27year old w/ sinus tachycardia

  My 27 year old daughter has had tachycardia for 10 years which has worsened in the past few months, recently causing
  her to collapse when at a bowling party.  She was taken by ambulance to ER found to have heart rate 200, EKG abnormal
  on lst reading, moving to normal in 2 hours.  Local cardiologist found MVP, & after 24 and 48 hr holter monitors showed
  heart rates 70-170 even sleeping, he said is is sinus tachycardia, caused from MVP.  Went to EP in Dallas, who agreed it is
  sinus tachycardia, but not caused by MVP and ordered event monitor, which she used 30 days.  Still no definitive diagnosis, and
  he wants her to wear it another 30 days.  Is this necessary?  She is most impatient with this process, and losing faith in docs
  (her dad is one).  What would you tell your daughter?  Is this life threatening?  What about the collapse?  Any suggestions?  
  Thanks.

[CCF CARDIO MD APS]

_
Dear Jo,
YES the second 30 day event monitor is key to capturing the cause of your daughter's collapse-as it is unlikely for anyone to pass out just from sinus tachycardia.  Because she has passed out (this often times is the only warning of a life threatening arrhythmia) some EP cardiologists might chose to just study her heart's electrical system with a low risk invasive procedure called an EP study.
Ask your daughter's EP doctor what he thinks of doing an EP study which he may say that he will consider in the future, perhaps if the second event monitor shows nothing that could be responsible for your daughters symptoms.
Tell your daughter that this type of problem requires patience on everyones part, in some patients it can be months or even a year until you catch tha abnormality, and just so you understand, just because you do an EP study, there is NO
guarantee that the doctor will be able to reproduce the bad rhythm.  In the case where you can not figure out the cause but you suspect a rhythm disturbanc then the patient willoften be given a trial of drug therapy.  It would be best if you and your daughter could discuss these issues as well as the longterm plan with her EP doctor.

I hope this information is useful. Information provided in the heart forum is for
general purposes only.  Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
cardiology staff that can be used to select the physician best suited to address your
cardiac problem.