How much tachycardia is too much?

[mika_k]

After reading the post and answer on 2/7/05 I got a little nervous. I am 28 years old, exercise at least 5 days a week, bmi of 19.  I started having tachycardia in the range of 140-160 about 10 years ago. in 97' my doctor sent me to a cardiologist who said I had a 2/6 systolic murmur.  He did a echo and a ekg.  echo showed mild mitral regurgitation, the doctor said, not significant and not to worry about it.  EKG had abnormal p waves, holter showed svt max heart rate of 194.  in 98' had ablation of eptopic atrial tachycardia and had no problems for 4 years, until I got pregnant.  Tachycardia on and off for a while, but for about the last 2 years my heart rate is constantly above 95. My resting pulse is 95-115 and most of the day it is in the 120-140 range.  It never gets much higher than that.  Last week it was in the 140-160 range for 3 days straight.  When it goes that fast I get pretty tired and short of breath. I get wake up 1-4 times a night with my heart racing.  I see my cardiologist every 6-9 months. He is so busy he only spends 2-4 min in the room with me.  My heart rate has been over 110 the last 2 times I have seen him.  He never seems worried, so I didn't worry either until I read the post on the 7th.  Can it be normal for some people to have there heart go faster, even when in good shape?  Should I get a second opinion?  I have not had another echo since 97' and no ekg in probably 3 or 4 years. Is a 2/6 murmer anything to worry about?  I take no medications and have no other med problems.  What are symtoms of cardiomyopathy?  should I be worried?  Thanks you!

[Cleveland Clinic]

mika,

It really isn't clear if it is the tachycardia that causes the problem or the underlying mechanisms. An ectopic atrial tachycardia can cause problems at a rate that sinus rhythm may not.  It is important to determine the mechanisms and not just the rate.

A heart rate of 95-115 may be normal in some people, but what you report as constantly 120-140 is not.  If this is truly the case, I would try to verify it with holter monitoring. A second opinion might ease your worries.

Worry about a murmmer depends on the mechanism of the murmmer.  If its from mild mitral regurgitation, periodic surveilance with echocardiography would tell if the degree of regurgitation has changed.

Chest pains, fatigue, shortness of breath, swelling and difficulty lying flat are some of the common symptoms people can report associated with heart failure.  Unfortunately, they are somewhat non-specific and need to be interpreted in the context of the patient and all of the history and physical.

If you havent had a thorough evaluation since 1997, its probably time to really get a good going over.  As I mentioned, a second opinion might help ease your worries.

good luck

[tickertock]

have you ever heard of inappropriate sinus tachycardia?

[tickertock]

i really don't know but if you had a rf ablation for ectopic atrial tachycardia i would think at least an ecg, echo and holter should be ordered especially if you have these fast heartrates everyday, just my 2 cents of worth of thought.

[mika_k]

I have heard of innapropriate sinus tachycardia.  When I first started having problems, they thought it was either that or ectopic atrial tachycardia.  When they did the ep study they said it was ectopic atrial tach.  I am so used to it racing and I have pvc's every day, I just thought it wasn't a big deal.  I forgot to ask the doctor what kind of treatment they would do for that.

[tickertock]

i was just the reading the archives and this came as a thought. i don't know what therapy they would use, sames from what I read beta blockers would be a standard therapy.

[KAD]

Hi Mika.  I have IST and am the one who posted that ? on 2/7.  From my experience with IST, they first try to treat it with meds.  Primarily beta blockers first, then if those don't work they may try calcium channel blockers and/or antiarrhythmics as a last resort.  If they have tried lots and lots of meds with little or no success, they might try an RF ablation or sinus node modification.  Of course the big risk with ablating on the sinus node is the possibility of ablating to much and ending up with a pacemaker.  That is why they try to control it with medication, I think.  It sounds like you are frequently having tachycardia.  Maybe your doctor should order a 24h holter monitor, to see how frequently you are tachy?  My doctors are just going to check frequent echocardiograms on me to make sure I am not heading towards cardiomyopathy.  Good luck!

[Linda123]

Hi there
If you haven't had an echo since 1997 - that's 8 years ago, I  really think it's time you had some basic tests done including an echo.  I wonder if it might be an idea to change your cardiologist (if possible).  
Sorry to hear of your troubles and hope you soon get some attention and progress.
Best Wishes, Linda

[mika_k]

before I had the ablation in 98' I tried several different medications.  I tried a few beta blockers and some antiarrhythmic drugs but nothing seemed to work.  The beta blockers had bad side effects for me, and the others didn't seem to work very well.  I think maybe I should get a different doctor.  He is supposed to be very good, I just think he is so busy he doesn't have time to really listen.  I have told him before that my heart it going fast all the time, but I dont think he realizes how fast and how often.  He always just says it's not a big deal, and maybe it's not.  I am so used to it I don't have many side effects other than getting tired and short of breath.

[I'mallheart]

Hey, i think you should get a secound oppinion.. and some of the basic tests they do should be done.. like ekg, echo , holter.. i take beta blocker, it does have side effects but for the most part has done okay for me.. just get tired and sometiimes slow pulse or low blood preasure..make sure your getting a good diet also, magnesium etc.hope all is good for you and you find your peace in this
dave

[mika_k]

I just want to thank you all for your comments.  It is so nice to have a place like this to get support and answers to your questions.  I know that my heart stuff may not be a big deal, but sometimes it can be scarey and it is nice to know there are so many other people dealing with the same things.  thanks again!

[Stelladallas]

If I were you, I would run to a different physician.  One who would take the time to talk with me and be proactive.  I cannot imagine having symptoms you mentioned at such a young age and with a young family.  Good luck!  Stelladallas

[Emmaj]

I have had problems with drs with good reputations ... I am for a 2nd opinion too. I am quite shocked you have not had the routine tests since 97, given your history. It seems to me that for the mitral regurgitation alone -- it can be progressive -- you should be checked by something more reliable than the drs ear for a murmer... svt tachy can be a symptom of mvp... and shortness of breath... anyway, my 2 cents -- for what it is worth. I hope you post again down the road and let us know how you are doing!!

[WPWGuy]

I think a second opinion is almost always a good idea.  But for once, I am going to play devils advocate here and say I think it is imperative to communicate well with your doctor.  If you go for the second opinion, good communication will still require a lot of focus from you...  

Maybe you could spend some undivided time with yourself before going to see your new and/or old doctor(s).  Maybe even write your symptoms and questions down and put them in order of priority.  If you forget to tell him something, call the office or write him an email, and follow up until you have the response you need.

Just a suggestion --- I dont know anything about the relationship you have with your doctor --- I can definitely relate to your frustration tho.

Good Luck.

[jan]

I would suggest a new cardio, too.  One of the things my cardio/ep treats me for is IST.  I am on beta and calcium channel blocker (both because I can only tolerate a sm. dose of the beta, but need that for NCS).  I have a visit every 6 mos. and he gives me all the time I need.  I get routine echos every 5 yrs. (it's actually been more often, because of diff. things popping up). (I,also, have mild vavular disease).

[Leslie8]

Hello there,

I have had IST for a very long time, had echo, stress testing, blood work, heart cath and everything is fine but a high HR. My HR most of the day is around 140bpm, when doing activity HR around 200bpm. I have tried many meds without sucess, and had 2 ablations on my sinus node. I have been told not to worry about HR it will not hurt you. We can only treat symptoms. Lightheadeness, SOB and nausea, So I have decided to ignor symtpoms and if i am active make sure there is a place to sit if symptoms come on.

Leslie

[dquenzer]

I think that if I were you I would go to a large medical university with a very well known EP specialist. Get a complete work over.  There could be many things that are the cause.

Good luck.

[Leslie8]

Hello,

I have gone to a major heart hospital in AZ. All test have shown no problem with my heart and all blood test have been negative, just a very fast resting HR. All IST and nothing to worry about. I have to try to believe that it is not going to hurt me, but the symtpoms are hard to deal with. I feel lightheaded, SOB and nausea a lot of the time. As long as I have a place to lay down when symtpoms get real bad, I will not feel like passing out. I have been living this way for years. I do get frustrated feel like this so much.


Lesie

[KAD]

does anyone have any experience/success with sotalol being used to control IST?  my cardiologist was toying with the idea of trying it for me?  do you have to be admitted to the hospital for initiation of sotalol?

[mika_k]

Thanks for the infomation.  I also get a lot of nausea and lightheadedness.  I have passed out a few times in the last year, but not as often as I used to.  My doctor said that it was because my heart raced so fast that my bloodpressure dropped and my brain wasn't getting enough blood to it.  Thankfully it doesn't happen often any more.  The biggest problem is I get really shakey when it goes that fast.  
  I did get a EKG this week and there were a few things that were wrong with it.  I am not sure exactly what.  Some things were better than before and some things were worse.  He said I had some inverted T and P waves and an extra R wave.  I have no idea what all those mean, but I am going to get a second opinion.  I would feel safer if I had a holter monitor so I could see how often my heart rate was really fast.  It does make me feel better to know your doctor told you not to worry though.