Inappropriate sinus tachycardia and LV with mild diffuse hypokinesis

[mergie]

I am 38, 5'2 and now 92 pounds.  Very active and healthy until this all started.

Coincidentally or not, I was hit on the head hard, by a horses hoof two months ago.  (My head is still sore - CAT scan normal)  Slowly building from that incident was a fast hr.  I would wake up in the middle of the night with it wailing away and all the symptoms I wrote below.  I went to the gp and hr was 144.  ekg showed lbbb.  She sent me home w/25mg topryl.  I ended up in the er.  The gave me another toperyl and sent my home.

All blood work normal except slightly low Potassium in er, 24 urine normal.  


I am on a fairly high does of beta blockers - 50 mg Atenolol 2x a day.  My appetite is not great. I fall asleep OK but awake every night after about 3-4 hours. I can get back to sleep after a little bit.  I found a 1/2 glass of wine is not teloreated well.

I now find out that my echo showed a part of my heart that should be pumping 50-60% was at 45%. The report says 'LV with mild diffuse hypokinesis, estimated EF 45% and mild TR". The 'event' monitor I was given recorded - Sinus arrhythmia with tachycardia, IVCD, inverted T waves, and baseline movement. My cardio here wasn't concerned and told me to come back in three months. He said it was all 'benign'.

Without the beta blockes I cannot function.  My heart pounds, my hands get cold and clammy, my armpits sweat like crazy, my heart pounds and I feel TERRIBLE.  

Does this sound like dysautonomia....stress/benign???  I just don't see how it can be stress if it happens when I am sleeping.

Thank you for any replies.  

[CCF-M.D.-MJM]

Hi Mergie,

Sorry to hear about your recent health concerns.  You are in a difficult position.  The problem is that there are people that present with these symptoms and it appears to be all anxiety/depression driven, some have this phenomenon you descirbed call inappropriate sinus tachycardia, and there are a minority that actually have a heart arrhythmia like PJRT (permanent junctional recipriating tachycardia).  Without seeing the data it is difficult to know the answer.  The only thing that grabs my attention is the reduced ejection fraction. Although this could be interpretation error, it is worth following this or getting another opinion.

It might be worth seeing an electrophysiologist or getting a second opinion from another cardiologist.  IF you decide to obtain a second opinion, make sure you take the holter, ekg's and echo plus any other test results that have been done so they do not repeat them unnecessarily.

Stress does effect sleep and influences our bodies autonomic tone even though you are not aware of it.  It is also possible for you not to feel acutely stressed yet be under a lot of stress or have anxieties.  Sleeping does not mean you body does not feel the physiologic affects of stress.

Do a little soul searching too.  If you think you are an anxious or stressed person in general, make sure you are not looking for a medical explanation for this problem so you can say it isn't stress.  I find that sometimes people know their problem is actually stress/anxiety but are shopping for another explanation because they have a hard time admitting to themself or others what the problem is.  Stress and anxiety is sometimes as uncontrollable as diabetes and hypertension, even if it is less well understood.

Good luck and I hope you feel better soon.

[mergie]

Forgot to add another symptom - my muscles all tremble uncontrollably without the bb....Most noticeable in the thighs.  W/o the bb it feels like I drank 100 gallons of expresso.
  I also have had off and on tingling in my feet and legs qit the bb.
BP has been between 95/53 - 110/70 the last few weeks.
I look forward to a reply.
-mergie

[CCF-M.D.-MJM]

The trembling makes it sound more like anxiety or panic attacks, but again, I can't be sure on this forum.  Tingling in the hands in feet that comes and goes is likely from hyperventilation -- again, more consistent with anxiety.

I would still consider a second opinion, but don't be surprised if the consultant comes to the same conclusion as the first.

Good luck.

[WPWGuy]

Hi.  Your write up is pretty sketchy,  but it sure sounds to me like these issues are medically and emotionally complex for a diagnosis over the internet.  Perhaps you should consider visiting (in person) a doctor who is thorough and can spend  time talking with you.  It is not difficult to find a good one. Plan to ask so many questions that all your concerns are eventually addressed, and you have a complete understanding of your diagnosis and how your doc arrived at it.

From where I sit, you seem to be working with a few contradictions on the "first draft" of your diagnosis, so dont be surprised if a second visit turns up an improved or completely new and different point of view --- one that results in medicine that makes a difference.

Regards,

[mergie]

Thank you for the responses.  I am back from the Dr's.  
He was very nice and listened.  
My EKG showed the LBBB with a rate of 68. BP 110/70
My echo was NORMAL this time....

I promise I do not have an eating disorder.  But of course appreciate the concern.  I have a very small frame (really) and am just a few pounds lower that what I have always been.  
My appetite seems a bit better.

OK, now back to the DR.  He recommended pursuing some metabolic possiblites (glucose and adrenal tests) and if normal returning for an EPS.  

While I currently have an event monitor, I could not manage off the meds for three days...I only did it for two and felt so awful I had to take the bb.  Again, with the rapid hr, sweating armpits, cold clammy hands and an overall uncomfortable feeling with no end in sight.  

I am facing the fact that it is most likely stress/anxiety.  But really does not seem like a panic attack, my mind is clear and I am not freaking out or scared.....I don't know but I am really tired of this.

I wonder if there are any health consequences to the LBBB.  

Thanks again,
mergie

[mergie]

Thanks for the 'ramblings', I do appreciate them.  
So I guess I need to face this anxiety head on!

I was given Ativan as well for sleeping at night.  It works wonders.  And I do now understand that just because it happens when I am sleeping doesn't mean it can't be stress.

The hit on the head, while scary at the time, doesn't trouble me.  I've been through a lot worse with the horses.
I think this must be a result of things going on in my life that I need to confront.
I am so glad I found this website.  I'd really like to get everything undercontrol.  I don't like the fact that I need such a high dose of the beta blockers but for now I have no choice.
  Do I have to go to a shrink (ick - sorry any shrinks out there) or can a gp give me the anti-anxiety drugs?

-mergie

[fearfactor]

Mergie, my GP gave me my meds to begin with but I do now go to a psychiatrist because my doses needed "tweaking."  I find that it helps because she's a bit more knowledgeable about anxiety than my GP was, though they have all been really supportive and understanding about my problems.

I know how terrifying it can be to wake up with a panic attack.  I couldn't believe it was just anxiety at first - I thought for sure I had a heart condition.  But, all my tests were normal except for a mild case of Mitral Valve Prolapse.  Now I believe that anxiety can really cause these problems.  I hope you get relief soon.

[fearfactor]

Hi - I went thru a period of extreme anxiety and panic attacks last fall.  I started waking in the night with fast HR and trembling all over.  My doctor said it was anxiety.  I have had all the heart tests, including stress test, echo, many many EKGs and 2 rounds with the holter monitor.  I started Xanax, beta blockers and an antidepressant and now I'm fine.  I had to stop my BB this week because I'm on a new antidepressant (Celexa) that makes my HR go too low with the BB.  I'm a small person, too and was only taking 6.25 mg of Toprol (tiny dose), but I think I was using it as a crutch because I was so scared I'd have tachycardia again.  Since I've gotten the anxiety under control, I'm OK and not waking up with the high HR anymore.  I hope you find what's causing yours.  Take care!
Stacy

[fearfactor]

I wasn't trying to say that going to a psychiatrist is best for everyone.  It just happened to work for me.  If I didn't take the drugs I'm on, I wouldn't be able to function.  That's how bad things were for me at one point.  You just have to find what works for you and do it, and medications have just happened to work for me and I'm glad they did or else I'd still be sitting in my house surfing the web 24/7 trying to find out what was wrong with my heart.

[marching on]

Hi, I agree with Fear Factor, seeing a psychiatrist and therapist for a twelve month period was very beneficial to me.

Anacyde, you really should be careful about "bashing" this profession. I'm sorry you have had a bad experience, but that doesn't mean we all do.  Saying that they are a "cesspool of egomaniacs" is pretty strong language. There are "bad apples" in every profession, so perhaps temper your comments on this a bit. I wonder if you could possibly help raise the standard in this profession, since you are degreed in this area and help undo whatever wrong you see with it??  Just a thought.  Sounds like you have really been burned by it.
Also, accusing people of eating disorders is a little out there.  My mother is 58 years old 5' 1 and 95 pounds and actually is  a very healthy little lady.

Thank you
Marching on

[marching on]

Hi,
Thanks for the additional info.  I'm glad to hear you took a shot at trying to raise the bar in conventional psychiatry.  I know it must be a difficult field.
Thanks,
Marching on

[mergie]

OK, group hug!  ;)

-mergie