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Seasonal AVNRT and Neck Pressure
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Seasonal AVNRT and Neck Pressure


  I was diagnosed with AVNRT with right bundle branch block in 1996 (at age 36)
  during an EP study and was not ablated because of the close location of the
  abnormal pathway to the normal pathway (and episodes had been infrequent
  at that time. Cardiac catherization did not show any blockage. After another
  episode in February, 1998 i was prescribed 50 mg Tambocor twice daily and
  in March was increased to 100 mg, twice daily. (no prior heart attack)
  Fall and winter seem to be the time that brings on episodes of
  AVNRT for me. I usually have to be electrically cardioverted due to the
  stubbornness of my rhythm and poor response to medications (Kalan sometimes
  works), which starts with a few palpitations then shifts into high gear (
  180-240 bpm). Yesterday I had my first episode since March of 98
  (episodes occured about every 6 weeks during the fall and winter season)
  and I wondered if there is any information as to why my episodes
  occur in this manner.
  Secondly, between episodes, i frequently have a feeling of "neck pressure"
  from the uncomfortable feeling of hands gently gripping my neck to
  a "swollen gland" type of feeling. (this will often last for weeks)
  Sometimes it is accompanied by acute pressure/pain in my lower jaw.
  More infrequently, i get a sudden "spike" of pain originating from
  the back of my neck/shoulders upward to the base of my skull but more
  inward, and i get the feeling that for that fleeting moment
  my system might shut down. Its frightening. On two occasions it occurred
  when my hands had been over my head (like in shower...washing hair). What
  can you tell me about this neck pressure? My Cardiologist has not looked
  at the arteries in my neck...but said they are clear because of the clear
  Cardiac Catherization I had in 1996 before the EP study was done. He also
  has no clue about the neck pressure.
  Any ideas?
  Additional info: I am 38, obese and fairly sedentary at work and home.(I
  know i need to work on that!) Blood tests are reportedly normal
  (occasional anemia) and I don't smoke, drink and i try to limit caffeine
  in tea and colas (i don't drink coffee) BP is usually around 135-150/78-85
  range. My AVNRT episodes usually occur following some sort of adrenalin
  stimulation from falling down ice-skating, laughing hard at a joke, stress,
  excitement, to decongestant cold preparations.
  Any help you might give would be greatly appreciated.
  -Patty
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Dear Patty,
Firstly I commend you on your thorough understanding not only of your AVNRT,
but also on your assessment of your weight and exercise problems (that need to
be addressed asap, i.e. before you get complications of the obesity like diabetes.)
Complaints of an unusual sensation in the neck are often spoken of when the patient is
in the tachycardia, and not so much in between episodes as you are experiencing.
The interesting fact that I would like you to consider (and I am not sure who might
be the best physician to investigate this, but give me a momment) is that there are the
carotid arteries that run through the neck on both sides of your midline throat.  The carotid
arteries have influence capabilities on the heart rate and volume status (blood pressure) via
an area termed the carotid sinus.  All the effects of these little centers at the sinus' are not
understood, but if you may know, physicians often try to break an AVNRT with carotid sinus massage-which
will increase vagal tone (slows conduction capabilities of the AV node and sometimes breaks the rhythm.
OK, enough technical jargon, my idea might be a little out there but it may be possible that there really is
an abnormality in your neck that stimulates the carotid sinus control mechanism.
I guess the best physician to investigate your neck would be an ENT physician. Even if you did not have the diagnosis of
AVNRT, I would suggest that you seek an evaluation of your neck or at least your neck symptoms.  Do not automatically
assume that anything and everything is related to your AVNRT; keep in mind that it is very
possible that not only is there nothing wrong with your neck but also that an abnormality detected doesn't mean that it is
related at all to your AVNRT. It might also be a consideration to wear an event recorder so that you can evaluate your rhythm
during these neck sensations.  I hope that this information has been useful. If you have any further questions, please feel free
to write again.  Information provided in the heart forum is intended for general medical informational purposes only, actual diagnosis and
treatment can only be made by your physician. Good Luck.





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