Arrhythmia/IST

[dande4]

DR.,Thank you for your time.

39yrF w/3 children/on the go!. Recent echo/stress fine. Borderline MVP,trace mr./tr.(tests done yearly or every 2) Episodes of gradual increase/decrease of hr. Chills,teeth chatters. Recently was trying to switch from atenelol to toprol. While changing meds, hr at rest was 90's to 100 and when getting up/walking jumped to 130/140's. Took event monitor,showed sinus tachy.(thought maybe it was due to stopping atenelol and starting toprol) Went back to atenelol after 2 days. History of pac/pvc's. Episodes stated eariler are slow increase to peak then slow decrease. Event monitor placed and pressed during episode shows sinus tachy. Afterwards hr remains in 90's till adrenaline seems to subside.

In absence of structural problems,good echo/stress does this sound like IST? I can't figure the chills and teeth chatters except for adrenaline. Dysautonomia~is IST considered in that category. My cardio is leary to give IST diagnosis, says feels more anxiety/hyperadrenergic though I don't see myself as anxiety giving rise to my rate when I stand. Any reassurance?

Long term prognosis?
Can IST return to normal over time?
Would exercise help to reduce resting rate further even if meds.keep it in 70's/80's?
Would that possibly help to correct the tachy? Could this be POTS,no sig. b/p drop except little systolic 10pts or so.

Looking to get endocrine work/up done,though previous tsh etc., normal.

Thank you once again. Hope this post may help others.

[Cleveland Clinic]

dande5,

Thanks for the post. IST is a difficult diagnosis to make as it is often difficult to explain the what is abnormal, especially if your heart rate lies on the high end of normal. I would definitely want to see an extended picture of what your heart rate does over the course of a day to more clearly see the trends over long periods of time.

The main concerns of IST is whether the elevated heart rate can cause long term damage to the heart. If you truly had high persistant rates I would be more concerned then if you have elevations with activity.  It would also push me to treat you more aggressively. Overall, in all comers, IST has a fairly benign prognosis.

Certainbly conditioning, or lack therof can masquerade as IST. Physical conditioning wil be paramount for your health no matter what your underlying condition is. Better conditioning may also help with a small amount of rate control.

POTS and IST are probably linked and both represent a different subsets of autonomic dysfuction.  I would recommend seeking a second opinion with a cardiologist who specializes in autonomic dysfucntion, such as at a syncope clinic before establishin this diagnosis and looking into other treatment options.

good luck

[KAD]

I had IST problems for about 1yr.  MD's were very aggressive about treating it.  You sound a lot like me.  My rates would rapidly increase to 140-150 with just getting up and walking across the room.  I hated being on all the medications so they ablated my sinus node-several times.  Ablating the sinus node is tricky and runs the risk of needing a pacemaker.  I ended up with a pacer(at a very young age).  I still see high heart rates, which is hard to believe after 4 ablations of the sa node and a pacemaker.  But do feel much much better.  And don't have to worry about cardiomyopathy(enlarged heart) at the age of 30.  I don't regret my decisions and do think the doctors did everything they could for me.  Did you ever get a tilt table test?  Supposedly it sorts out pots vs. ist.  I hope things work out for you.  Best of luck!

[mom3kids98]

Hello. Just wanted to let you know you are not alone! My gosh, you sound like me. I have 3 kids and on the go too. Have had mvp and svt since 21 (am 42 now). Had ablation about 10 yrs ago and did ok but still had to take lopressor(beta blocker) since. Just started having more tachycardia not really super but enough to bother me. Dr. put me on rhythmol instead and tried to come off of lopressor and my heart rate would do the same thing. When I got up or attempted to do any movement much my heart would take off. I think it was coming off lopressor cold turkey. My resting heartrate is usualy around 75-80. I went back on my lopressor with the rhythmol after about 3 days, I couldn't take it anymore! Now Dr. wants to do another ablation and says I have to come off meds for 4-5 days before. Is he crazy?! I couldn't come off the meds, my heart would go crazy! Oh well, I am having to think it over. Hope everything get better for you. God Bless! Joy

[jan]

I had the same problem.  I tried to get off the bb and every lil thing I did my heart went nuts!  I was on a ccb at the time, too!  This has happened ea time I tried to get off.  

I was at my pcp about another problem, but when I got off the exam table and literally walked 1 or 2 steps I was SOB.  He came over and listened to my heart and couldn't believe it.  He increased the ccb.

Unfort. I had to go back on the bb, because of another problem it was helping with.  I wonder if anybody can ever get off of bb's?  I didn't have a problem when I stopped the ccb before.

[mom3kids98]

Hi Jan. May I ask why you came off the ccb. Is that what rhythmol is? I get all this stuff mixed up. I am taking both right now but I try to take them in small doses, I mean even less than I used to take cause I don't know how much it might slow my heart. The rhythmol has some bb in it too. Take care, Mom

[Momto3]

Rhythmol is a SODIUM channel blocker.  This was on the heart rhythm society website.  

Class IC antiarrhythmics are strong sodium channel blockers. They also slow nerve impulses in the heart, but have little effect on repolarization. They may be used for supraventricular and some ventricular arrhythmias.

Flecainide (Tambocor®)
Propafenone (Rhythmol®)

Hope you're feeling better.

[Bromley]

Hi. A lack of physical conditioning or anxiety might underlie a part of the problem, would be a lot better than having a heart condition that causes the IST, and offers reason to have hope. For one thing, there is a good chance that you could eventually control both adequately thru exercise, medication, and lifestyle mods.

Following an ablation in 2004 for Wolf Parkinsons, I had fits of PVC's and PAC's, short runs of SVT and NSVT, and some IST. I had shortness of breath after light activities, and pain in my chest that both me and my doctor thought could be heart disease. I didn't know whether I would have an MI, eventually get bad VT's and die, end up with a Pacer, or be limited for the rest of my life in terms of physical activities that I would be unable to do.

After consulting my doctor, I started an exercise program and made diet modifications; both of these "initiatives" were adhered to faithfully everyday almost without fail.  I am convinced that my present good health (all symptoms but for occassional blips have subsided, off of Beta Blockers) --- though an incredible blessing for sure --- owes a lot to exercise, and of course to some great medical care I received from my Doctors (and nurses).

Talk to your personal doc before doing it, but as the doc here suggests, get going on exercise.  In my case, I just cant say enough about how much all of it helped.

Good luck.  -B

[rickyc]

I am 61 years of age.  I have had skipped beats since I was 17.  Back then I was a heavy smoker and coffee drinker.  I quit smoking better than 20 years ago; now I chew copenhagen 90% of the day.  Years ago doctors told me that caffene and nicotine could very well play a major role in these extra beats, so you would think that I would quit. (Not me. Stupid Huh)?  I've since retired and one evening last fall I had them at the rate of 1 for every three beats.  I went to the hospital and they hooked me up to everything and pretty much came back with the same response:  Cut the caffene and nicotine. I've cut down on the coffee but still chew the stupid tobacco.  I also wore a Holter moniter.  This device picked up a couple hundred in a twenty-four hour period My doctor said that I should also have a stress test.  I passed on that because I had one years ago and it came out fine.  The nasty thing about these skipped beats is that they drive you nuts.  I'm a worry wart to begin with and they just make it worse.  Last year while browsing this forum a gentleman had a posting where he claimed that Malox
or gaviscon had help him rid himself of some of these extra beats?  I would like to hear from him again.  Would be glad to hear from anyone who suffers from these nasty infractions and perhaps chat about them.
Thank you

[dande4]

Thanks everyone!

Bromley, you changed your diet also? In what way? I have once again started to do my walking routine. I try to eat well, though I do like sweets. I am not overweight, probably a little underweight. I would like to get off this BB one day. Thanks for your input!

Ricky, I have pvc and pac. For several years. Sometimes worse than others. Definately stress, caffiene can aggravate, especially for me. Hang in there.

[calico1]

Hi Everyone,

I am taking Toprol XL 25 mg everyday for IST and mild hypertension. Both problems are well-controlled by BB. I'm planning to travel to Asia next month. I'm worried about what the elevation (especially sudden increase) will do to my HR & BP as I would be basically up in the air for at least 16 hours. Any idea?

Thanks!

[Bromley]

I cut back on fat, cholersterol, and caffiene, and eliminated alcohol.  I am as careful with calories as I can be.

The bit about calories is a little easier for me to do when I engage in one of my favorite things to do: long distance running. But running is not for everyone.

Consider --- for this exercise, calories burned can be found out based on weight and distance traveled: Calories ~ 0.758 * lbs * miles. So for example, 145lbs * 10mi * 0.758 = 1099 calories, which makes it easier.  I dont usually run this distance; I use it to make a point. Running ten miles is time consuming and a minor annoyance in light snow. It is nearly impossible in deep snow, on icy surfaces,  in heat or strong wind. If you can only spend the time or endure three miles in the weather, then you get 330 calories, which is easy to reverse with a mistake such as eating a bagel or drinking too much GatorAide. Walking is very similar, but you get less calories per mile.

On top of this, the whole calories burned thing is more complicated for people with heart issues. From a purely "calories burned perspective", some people say it's better to combine aerobics with weight lifting. True, it's harder to predict the calories required for weight lifting, but the activity  burns calories very well compared to aerobics. But, if you have heart issues, I dont think weight lifting necessarily develops your heart muscles the way you would like. And as you approach middle age you run some risk of injury (rotator cuff, or back injuries are examples). Who wants a damned rotator cuff injury ontop of a heart problem?

What I am saying is that the benefit of the distance running seemed to go beyond the calorie burn. It was intense exercise that consumed a good deal of time and energy. I really wonder whether it didn't somehow modify the electrical substrate of my heart in some way.

Did it stretch the substrate? I dont know. Since all the problems after the ablation (VT, SVT, IST etc...), the improvement has been very very good.

Good luck. -B

[rickyc]

Thanks for the response.  I'd be a lot better off if I'd get of this copenhagen.  I've got this in my lip 20 hrs a day.  I think there is a lot of nicotine in this ****.  But you know how it is.  Years ago, my doctor who is retired now and was somewhat of a heart specialist told me he doctored a runner in track.  This runner got a series of skips and was told to grunt as if you were having a bowel movement.  He stated that this would help.  It does not really help me.  Also years ago, when I was just a teen, a older lady who was a doctor told me several times to get off the coffee and tobacco.  She stated that this contributed heavily to the skips.  I know exactly just how all of you feel with these.  They are terribly annoying and stressful.  I also know quite a few individuals who get them.  My wife included.  Although she does not get as many as I do.  Like I stated earlier, the one evening last fall I had one out of every three.  I thought I was dying. I've heard talk of this Malox or Gaviscon deal.  Thought I'fd give it a try.  Also, I take 25 mil of Tenormin a day for slightly high blood pressure. I thought I'd read somewhere that they can actually cause skips?  Anyone heard of this.
Thanks everyone.  Hang in there.  We'll beat this.

[Bromley]

Hi. Never heard of the Malox thing, but I was once told of the valsalva manuever (the grunt thing).  I think I was supposed to use it to convert from PSVT to normal rythmn.  So it's not intended for individual skips,  as much for a whole slew of 'em in a row.

I've never tried chew.  I think I would scale that one back a bit, or end it immediately, if every third beat is being skipped.

I dont think I have every heard of beta blockers causing more skips, although you start to depend on them if you take them. The doctor here has said that after you take them for a while, you have more skips when you stop taking them, as compared with not having taken them at all.

Later.

[Bromley]

By the way, I dont think the valsalva helps much with VT either.  Not sure on that one. I do know PSVT can be positionally affected, whereas VT is not.  Could the Malox be helping acid reflux, and threfore be helping your heart indirectly?

Good luck.

[rickyc]

Thanks for the response.  I'll keep you posted on any progress.  I was curious.  How often and how many of these buggers do you get?  Good luck.

[rickyc]

I posted the question regarding how many and how often regarding the skips to Bromley.  I'm re-doing it.  Didn't know if I got your name in there.  Sorry.   Later.

[Bromley]

Hi. It was about 6 minutes worth of PSVT beats prior to ablation. 6 minutes * 250 bpm = 1500. PVC's and PAC's were basically non-existant. This was getting worse over time.

After ablation, it's all very random and hard to explain. I get little runs of different stuff (VT and atrial tachy/SVT) and days where isolated skips get to be fairly hectic.  But as I said before, exercise seems to have helped quite a bit. Anymore I've dropped the beta blocker, unless I have a dire need.  Caffeine may not be as much of a factor anymore either. Not sure.

[rickyc]

Thanks for the response.  I'll keep you posted on these crazy buggers.  There will be times for maybe months at a time when I'll never notice even one; then they sometimes start all over again.  Go figure.  Stay well.

[rickyc]

Back in 2002 you had postings regarding skipped beats.  Wondered if you were still around.  I e-mailed you back then, however, got no response.  Please reply...

[tickertock]

Sheryl 1945 was very ill the last time I communicated with her which has been a long time. I don't know if she is still around to be quite honest as I emailed her on several occasions and never received a reply and we communicated quite often. I pray she is better and that she will respond, I dont want to elaborate on her illness here on a public forum, but I thought you might like to know. Happy Thanksgiving.

[rickyc]

Appreciate the response regarding Sheryl.  I attempted to contact her several times.  If you like yoou couthat info with me.  My e-mail is ***@****

[Lana_05]

I have this strange problem with IST too.
This is what happens to me. If I lie in bed and move from side to the other, my heart starts galloping from 60 to 100 bpm (recorded by Holter).
If I stand up, the same story but it beats fatser - 120+.
Most of the time I feel my heart pounding in the chest when I change positions and just stand up. Imagine what my heart does when I walk fast or run.
This is all very strange to me because up until this April I was jogging 14 km a day.
This condition (IST or POTS) sometimes goes away. If there is a stressful moment in my life, it comes back and stays for a while.
Can someone with POTS or IST tell me if it is possible to have it all the time or it may go away and then come back?
Some days are better than others and I wonder if stress can make me feel this way. Without a doubt, I will not be able to go for a run now, after I have been doing it for over 5 years.
Please let me know if you have the same problem.
PS I also have troublesome extrasystoles which appeared at the same time (this April).
Thank you.

[zeliig]

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