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Inappropriate Sinus Tachycardia
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Inappropriate Sinus Tachycardia

I've recently been diagnosed with IST, after months of tests, meds etc. I also have very frequent runs of bigeminy and short runs of NSVT (5-6 beats at a time. I have a few questions I'd like to hear your opinion about...as I wait to see my own doctor
1. What is the likelihood of developing cardimyopathy from IST? If I don't take medications I can have rates up to 150-170 for hours at a time, despite making all the usual lifestyles changes (no caffeine etc.)
2. Is ablation an option to treat IST? If so is it usually successful?How risky?
3. Is the IST and the ventricular ectopy related. Since I have a normal heart by echo, I wondering if the IST somehow causes the venticles to be irritable as well.
If it's of any consequence I'm 29, female...exercise regularly,relatively stress free good cholesterol, mild HTN, don't and never have drank or smoked...and sadly now , no coffee either :(
I'd appreciate any answers you can give and thanks for providing this great service.
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Hello,

I am sure you have already figure out this is a difficult problem to treat.

1. What is the likelihood of developing cardimyopathy from IST? If I don't take medications I can have rates up to 150-170 for hours at a time, despite making all the usual lifestyles changes (no caffeine etc.)

very low, but not impossible.

2. Is ablation an option to treat IST? If so is it usually successful?How risky?

It is an option for medically refractory symptoms and heart rates.  It is a tricky procedure and should be done in experienced hands.  Dr. Patrick Tchou does most of ours at the Cleveland Clinic -- he is very good.

It is usually successful of reducing the heart rate, but there is often a component of residual tachycardia.   The big risk is needing a pacemaker.  I am not sure what percentage to quote you and it probably varies by operator.

3. Is the IST and the ventricular ectopy related. Since I have a normal heart by echo, I wondering if the IST somehow causes the venticles to be irritable as well.

I do not know of a relationship, but I have not extensively read this literature.  

I hope this helps.  

Cheers to all for a tachycardia, chest pain and PVC free new year.

26 Comments
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84483_tn?1289941537

This is a great question, I been wanting to ask a similiar question myself about the relationship between IST with PVCs and NSVT, saves me having to wait 6 months to post.

I usually used to have high resting heartrate in 90-110 range which is not bad,though it would be in 60s at night and really not that excessive with exercise, though it is completely controlled with beta blockers, with them it is usually in 58-66 bpm range at rest. All the best for the New Year.
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Avatar_n_tn
Tickertock...did your IST start after any identifiable (sp.) event? I had never had any problems until I started exercising! About 3 yrs ago I lost around 60lbs through diet and somewhat vigorous exercise and thats when everything went downhill. I find it bizarre that people with young and healthy hearts can all of a sudden find themselves with these rhythm problems. I also notice on this site that many people have been told it is "anxiety" causing their problems. I shake my head at this. Iknow how aggravating this whole IST mess is to me. While I'm sure anxiety contributes to any health problem, I'd like to know how anxiety explains one's heart racing to 170 simply from washing one's hair in the shower!

Happy New Year to everyone and best wishes for a healthy or healthier 2006.
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Avatar_n_tn
I had IST for about one and a half years.  My rates were very rapid all the time with rare episodes less than 130.  My doctors told me I would for sure develop cardiomyopathy and I took them very seriously(I'm only 28yo)  So I underwent an ablation to the SA node.  The first ablation did not do anything and the IST returned in about 1 week.  The second ablation did to much and they ended up ablating a little to much of the sinus node and I ended up needing a single chamber atril pacemaker for my heart rate dropping to 30-40 beats per minute.  About 3 months after getting the pacemaker the IST came back again, with heart rates in the 130's.  So they did a third ablation, this one seemed to have worked(knock on wood).  It was done this past April and now I am dependent on my pacemaker for my heart rhythm, but it's better than getting cardiomyopathy.  I was told that ablations only have about a 50%-60% success rate, but I don't really know what the alternative would be for severe cases of IST.  The meds made me feel awful and were ineffective anyway and I didn't want to just wait around for cardiomyopathy to develop.  It's a really tough decision with this problem.  It's kind of a no win situation.  I hope thing do work out with you and hopefully you have a good cardiologist.  I am very fit and active just like you and the pacemaker did give me the lifestyle that I wanted back!  Happy New Year!
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84483_tn?1289941537
To be honest I never was really diagnosed with IST, just a high resting heartrate, usually in 90-110 bpm at times 115-120, but probably averaged out to high normal in a 24 hour period. I had this all my life , it never did just start with me and my heart responds fairly normal to exercise maybe just a little higher than the average,but I always wondered about IST. I also notice that many persons with a high or low resting(either end of the extreme) heartrates often go on to develop PVCs or even occasional small runs of NSVT such as was the case with me, though every test indicate an essentially normal heart.

I have always been a high strung person with anxiety issues so I guess that is a contributing factor in my case also, I know for the last 20+ years beta blockers have been a great relief to me.

From what I gather IST can be difficult to treat and ablation usually never works for long and those that ablation works one is usually dependent on a pacemaker.

I also understand it usually gets better in middle to old age for some reason, rarely causes cardiomyopathy , but can in rare cases. I am not doctor this only my undetsanding of IST. Good luck, hope you feel better soon.
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Avatar_n_tn
This is my first time using this resource and thank you all for sharing your experiences with your arrhythmias.  I'm a 35yo female with arrhythmia dxed since age 21.  Have been on beta blocker since then.  I am now on 2 beta blockers, calcium channel blocker, and my resting rate is staying 130-160bpm.  My bp is staying around 80/60 because of the above meds.  Have an appointment with electrocardiologist in 2wks to discuss ablation.  My question to you guys is do you experience chest/back pain with your arrythmias?  I have non stop for about 2 days and don't know if it's anything to be concerned about.  Thanks!!!  jasta
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Avatar_n_tn
If my rate is high for a long period I get short of breath, with some chest tightness...not pain per se. Also when I get the runs of PVC's together there is usually a little chest tightness. This always stops as soon as the rate or PVC's are under control. I think this type of discomfort is normal....but I would be concerned that it's lasting days for you.
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Avatar_n_tn
Does anyone experience a variability in their heart rate?  I bought a heart rate monitor and constantly monitor my heart rate.  Just moving around can cause it to jump 20-30bpm...sometimes even 40bpm.  The rates aren't really sustained that long though.  I can't explain this.  Docs say it's anxiety, but I'm on vacation and don't really feel anxious.  Can anyone help?
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Avatar_n_tn
Hi..it's normal, in fact healthy for your heart rate to vary from beat to beat. Most healthy and or young/fit people have a large degree of variability in their heart rate, anxious or not.
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Avatar_n_tn
Hi everyone and happy new year from Italy!
I have a question that I would like to put to the doctors when I manage to click at the right time :-) but maybe you can help me. I suffer from sinus tach and PVCs. I can be OK for months and then have an episode. My cardiologist says my heart is healthy, PVCs are benign, etc, and that I must not let it scare me. But sometimes I lay there in bed at night, scared to death, with a racing heart, just praying for it to end. It usually goes away with a beta blocker which I take when needed, as prescribed.
My question is: when should we bo to the ER? Is it OK to just lie there and wait? Are there specific symptoms we should watch for? My cardiologist just tells me to wait till it goes away and not be frightened....easier said than done!

Thanks for listening and again have a wonderful, healthy new year

Fran
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Sorry, of course I meant "go to the ER"!

BTW, does sinus tachycardia really improve with age in some cases? That sure was great news to start the year...!

Thanks again
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84483_tn?1289941537

All the best and a Happy New Year. Go to this website,very informative on IST.

http://heartdisease.about.com/cs/arrhythmias/a/IST_2.htm

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Avatar_n_tn
Thanks so much for the very interesting site. It is really reassuring! It confirms what the great doctors on this site keep telling us...And it's so nice to know it may improve with age. The suggestion that an increased salt intake might help in some cases is a bit odd, but who knows...

Thanks again and best wishes
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Avatar_n_tn
Hi, I have not been diagnosed with IST or any other heart problem, but here is my story. About 2-3 months ago, I awoke in the middle of the night with my heart about to beat out of my chest. I thought it was a panic attack and that it probably wouldn't happen again for awhile. Well, it has happened again several times. The episodes are getting more frequent and seem to be much worse at night. And, I am constantly aware of my heartbeat, even hearing it in my ears a lot. I thought someone was driving by my house with their bass turned way up and it was just my heart beating loudly and reverberating in my ears. I am going to schedule a doctor's appt. ASAP. I just wondered if anyone's problems started out like this? Thanks for any help!
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Avatar_n_tn
I was just diagnosed with sinus tachyardia, beginning with frequent visits to my doc and one to the er with symptoms of feeling like i was going to pass out, rapid HB and occasionally skipping beats, feeling like i cannot take a deep breath, chest pressure, and just a weird feeling overall. I had an echocardiogram which they tell me looked fantastic. I have had suggestion from my doc and cardiologist that this could be anxiety and panic attacks. I am taking a very small dose (.5) of lorazapam, doesn't seem to be helping much, at least with the breathing thing. Any ideas?
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Avatar_f_tn
Hi,

Although your problem may be anxiety, I just want to make sure you don't make the same mistake I did.  I have had tachycardia for about ten years and was told that my heart is completely normal so it must be anxiety.  I have tried MANY SSRIs (ie-Paxil, Zoloft)  They have helped to some extent, but never really took away the tachycardia.  I also tried Lorazepam and it just made me more tired.  Anyway, there is an excellent article you should read to help you determine if your problem may be Inappropriate Sinus Tachycardia.  

http://heartdisease.about.com/cs/arrhythmias/a/IST.htm

Please go to this website and see if you can relate to this.  Also, follow some of the links to read about Postural Orthostatic Tachycardia Syndrome and dysautonomia.  I am 35 years old and over the last ten years, I was referred to many different specialists trying to find out what was wrong with me.  The allergist said I had asthma because of my shortness of breath.  Of course the inhalers made it far worse as far as my heart racing - even more shortness of breath followed.  With minimal exertion, I can hardly breathe because my heart goes so fast most of the time.  I am in the process of trying some other avenues since reading the article I referred you to.  The doctor who wrote the article suggests going to a Cardiac Electrophysiologist.  That is where I am headed next.  

I just wanted to share that in case it could help you avoid searching for answers as long as I did.  I wish you well and pray that you find your answer quickly.  God Bless You!
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Can I just ask if those people who are on heart meds for anxiety related arrythmic heart issues have actually tried some of the range of anxiety related meds?

Just seems odd that so many people are on these - sure it will settle your heart rate but aside from the adrenaline issue other hormones which come with the fight or flight (anxiety response) are still being fed into the system hence increasing the likely hood of further anxiety attacks leading to requirements of higher doses in the long term??  No??

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Avatar_n_tn
Hi Catelynn

I just wanted to thank you for the link to that article you sent. I know it wasn't directed to me but I had been watching Jenni's post for responses as her symptoms appear similar to my own. I had always had flip flops in my heart, even as a kid...maybe once or twice a year and it felt kind of neat (in my innocent kid mind) and never concerned me.
Over Christmas, (which was happy and uneventful) I started having more frequent palpitations, (my idea of palpitations is a skipped beat or flip flop feeling) rapid heart beat and generally feeling weak and very scared. That impending doom type of feeling. Also a very deep cough whenever I had the flipping. (anyone get this??) I finally went to the doctor who wanted me to have an ekg done first which showed my heart rate at 109 (pretty slow for me, actually) but normal otherwise. My pulse upon going into the exam room was 112. I was given the array of blood tests to rule out a deficiency or infection, etc. All of the blood work was normal.
I was sent given xanax and referred to a cardiologist. The cardiologist was very nice and explained that he didn't think the pain in my upper back was related to my heart at all and was musculoskeletal (sp). How he knew this, I don't know...maybe my description of the pain, etc. He, as well as my primary doctor said my lungs were clear so they can't explain the coughing. He ordered a 24 hour holter monitor which will start Jan. 30 and an echocardiogram which will be done when I return the monitor on the 31st. He said that I will hear usually within a week if there is anything unusual in the tests but that he expects not to see me again.
Don't get me wrong, I was so happy to hear that but once the euphoria faded, I was home, thinking, 'But, I am still having all of these symptoms and I can't be out shopping or something for longer than an hour and I am ready for a nap. I am only 37 years old! I have a 7 year old to keep up with.' What do I do if my heart appears normal (fingers crossed) but I am still plagued with these symptoms?
I just don't know where to go from there. I would appreciate ANY advice from anyone here if they know what kind of doctor to seek out next if my heart appears normal with the exception of the tachycardia and pvc's or pac's (yet to be determined with holter, I hope).
I don't know if the doctor will see this post but if he/she does , I would love to hear their impression. Anything, at this point. I feel like the tests he offered are a formality and maybe I am being cast off to the anxious crowd? I told him myself that I hope it is anxiey but why all of a sudden? I am quite happy in my life and this is really ruining it.
This site is wonderful and I am happy to feel less alone in this whole mess. Thank you for reading.

Heart_and_Soul <3
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Avatar_n_tn
feels good to hear I am not alone, but I am sorry you have similar symptoms. I too will cough, but only for a second, when my heart skips a beat. I forgot to tell the cardiologist this, but don't think it would change anything. I have been cast off into the anxiety world. This all started one day at work when my heart started racing and I felt like I was going to pass out. I don't get the fatigued thing that many of you get (unless I am taking my lorazapam), and actually have slightly higher blood pressure rather than lower (such as in that website). I have always been an anxious person, and hope I can say this is all related to my anxiety and nothing more serious than that. I hvae had a normal echo, and even a CT scan done on my lungs (also upper back pain that comes and goes), which appeared fine. Good luck to you heart and soul and good luck to me to figuring out our problems!!
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One more thing I forgot to mention to heart and soul. I have been seeing a chiropractor and he said that anxiety and depression can "sit" on your upper back, causing back pain. Since I have been going to him as well as frequent back massages, the back pain has almost completely subsided. Hopes this helps.
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Thank you so much! I was, like you, sad to know someone had the same thing I did and was going through the misery of it but was more than a little relieved that I am not alone. My blood pressure was 112/74 at the cardiologist and I was very stressed out at being there...pulse was 112. He said it was an excellent blood pressure, I was thinking, there's nothing excellent about any of this. I wish you the best of luck in finding a solution to your problem and ease of symptoms. I will be watching and I will post when I have my results from the holter and echo. Thank you also for the back pain information. That's very good to know...I will seek a chiropractor's care once all of this testing is overwith. Take care, Jenni.

Heart_and_Soul <3
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Avatar_n_tn
I am only 14 years old and have sinus tach!
I saw the top specialist in Britain of hearts problems and she told me that IST is not life-threatning, although it causes people with it to feel scared and extra tired.
I've had it for 3 years, it keeps going and coming back, its awful, but it hasn't stopped me doing things i love like running. Sometimes my heart beats so fast i feel sick. IST is annoying, but learn to live with it. (unless you've got a bad case)

Love from xLoveHeartx
:) xx
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Avatar_n_tn
I was dx with IST about 5 years ago. I'd had a fast heartrate for so long that it seemed normal to me. An echo showed that my heart was enlarged. I've had two ep studies and ablations, but the fast rate came back both times. I am on sotalol 80mg every 12 hours to control my heartrate. I've tried other medications, but sotalol is the only one that seems to help. I was really quite ill by the time I saw an electrophysiologist. I was developing heart failure symptoms. I am doing much better now, but must remain on medication most likely for the rest of my life. IST is not always a benign condition.
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Hi everyone.  First time here.  I'm the mum of a 3 year old girl with Inappropriate sinus Tachycardia diagnosed at age one.  Her heart rate is between 97 and 247 BPM.  They believe it has been higher but after 247 the moniters here in Australia switch to bradycardia.  She has had yearly holters and echo's and the cardiologist has seemed happy with her but over the last few months she has been falling asleep with the episodes. (up to 5 times a day)  We have an appointment with her cardiologist soon but I wanted to know from anyone out there who has this if feeling this way is normal?  She is also a severe asthmatic and cannot be medicated due to drug interactions.  Any help appriciated.  I feel helpless not being able to know how she feels.
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Hi Charlotte's mum :o)

I don't really have any information about your daughter falling asleep during her episodes but I just wanted to wish you well and I hope the cardiologist can help. Good luck..

heartandsoul
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heart_and_soul,

I just finally checked back at this posting, but must get to bed now since I have to get up with the kids for school.  I will try to post tomorrow because I could really relate to everything you said.  I pray that you get answers from your test!  Take care and God bless you.
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