PAT or something else?

I am a 36 year old who has recently been diagnosed with PAT, but I'm not sure that diagnosis is complete.  Over the past 2-3 months I have had frequent bouts of fainting, severe nauseau (not always accompanied by vomiting), dizziness, and extreme fatigue.  Not all my symptoms always occur when my heart starts to race (been noted up to 156 bpm).  Also, sometimes when I begin to really feel bad, I get diarrhea and body aches like crazy.  I occasionally get chills, but no fever.

My symptoms came on very suddenly -- no past history of this.  My sister does also have PAT, but she has never had the actual fainting, etc.  She does get the heart racing, but that is her only symptom.

Another symptom that I have, which may or may not be related is pain in my abdomen.  It is mostly on the left side about 2 inches above my navel, although I sometimes get pain on the right side up under my ribs.  I had my gallbladder removed a year ago (due to gallbladder disease/no stones) and recent LFT blood work came back in the normal range.

I did have a complete hysterectomy about 2 1/2 years ago and had not been on any hormone replacements until about 2 weeks ago (which has made no improvement on my symptoms)

My current medications are:  Premarin, Prilosec, and Lanoxin.  The extreme fatigue and other symptoms were all present before beginning these medications, so I doubt that they are related to the meds.

I'd be extremely interested in your input into whether you think my doctor is on the right track with the PAT or if you think there may be something else going on.  I am currently on a 30-day event monitor -- I had a 24 hour holter monitor about 2 weeks ago which did show that PAT episodes, but since I was continuing to have the fainting spells and feeling lousy, my doctor and my cardiologist felt it was warranted to go to the event monitor.  I have only been on the event monitor for less than a week.

The Prilosec was prescribed by my doctor (actually one of her associates) because he thought maybe I was had GERD, but I never get heartburn or reflux feeling.  I have had no improvement with the Prilosec either.

Please give me your input and suggestions -- I'm tired of feeling tired and sick!!

Thanks

[Cleveland Clinic, MD]

Dear Robyn,

Thanks for your question.  The single best way to determine if an arrhythmia, such as paroxysmal atrial tachycardia (PAT) is causing your symptoms is to correlate the heart rhythm with the symptoms.  The event monitor should enable you to do this.  Be sure to keep a log of when and what symptoms occur and also to activate your monitor.  

Your symptoms may be due to arrhthymia but may also be due to a broader syndrome such as POTS or chronic fatigue syndrome.  After the results of the event monitor are in you can discuss with your doctor possible causes of your symptoms and the best treatment which may include beta-blockers and/or serotonin reuptake inhibitors (SSRIs).

[dah]

I was also diagnosed with PAT, but I get short, sporadic eposides of them, lasting from a second up to about 10 or 15 seconds.  I have had these bouts and other arrythmia episodes (PACs, PVCs, SVT)off and on for the last 20 years.  The PAT eposides have subsided a great deal over the last six months.  I take 25 mg of Atenolol (at bedtime due to mild fatigue) and it really works well for me.  Thought I'd mention it.  Large doses of arrythmia meds make me dizzy and "out of it".  Good luck!

[dozerscritch]

Thanks for your reply dah -- during your episodes, do you have any of the other symptoms that I get -- fainting, chills, etc.?  I'll mention the atenolol to my dr when I go next week.  I've been on the 30-day monitor now for a while and I'm hoping that some of the strips that I've sent will help the docs determine the best course of treatment for me.  The meds really don't seem to be helping too much and the side effects are miserable.  If you have any other suggestions or comments, I'd be very interested in hearing them.

[Julie]

Your symptoms sound very similar to several I've been battling for the past six months.  I also went through surgical menopause two years ago.  There appears to be, at least in part, a connection between getting enough estrogen and racing ehart symptoms.  

I'm trying to stay off Atenonol, because it makes me tired, but it helped alot with the racing heart and palpitations when I tried it for a while.  Now I'm hoping more estrogen might help . . .

[dah]

Hello Robyn,
Sorry I did not reply to your question earlier in the month; I know you may not find this reply but thought I'd take a chance.  I have not been on this web page for quite a while.  

Although I do not get chills or feel faint when I get my arrythmia bouts, I get very short, quick jabs of chest pain (left breast area)that lasts generally a second or less.  The only time I've felt dizzy and had chills was when I was taking a higher dose of Atenolol. The symptoms went away when the dose was reduced.  

During PAT episodes I generally feel just "panic" - the shakes, etc. The chest pain generally occurs during PVC episodes or when my heart is beating normally.  The jabs of pain drive me crazy - I complain to the docs and am told there's nothing to worry about.  Good luck.

[Penny To All Above]

I have been convinced for ages that my PATs and PVCs/PACs have been related to my menstrual cycle.  This web site shows recent research going on in arrythmias....sorry for all the scientific jargon but i think you all might find it interesting
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10190518&dopt=Abstract

[Penny To All Above]

Here is another one:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8622333&dopt=Abstract
I know these are long addresses, just copy and paste into the section where you type web addresses.

[blade040 July 6, 2000]

Hello, I hope when you go back to your cardiologist they also check for WPW-Wolff-Parkinson-White Syndrome.  Your symptoms sound like this is a possibility.  My mother just found out she has this and it is hereditary.  My daughter(11) also experiences the same symptoms but does not pass out totally.  WPW's most common symptoms include:palpitations, dizziness, chest pain or discomfort, faintness-to the point you totally are out or to the point you just collapse, nausea can also be a symptom along with fatigue.  I am not a doctor but I have been doing alot of research and have found WPW to possibly be my daughters problem too, although her doctor said PAT.  My daughter also had holter monitors and ECG, but no one diagnoised her with WPW as some doctors and the public have never heard of this-so I am told.  My daughter will be returning to the doctor to be checked for WPW and I will to even though I have no symptoms of WPW I may still have it.  Some people with WPW do not have arrhythmias or any symptoms.  Please check into this and I wish you all the luck.

[dozerscritch]

Thank you for the insight into WPW.  I will certainly ask my doctor to test me for this.  I don't know anything about this condition - could you refer me to anywhere I can research it, or can you tell me more about it --- you can email me at ***@****.

Thanks again.