrhythmia. He pioneered a circumferential ultrasound vein-ablation system to correct atrial fibrillation and performed the procedure on the world’s first five patients.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: ©Lorra Garrick
Heart Racing in Middle of Sleep: 200 Beats/Minute
If you’ve accurately taken your pulse in the middle of the night to be 200 beats per minute or even 150, after being awakened by this furious heart rate, you should not just stew over this and keep trying to guess what happened. (more…)
Why Does Angina Cause Pain to Spread to Left Arm & Shoulder?
“It’s a common misconception that angina causes pain to spread to the left arm and shoulder,” explains Charles C. Cummings, MD, Interventional Cardiologist, LifeBridge Health Cardiovascular Institute in Baltimore, MD. (more…)
Why Can Angina Get Worse with Exercise?
You’d think that exercise would benefit the heart and thus improve the angina condition, but the truth is the opposite:
Exercise will make angina get worse. (more…)
Can You Get a DVT in Your Arm?
Yes, a deep vein thrombosis can occur in the arm, not just in the legs.
The risk factors for a DVT occurring in an arm are the same as for the leg — generally speaking.
But there’s a subset of risks that are much more applicable to blood clot formation in an arm.
Symptoms of an Arm DVT
• Swelling of the arm as the blood builds up, since the blood can’t get past the clot.
• Pain or tenderness in the arm, caused by tissue damage.
• Red or purplish color to the skin.
• Arm feels warm, due to irritated blood vessels.
• Bulging veins (when previously they weren’t).
• Hand weakness
• You won’t necessarily have every one of these symptoms and sometimes may not have any symptoms at all.
• Typically only one arm is affected.
DVT Risk Factors
“DVT, or deep venous thrombosis, is the process of blood clotting in any large veins, which is abnormal,” says Morton Tavel, MD, Clinical Professor Emeritus of Medicine, Indiana University School of Medicine, and author of “Health Tips, Myths and Tricks: A Physician’s Advice.”
“Anything that slows the venous flow excessively, such as heart failure or prolonged sitting, motionless standing or the presence of dilated (varicose) veins, will increase the likelihood of clotting,” continues Dr. Tavel.
Additional risk factors are uninterrupted long periods cramped in a seat during long air or road travel, obesity, smoking, birth control pills and joint replacement surgery.
“Clotting in veins is unusual but enhanced by slowing of blood flow, and because of the slowing effects of gravity, it is encountered almost exclusively in the lower extremities,” says Dr. Tavel.
“By contrast, clotting in the arms and other parts of the upper body is rare since venous flow is not retarded by gravity, and therefore, flow is brisk unless retarded by some type of obstruction, which is unusual.”
A venous blood clot in an upper limb is indeed highly unusual – enough so that nobody should ever have anxiety over developing one of these.
Nevertheless, upper extremity DVT’s do occur, and they actually have a different set of risk factors more applicable to them.
• Bone fracture
• Medical procedure such as catheter insertion
• Strenuous movement (e.g., pitching a baseball, moving furniture). This risk is VERY rare and by no means contraindicates intense or heavy exercise.
• Genetic blood clotting disorder
• There are cases in which an arm DVT has no known cause.
The presence of five identified risk factors for DVT development in the arm in no way contradicts the rarity of this event.
What to Do
Stop worrying. But … if you do suspect a deep vein thrombosis in your arm, and especially in your leg, you need to go to the ER.
An emergency room setting will allow prompt diagnostics.
Dr. Tavel’s medical research includes over 125 publications, editorials and book reviews in peer-reviewed national medical journals. He was formerly director of the cardiac rehabilitation program at St. Vincent Hospital in Indiana. mortontavel.com
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
ALS vs. MS Symptoms: What Really Are the Differences?
Some similarities between ALS and MS symptoms are frightening.
But most differences are very reassuring to those who can’t stop worrying that they have the fatal motor neuron disease.
A person with health anxiety may be fearing only MS, while others with health anxiety may be wondering which one of the two they have.
Symptoms Common to MS but not to ALS
• MS usually impacts one side of the body; ALS affects the entire body, though may start out in a small area on one side, such as one arm first.
• MS symptoms take their sweet time progressing, while ALS symptoms typically progress fairly quickly, e.g., no such thing 12 months of ALS symptoms being confined to just the legs.
• MS symptoms can come and go. You’ve probably heard someone say, “My multiple sclerosis is in remission.” Remission can last for months.
There are cases in which MS patients have been virtually bedridden, only to be eventually up and around in the community. ALS symptoms, once they present, are there to stay, and only get worse.
• Symptoms of multiple sclerosis may include issues with taste, smell and sight – which are not affected by ALS.
• MS may affect cognition, which is not affected by ALS.
The Multiple Sclerosis Pattern
“MS attacks can present as many different symptoms,” says Joseph Krainin, MD, board certified neurologist and sleep doctor.
“Common MS symptoms include blurry vision in one eye, dizziness or imbalance, weakness or numbness on one side of the body or from the chest down, and difficulty walking.”
Why Some People Get Confused Over ALS vs. MS Symptoms
Both conditions—in the early stages—can present with similar symptoms.
They are muscle weakness and stiffness, fatigue, a loss of coordination and control, and difficulty with moving the limbs.
In fact, this exact set of symptoms can describe numerous possible conditions.
Depending on the words googled, a person with health anxiety might end up convinced that they have a vitamin deficiency, fibromyalgia, myasthenia gravis, repeated transient ischemic attacks or a brain tumor.
Define “Muscle Weakness”
The concept of “muscle weakness” can be subjective. Obviously, there’s an issue with muscle weakness when suddenly you have difficulty carrying a gallon of milk across the room and struggle to lift one leg as you climb stairs.
But those with health anxiety are capable of perceiving a pathological weakness when at the gym, their heaviest bench press is 225, whereas for the preceding four gym sessions, they were benching 235.
Another example of “perceived weakness” is when someone begins imagining that it’s more difficult than usual to unscrew jar lids (but they do get unscrewed) or haul out heavy garbage bags (but they do get hauled out).
Any number of benign variables can explain the perceived weakness.
Some people with health anxiety immediately zoom in on multiple sclerosis, while others promptly zero in on ALS.
What determines which, in many instances, is what keywords a person searches for online. This then determines what pops up in the search results.
If it’s MS sites, the person is more likely to start fearing they have MS symptoms.
If it’s ALS information, their mind will tune into ALS. And of course, some fear both.
Double board certified in sleep medicine and neurology, Dr. Krainin is founder and president of Singular Sleep, LLC, an award-winning online sleep center.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Top image: Shutterstock/srisakorn wonglakorn
Sources:
cdc.gov/als/whatisals.aspx
webmd.com/multiple-sclerosis/ms-or-als
Chest Pain, Need to Burp but Can’t: Future Heart Attack?
