Accelerated heartbeat/breathing episode underwater w/tingling above water:Dehydratio?

[RyanDelMundo]

I'm glad you followed up with some testing.

If I were you, I'd be wary of taking propranolol (beta-blocker) while diving. The effects of the beta-blocker will reduce one's exercise tolerance which can, in some cases, cause a person to lose consciousness (related to decreased blood pressure and decreased heart rate). That would be a very unfortunate thing to have happen while diving. And we all know that diving can be a work-out at times.

Did the physician who gave you the prescription caution you about this?

No, she said to only take it if the symptoms show up, not before diving. I'm hoping to carry these around and not use them, but were I to have a recurrance, I'll keep out of the water.

Thx!

 

[RyanDelMundo]

My questions about Singha and decongestants were not entirely in jest.
A few days of party-hearty combined with diving can lead to serious dehydration; in many folks decongestants can set the heart off-to-the-races. I, for example, can drive an EKG crazy with irregular/rapid/pvc heartbeat for two or three days just by taking a single sudafed. Feels like my heart's about to jump out of my chest.
Rick

I misspoke, I took Declogen Plus, which contains in addition to what I mentioned before, everyone's favorite stimulant: 30mg pseudoephedrine HCl.

Not sure if it played a part - but think I'll keep away from it....

 

[Bubbletrubble]

I misspoke, I took Declogen Plus, which contains in addition to what I mentioned before, everyone's favorite stimulant: 30mg pseudoephedrine HCl.

Not sure if it played a part - but think I'll keep away from it....

Hmmm. Psuedoephedrine acts as a sympathomimetic. The adverse reactions of pseudoephedrine are well documented to include (but are not limited to): palpitations (patient feels like heart is racing), tachycardia (too fast heart rate), hypertension, and arrhythmia. That could very easily explain your symptoms.

Were you on any med containing pseudoephedrine (e.g., Decolgen Plus) during the incident in question? :shocked2:

 

[Duke Dive Medicine]

Gave me 10 tabs of propranolol in case this happens again, which apparently might also help my golf game, not that I golf.

They gave you a beta blocker for a random accelerated heart rate, without having any idea what caused it? Yikes. That could have adverse consequences for you not only when diving but on the surface as well. You might be on the right track with the pseudoephedrine line of thinking but you may want to follow up with the 24-hour Holter monitor. There are a lot of things that can cause your heart rate to accelerate suddenly. Agree with your plan to lay of the pseudoephedrine-containing drugs but it may be worth a followup with a cardiologist just for peace of mind, and most definitely if it happens again.

 

[TSandM]

Yes, if you took the pseudoephedrine, that could explain everything.

I agree with everybody else -- I would chuck the propranolol. If you have palpitations again, I'd ask for a Holter monitor.

 

[ScubaNurse758]

I agree that the use of "prn" beta-blockers is something I'm definitely not comfortable with. Sounds like the stimulates could definitely be a cause of the racing heart. But I would suggest if you do experience these symptoms again, try to get hooked up with a holter monitor for a few weeks. Many of my patients wear them for weeks at a time, and any adverse events are automatically recorded and sent to the monitoring company. The main reason for the extended time being that some heart conditions such as paroxysmal atrial fibrillation (afib) can pop up randomly during periods of stress, and go away for much longer than a few days or 24 hours. But heres to hopefully being a random event with no long term effects!

Jordan.

 

[cutlass]

Yes, if you took the pseudoephedrine, that could explain everything.

I agree with everybody else -- I would chuck the propranolol. If you have palpitations again, I'd ask for a Holter monitor.

Agreed.

A bout with infection and fever (dengue in this case) can do strange (immunological) things to the body so that developing a new sensitivity to pseudoephedrine with reactions like Rick's is a possibility. Regardless, cardiopulmonary risks must be assessed since these are the foremost potential lethal threats.

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Other musings:

Good BUN and creatinine levels relieves immediate thoughts of kidney dysfunction (affecting fluid balance, pH, electrolytes). A clear CBC lowers consideration of infection and anemia. Presumably, the rest of the basic bloodwork was unremarkable. The thyroid check was a plus; this also scores some points against pituitary and hypothalamic dysfunction (but is not conclusive for these). As for the rest of the PAH axis, nothing's been said to alert suspicions of abnormal adrenal involvement (i.e. Cushing-like signs/symptoms or call for cortisol tests) although the reported symptoms could be seen as a possible adrenaline-powered stress reaction. After all this, one considers drugs/toxins/other stimulants; pseudoephedrine would fit this bill. Going further into the weeds, there're rarities such as spinal irritation (trauma, degenerative processes) affecting the dermatomes associated with C3 to T1.