POTS, Sinus Arrytmias, PVC's and more.....

[MelissaA]

Hi!  I am a confused 30 year old female.  I have been diagnosed with POTS, as well as some other "minor" heart problems like MVP, mild thickening of the septal and posterior walls, and upper limit of normal Pulmonary Artery Pressure.  I also have what they called begnin heart arrythmias and that is where my question lies.  I have PVC's, PAC's and a Pronounced Sinus Arrythmia (they say it is a little more than what they normally see with respiration)  I also have caught sa node re-entry problems.  I take Toprol XL 25mg because I can not tolerate meds well with my POTS.  (I also have a low blood volume, tested twice both abnormally low)  I thought I had been doing well with the Toprol my heart don't race out of control like it did before and generally stays under 130 bpm with some minor racing, but most of the time is under 100 bpm.  I also noticed more PVC's after being on the Toprol they say that is because my heart rate is slower.  The last few months my heart has been going slower and I feel symptoms.  I feel my heart dropping in my chest and it has been documented via event recorder that this is the sinus arrytmia.  I also experience mild chest discomfort when my heart rate is slower 65bpm and below, which it does quite frequently these days.  I was told to go to the ER if it kept happening and I did.  I was hooked up to a heart monitor and it started beeping and was flashing "IRREGULAR" with a rate of 64.  I jumped and adrenaline surged and took me right out of it what ever it was.  No one at the ER saw it and it didn't print.  They said it could have been anything, including sinus arrythmia.  They also said I had Vagal Tone?  While I was there my heart rate ranged between 60-97 on their report that was sent to my Cardio.   My ekg was normal and my Co Enzymes were also normal.  I am so frustrated and not knowing how to get myself treated.  I was told a SA node ablation with a pacemaker was an option to me it seems drastic.

My questions are:

1. Are the increase in PVC's okay with Toprol, I always thought beta blockers surpress the PVC's, why am I getting more?  It makes me scared.

2.  What is increased Vagal Tone?  Is that bad?  When you have a sinus arrythmia should you be able to feel it?  It feels like dropping in my chest when it happens.

3.  Should I worry about the irregular on the ER heart monitor?  What could it have been?  What would read irregular on a monitor like that?

4.  Do you think a SA node ablation w/ pacemaker is a little drastic for my age?

5.  What kind of doctor besides a EP Cardio can help with POTS and the low blood volume?  I am supposed to see a Kidney Doctor again, but have in the past and they didn't seem to think low blood volume was a problem.

6.  How often is it recomended for someone to have follow up echos with the enlarged septum and posterior walls just sligtly above normal limits at 1.3 cm, and MVP, etc?

I appreciate your forum and thank you in advance for the service you supply.  I wish you and all the doctors at Cleveland Heart Center a Happy Holiday Season!!

Thanks,
Melissa

[NinaVJ]

A related discussion, What is the meaning about sinus arrhythmia was started.

[poly]

Hi:
I'm 26 yrs old and I was diagnosed with Innapropiate sinus tachycardia (my resting pulse used to be around 100, and always higher than normal under exercise and stress).  They also found MVP with no regurgitation, and I think I could have POTS (because of my low blood volume and low blood pressure).  My electrophysiologist put me on Toprol (50 mg), which helps some (I still have rapid pulse sometimes).
I found an excellent site for people with POTS, and you can find a lot of information about many of your problems:
www.ndrf.org (look under Discussion; the message boards are full of similar cases).
My best wishes for you,
Poly

[CCF CARDIO MD - DLB]

1. Sometimes the PVCs are more noticeable when the heart rate is slowed by beta blockers.
2. Increased vagal tone is common in young people - it just means that you have a tendency towards things like a slow heart rate, sinus arrhythmia, fainting. People are not usually aware of sinus arrhythmia, but occasionally are.
3. Lots of minor abnormalities are picked up as irregular by the computer. That in itself is nothing to worry about.
4. Yes. I would not recommend it, though if you remain highly symptomatic, your doctors may feel that there is nothing else that they can offer.
5. An EP doctor is best-suited for your combination of heart rate problems and POTS.
6. I see no need for routine follow-up echos, unless you develop new symptoms. Most likely, the minor abnormalities noted on your echo are of no real clinical significance.