Single a-fib and sinus tach

[ratatat]

35yr old m general good health.BP borderline,last 4 mths high (140-160/90-120).Got bronchitis Nov,and the day after Dr and meds I got real flush,nervous and faint.Went to PCP,EKG norm,BP 160/120 up and down.Over the next wks,@ 1x per wk.Strong fast pulse,nerv,etc.24hr urine Pheo norm,4 EKG's norm,str echo norm (reach 196hr)only slight large L vent.Told could be BP or size (6'5,275#)and of no concern.Told cause was anxiety.Started 50mg Toprol-XL palps/BP,Zoloft for Anxiety.Sympts cont'd.On BP check told the rn once and a while checking my pulse had a subtle change.30 day event monitor ordered.Started 2/3.On 2/5 was awakened w/the feeling of a rabbit jumping out of my chest. different than anything I had ever had.No chest pain,sob,etc. Recorded and trans and w/in 5 mins cardio called,I was in a-fib. Lasted 30-40 mins and corrected.1 week later had Sinus Tach.Start on 325 asp,20mg Lisinopril/hctz.BP down to 115/80 but sinus tach still mainly afternoons as I get to Toprol time.Rythmol's on the table but we are waiting to see how I resp to the BP med.Yest,strong pulse all afternoon,last night felt like my hrt "paused" for a sec/2 then went back to running hard.?'s 1.W/no other prior,could BP cause this or something else.2.Why so many diff things suddenly occuring after being sick?3.Very uneasy about Ryhtmol/side effects.W/Toprol my night p will run 54-62 and afraid Rythmol will drop it more.4.Zoloft os helping but not fix all.Working w/cardio but what should I be thinking about now?5.Was pause a pac last night/what are they?6.Rythmol?7.Could Bronchitis infect be catalyst?THANKS!

[ratatat]

No, I was not taking over the counter meds due to my borderline BP.I was taking Biaxin, and given a sample of an antihistamine called Ryneze (Methscopolamine Nitrate 2.5mg/Chlorpheniramine Maleate 8mg) to dry up the nasal drip. My PCP and myself try to avoid psuedoephedrine like the plague. I had never heard of the Ryneze before. Also the sinus tachycardia was revealed from the 30 day event monitor which I still have. The heart rates were/have been in the neighborhood of 120 and duration varies from 5-15 minutes to several hours a couple of times. Everything I have transmitted on the monitor has been of normal (I guess) rythm except as sinus tach from time to time. No episodes of a-fib except the   once the event monitor was started. The strange thing is how the symptoms have either changed or progressed. The only other strange thing is that when I take the Toprol in the evening, I have fast runs with my heartrate that begin approximately 1 1/2-2 hours after I take it.

[CCF-M.D.-MJM]

Hi ratatat,

You are too young for blood pressures that high.  It sounds like they started you on appropriate therapy.  You will need to follow this closely.

1.W/no other prior,could BP cause this or something else.

Hypertension is one of the most common risk factors for atrial fibrillation.  

2.Why so many diff things suddenly occuring after being sick?

Where you talking cold medications with pseudophedrine while you were sick.  that could explain the blood pressure, anxious feelings and atrial fibrillation.  It is also possible that the atrial fibrillation and weight are contributing to initial episodes of atrial fib.

3.Very uneasy about Ryhtmol/side effects.W/Toprol my night p will run 54-62 and afraid Rythmol will drop it more.

I don't fully understand the sinus tachycardia issue you mentioned (the sinus tachycardia -- how fast, how long).  I don't think I would start rythmol or any other antiarrhythmic besides a beta blocker for a single episode of atrial fibrillation.  I would focus on blood pressure control and weight reduction first. If you have recurrent episodes, it is worth a consideration.

4.Zoloft os helping but not fix all.Working w/cardio but what should I be thinking about now?

I don't think the zoloft is affecting your heart rhythm.

5.Was pause a pac last night/what are they?

I can't answer this without seeing a rhythm strip.  I pac is a premature beat that sometimes resets your hearts biologic pacemaker -- this can cause a pause.

6.Rythmol?

I mentioned my thoughts on rhythmol above.  I do not think it would significantly drop your heart rates but the only way to tell is to try it.

7.Could Bronchitis infect be catalyst?

any illness can potentially increase your adrenaline or catecholamines.  This can affect heart rhythms.  I would give this all some time to settle out.  If it persists or recurs, I would see a cardiologist or electrophysiologist for options at that point.

Good luck and thanks for posting.