Fast heart rate/Pulmonary Hypertension

[labrat]

Dear Doctor,
After feeling as if I were about to black out, I was hooked up to a Holter and these were the findings (I'm 43, female, weight ok):
-sinus rhythm, sinus arrhythmia, sinus tachycardia, at a rapid average heart rate.
-rare, unifocal PVCs, all single.
-no atrial ectopy was detected.
-no sustained, ectopic arrhythmia detected.

Predominant rhythm:sinus rhythm/sinus tachycardia
ST-Segment/T-Wave Changes: no significant changes noted
Significant Ventricular Ectopy:unifocal PVCs
Significant Atrial Ectopy:none noted

Maximum heart rate: 141 bpm (1 minute average)
Mean heart rate: 100 bpm (1 min average)
Minimum heart rate 73 bpm (1 min. average)

normal beat total 130516
aberrant total 79 av. 3/hr
PVC 30 av 1/hr

Blood work: no anemia, normal thyroid function, LDL/HDL ok; however extremely high C-reactive Protein

I understand that the sinus rhythm is good, however the pulm dr. did hear pulmonary hypertension via stethoscope.  I have had indications of it on previous echos. I am repeating the echo and PFTs to see what's next.  (I have annual echos/PFTs due to scleroderma.)

Do you think that the rapid heart rate is due to pulm hypertension?  What would you suggest?

Thank you.
labrat

[CCF-M.D.-RCJ]

Labrat,

Thanks for the post.

The diagnosis of scleroderma should figure predominantly in the search for your spell.

Scleroderma can cause many cardiac abnormalities: pulmonary hypertension, cardiomyopathy, arrhythmias, pericarditis, sinus tachycardia, myocardial hypertrophy, and valvular disease, to name a few.

Complications from these cardiac manifestations could certainly be at the root cause for your symptoms.  Pulmonary hypertension can lead to syncope, but usually at a late stage in the disease process.  An echocardiogram and event monitoring are certainly indicated.  A stress echo may also be worth considering.  However, I strongly encourage you to see a scleroderma specialist.  I personally know, and greatly respect, Fred Wigley at the Johns Hopkins Hospital in Baltimore -- but other scleroderma centers exist as well.

Good luck.

[labrat]

I should add that I have severe Raynaud's, believed to be systemic, not just hands/feet.
Thank you.

[Mr. J.]

Hi Labrat,

I love your name - very clever!  We are in somewhat similar circumstances.  After being sick for 2 1/2 years now my doctors are starting to think I have some type of collagen vascular disease.  I have many scleroderma-like symptoms but no skin involvement and negative antibody and inflammation tests.  You can find a thorough discussion of my symptoms by looking back to my first post in mid-September of this year.

Anyway, the reason I am responding to you is that I have suffered from an increased heart rate and palpitations for two years now.  Based upon several echos, they thought I had pulmonary hypertension but after a right heart catheterization, they determined I did not have PH.  But they did find that my heart is pumping twice as much blood through my body as it should.  My doctor now believes it is possible that inflammation in my body is causing my blood vessles to constrict which in turn is resulting in the high cardiac output and increased heart rate as the heart tries to compensate.  This would make sense because the heart rate increase and palpitations first started at precisely the same time that I developed vascular symptoms (raynaud's and overall coldness).  Like you, my raynaud's appears to be systemic.

After wearing an event monitor, I have been diagnosed with short periods of sinus tachycardia and SVT - although my heart rate runs higher-than-normal much of the time - even when it does not qualify as sinus tach.  I don't know if I am helping you out much here but I wanted to let you know that there is someone who can relate to your situation - at least somewhat.  I am currently taking Toprol to slow my heart and have started calcium channel blockers to try to dilate my blood vessels.

I've sort of rambled on here so forgive me but I wanted to make sure I responded to your message right away.  I would like to visit with you further if you would like.  My e-mail is [***@****].  Make sure you mention "heart" or "scleroderma" or something like that in the subject so I don't delete your message thinking that it is some sort of spam!  I hope to hear from you.

-Mr. J.