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Heart Disease (Expert Forum)
Inappropriate Sinus Tachycardia,Panic Attacks,or WPW
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve, Pacemaker, PAD, Stenosis, Stress Tests
Inappropriate Sinus Tachycardia,Panic Attacks,or WPW
by ChasD, Oct 14, 1999 12:00AM
I am writing to you to talk to you about the diagnosis of Tachycardia. I have been having Tachycardia attacks for 6 years it will be this December and have been unable to get an exact diagnosis. Here is my story: In December of 93 i had and episode of tachycardia of 180bpm that took me to the emergency room. They said that i was having Supraventricular Tachycardia and that my EKG showed "Wolffe Parkinson Whites Syndrome"- it resolved on its own without medications. They referred me to an Electrophysiologist- I went to my vist and they explained the condition and my options- medications or cardiac ablation. They put me on Tenormin in the mean time til i made my decision on the surgery. Between DEC93 and FEB94 i went to the emergency room on numerous occasions scared and afraid i was going to die with these frightening attacks. I felt like i could not lead a normal life so i decided to have the surgery. In Feb 94 i underwent the surgery of ablation for 2 accessory pathways. After my surgery my doct came in and said he was successful at ablating both pathways but that he didn't think that was my problem because they were so small. I guess he was right because the attacks continued even though my EKG was back to normal. So, we looked into other things it might be: Tilt table study(normal),Echocardiogram(normal),Pheochromocytoma(normal),Thyroid studies(normal). He found everything to be normal and said that i actually had a very healthy heart and that the only other thing he could think of was Panic Attacks--- I'm thinking "After all this". Anyway, from Feb 93 til July 97 I have been in counseling for Panic Attacks with still no resolvement so when i moved back home after my husband getting out of the military i went to seek help from another cardiologist thinking something was missed. I told her my story and did an Ekg,echo,holter monitor, and event monitor and diagnosed me with "Inappropriate Sinus Tachycardia" and gave me my option-medications or Sinus Node Ablation. Well here i go again - another surgery that might not be necessary or even be successful. So from August 97 til now i don't know what to do. How can it be differentiated between these diagnosis. Here is my symtoms: Tachycardia and pounding heart,sweating,tingling of hands,intense nervousness and panicky feeling,upset stomach that lasts anywhere from 5-10 min and then i go back to feeling fine but tired. On a few occaions-probably 10 total it raced for and hour leading me to the ED- i have never had to have meds to stop -it always resolves on its own. Now my cardiologist is saying "Inappropritate Sinus Tachycardia" and "Panic Attacks". How do we know what needs to be treated??? Sorry to be so long but i wanted you to have a true understanding of my frustration with a diagnosis. Please Help- I greatly appreciate your services that you provide.
Doctor's Answer
by CCF CARDIO MD - CRC, Oct 14, 1999 12:00AM
Dear ChasD,
Thank you for your question. There are many causes of tachycardia (fast heart beat) and they can be divided roughly into sinus (originating from the sinus node or heart's natural pacemaker) and non-sinus tachycardias. Nonsinus tachycardias are either supraventricular (coming from the upper chambers of the heart) or ventricular (coming from the lower chambers of the heart). Supraventricular tachycardias include: paroxysmal supraventricular tachycardia, atrial flutter, atrial fibrillation and AV nodal tachycardia. Ventricular tachycardias are more serious in nature and are due to a rapid depolarization of the ventricles.
Sinus tachycardia is defined as a heart rate of greater than 100 beats per minute originating from the sinus node. Sinus tachycardia is classified as either appropriate or inappropriate. There are many causes of appropriate sinus tachycardia such as exercise, anxiety, panic attacks, dehydration, deconditioning, volume loss due to bleeding or other loss of body fluids, hyperthyroidism, electrolyte abnormalities and many other conditions.
Inappropriate sinus tachycardia can only be diagnosed when all causes of appropriate sinus tachycardia have been ruled out. It is not clear what causes inappropriate sinus tachycardia but possible etiologies are an increase in the rate at which the sinus node depolarizes and an increased sensitivity to adrenaline. Once the diagnosis has been made by ruling out all of the potential causes of appropriate sinus tachycardia there are several treatment options. If the symptoms are not overly concerning no treatment needs to be done. There is no increase in morbidity or mortality in persons with this condition and they can expect to have a normal life-span. For persons in whom the symptoms are unbearable medications such as beta blockers or calcium channel blockers can be used, usually with good results. In the rare person unable to tolerate medical treatment catheter ablation (burning) of the sinus node with insertion of a pacemaker or surgical removal of the sinus node have been used in the past. Newer techniques are being developed using catheter ablation to modify and not destroy the sinus node thus avoiding the need for a pacemaker. This procedure is still in it's infancy and should only be undertaken at a major medical center after consultation with an electrophysiologist.
Thank you for your question. There are many causes of tachycardia (fast heart beat) and they can be divided roughly into sinus (originating from the sinus node or heart's natural pacemaker) and non-sinus tachycardias. Nonsinus tachycardias are either supraventricular (coming from the upper chambers of the heart) or ventricular (coming from the lower chambers of the heart). Supraventricular tachycardias include: paroxysmal supraventricular tachycardia, atrial flutter, atrial fibrillation and AV nodal tachycardia. Ventricular tachycardias are more serious in nature and are due to a rapid depolarization of the ventricles.
Sinus tachycardia is defined as a heart rate of greater than 100 beats per minute originating from the sinus node. Sinus tachycardia is classified as either appropriate or inappropriate. There are many causes of appropriate sinus tachycardia such as exercise, anxiety, panic attacks, dehydration, deconditioning, volume loss due to bleeding or other loss of body fluids, hyperthyroidism, electrolyte abnormalities and many other conditions.
Inappropriate sinus tachycardia can only be diagnosed when all causes of appropriate sinus tachycardia have been ruled out. It is not clear what causes inappropriate sinus tachycardia but possible etiologies are an increase in the rate at which the sinus node depolarizes and an increased sensitivity to adrenaline. Once the diagnosis has been made by ruling out all of the potential causes of appropriate sinus tachycardia there are several treatment options. If the symptoms are not overly concerning no treatment needs to be done. There is no increase in morbidity or mortality in persons with this condition and they can expect to have a normal life-span. For persons in whom the symptoms are unbearable medications such as beta blockers or calcium channel blockers can be used, usually with good results. In the rare person unable to tolerate medical treatment catheter ablation (burning) of the sinus node with insertion of a pacemaker or surgical removal of the sinus node have been used in the past. Newer techniques are being developed using catheter ablation to modify and not destroy the sinus node thus avoiding the need for a pacemaker. This procedure is still in it's infancy and should only be undertaken at a major medical center after consultation with an electrophysiologist.
Thank you so much for your time that you take to answer the
questions on this board so thouroughly. This is a wonderful site to have;I only wish i had found it much earlier to know that i'm not alone with these heart problems at age 26.
Thanks Again