Re: tachycardia

Posted By CCF CARDIO MD-APS on February 01, 1999 at 23:01:26:

In Reply to: tachycardia posted by Patricia on January 28, 1999 at 19:26:31:






I was diagnosed with benign sinus tachycardia ten years ago as well as panic disorder.  Prior to being put on medication, I ended up in the emergency room with a sudden heart rate of 140-150 bpm on several occasions, with symptons including dizziness and feeling unable to breathe. I was put on propanolol for the tachycardia and klonopin for the panic disorder.  I was then switched from the propanolol to corgard.  I have been on 60 mg of corgard for several years until I had a recent episode of what I call "skipped heartbeats."  It was so bad that I saw the first cardiologist open the next day.  I had a holter monitor put on and was told I had 400 "non-dangerous" PVCs over a 24 hour period. I was put on 60mg of long acting inderal. The inderal helped the PVCs tremendously but I found that the inderal was making my legs swell and was causing dizziness and a lack of ability to think clearly.  The doctor then reduced the inderal to 30 mg every other day.  I called her and told her that on the days when I wasn't taking the inderal, I was still experiencing tachycardia in the morning to the point where it was debilitating. She then decided to take me off all medication to see my baseline heart rate.  I was reduced to 20 mg of long acting inderal for two weeks and then 10 mg for one week. When I called her to tell her that my heart rate was still going over 100 bpm after the end of the inderal, especially in the morning, she told me that the effects took awhile to determine and did not even want to see me. When I finally saw her a week later, at my request,
she told me to try biofeedback and stated she did not know what was causing the tachycardia. I was also told that my resting heart rate at sleep was 40 bpm, which is "not dangerous for a young person." I am 36 years old.
I then read about a cardiologist who specializes in electrophysiology and ablation.  I went to see this cardiologist who spent approximately 5 minutes with me and gave me an event monitor for four weeks to record any episodes I had. He then told me not to wear it every day and not to press it for every "little episode of tachycardia or premature heartbeat." I was left somewhat in the dark as to when to record an event and this particular doctor who practices at St. Francis Hospital in Roslyn, New York never got on the phone when I had a question.  His nurse would call me back with an answer if he decided to give me one at all.
During the last two weeks of wearing the event monitor, I put myself back on 10-20 mg of Corgard because I was unable to go to work in the morning due to the tachycardia. I did not call the doctor regarding the fact that I put myself back on the medication and this concerns me.
I got back my results of the 4 week event recorder and was told I had benign sinus tachycardia, even though my heart rate was recorded as 140 bpm on two occassions and over 100 on other occassions.(Again, the doctor's nurse called me and only after I requested a phone call,regardless of the results.)  The doctor(through his nurse) had no suggestions and I had to ask his nurse to ask him what I could do to relieve this situation.  I also had to ask her to have him review my holter monitor results again.  
The doctor's nurse then called me and told me that I may be having a vagal reaction based upon a reading of my holter monitor results and recommended a tilt study where I would have to have an IV with adrenaline. The thought of being injected with adrenaline in a person with symptoms such as my own is very frightening and I do not know whether to undergo the procedure.
Additionally, I spoke with the doctor during my intial five minute consultation about the possibility of becoming pregnant because I am now 36 years old.  I asked him if I could be on any medication to relieve the tachycardia while pregnant.  He suggested that no medication was safe during pregnancy, but the safest medication was something called
Sectra (I am not sure of the spelling because he told me so fast.)  The doctor will not prescribe any kind of beta blocker until the tilt study.
I am wondering whether to undergo the tilt study or seek out a second opinion with a doctor that I can at least speak to like a normal patient.
This situation is very debilitating and prevents me from conducting my life on a normal basis. I would be less concerned if it wasn't for the fact that my time is running out regarding having a child and I have been told that episodes of tachycardia get worse while pregnant.   It is extremely difficult to get off medication you have been on for ten years.







Dear Patricia,
I am sorry for your trials in communication regarding your care.  A second opinion is a good idea, for anyone that is, but I advise that you specifically seek the opinion of an electrophysiologist (cardiologist that specialized in abnormal heart rhythms) at a major university hospital (where it is more likely that the electrophysiologist has experience with such matters.)  And there are usually fellows (cardiologists still training in electrophysiology) at such institutions that will be able to spend more discussion time with you in regards to your rhythm abnormality, and potential treatments.  As for the tilt test with your current physician, I would request a consultation in his/her office in the day or so following the tilt test as a prerequisite to having the test done; as well this physician and whomever is doing the test absolutely needs to be notified of the resumption of the Beta-blockers (inderal).  It is understandable that you started them again considering how debilitating you find the tachycardia, just remember never to stop the beta blockers without the advise of your physician.  All in all, the tilt test may provide information that will be helpful in your care, however, it sounds as if just as important is a cardiologist who is willing to sit down with you to explain the game plan so to speak AS WELL AS someone who is willing to help you through a pregnancy (it is not 100% that your tachycardia will worsen during pregnancy.)
I hope this information is useful. Information provided in the heart forum is for
general purposes only.  Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
cardiology staff that can be used to select the physician best suited to address your
cardiac problem.