The Clinton Herald, Clinton, Iowa

October 22, 2013

Sleep apnea might cause palpitations

Dr. Keith Roach
The Clinton Herald

---- — DEAR DR. ROACH: I am 26 years old, 6 feet, 3 inches tall and weigh 290 pounds. About two years ago, I had chest pain and palpitations. I saw a cardiologist, who performed an echocardiogram. It showed mild LVH and mild pulmonary hypertension. I had multiple EKGs, and my doctor says I have a clean bill of health. Are any of the symptoms I have dangerous, or am I overreacting? — J.A.

ANSWER: Chest pain and palpitations are common concerns that occasionally represent serious heart disease but often don’t. It’s estimated that the average person has 500 or so abnormal heartbeats a day, and these can be felt as palpitations. Chest pain should raise the concern for angina caused by heart blockages, but that would be extremely unusual in a 26-year-old.

The concern I have in hearing about your echo results is that they could represent obstructive sleep apnea. Left ventricular hypertrophy (LVH) is the heart’s response to chronic stress, especially to elevated blood pressure, which is common in sleep apnea. Pulmonary hypertension has many causes, but in someone very overweight (your body mass index, BMI, is 36.2, where “obese” is defined as over 30), I have to be concerned about chronic low oxygen to the lungs. There are many people with sleep apnea who aren’t diagnosed. I would recommend a sleep study. Certainly I recommend careful checking of your blood pressure, and weight loss.

Heart disease remains the No. 1 killer. The booklet on clogged heart arteries explains why they happen and what can be done to prevent clogging. Readers can obtain a copy by writing: Dr. Roach -- No. 101, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I am an 85-year-old woman living in a nursing facility. A little before my arrival here, I began experiencing night sweats. I have seen my doctor regarding this, and he said he cannot help me. I feel weak when I wake in the morning, and I need to constantly change the towels I put under myself. This is a big concern. — A.M.

ANSWER: I take night sweats seriously. Tuberculosis is the classic cause of night sweats, which is of immense concern in a nursing facility, where most people are tested for TB yearly. But other chronic infections, high thyroid levels and even blood and marrow diseases like lymphoma can show up with night sweats. Most of the time, a chest X-ray and blood tests, along with a careful exam, can make the diagnosis. Other times, it’s harder to find. More often, it goes away as mysteriously as it came. But it is worth another look.

DEAR DR. ROACH: From a blood test, how can I tell if I am an insulin-dependent Type 2 diabetic? For instance, what would my insulin or glucose readings have to be?

Secondly, at what point would I have to start taking medications? — E.

ANSWER: Diabetes is diagnosed with any of the following: hemoglobin A1c of 6.5 percent or higher; fasting blood sugar of 126 or higher; blood sugar during a glucose tolerance test of 200 or greater at two hours; or random glucose of 200 or greater in someone with classic symptoms. In Type 1 diabetes, insulin levels are very low, while in Type 2 they are normal or high.

Not everybody with diabetes needs medication. Many people can be well-controlled just with dietary modification and often weight loss, and almost everybody can improve with a better diet.