Sinus Tachycardia

[Mark882]

26 m, regular weight BP,a bit of an anxious person A year ago my heart would race for no apparent reason after meals would go to 120 and stay there for 2 hours, in the shower etc. However this would happen occasionally. I did an Echo 10 months ago which showed normal heart & EF=70%. At the same time I did a stress test w/echo which was normal. normal blood test & urine. But 2 months ago as I was on the treadmill my heart rate jumped suddenly to 170, stayed there for 2 minutes then went back down (only after 5 min brisk walking). So I wore an event monitor for 30 days. The monitor showed it was Sinus tachycardia (not SVT)& it did show PAC’s/PVC’s especially during the recovery period (I recorded when I stopped exercising). 2 cardiologists said to ignore the sinus tachycardia and that it will clear on its own (one of them wanted to put me on 25mg of Toprol, the other on an SSRI).
1.Panic attacks last for 20 min and are accompanied by fear which I don’t have. my tachycardia will last much longer and in atypical situations (in the shower, after meals) and it hits me out of the blue. Should I pursue further testing like EPS or Cath (given the tach will not clear with the SSRI?)
2.The doctors said this kind of tachycardia will not ruin my heart muscle and to ignore. Do you agree? (But when I was at the clinic of the two cardiologists I was in a calm state and my HR was only 65)
3. I feel I cannot exercise anymore cause each time I try to, my HR jumps very high & I feel weakness in my stomach, hands
4. Are PAC and rare PVC in the recovery period a concern?
Thanks a lot

[CCF-M.D.-MJM]

Hello,

1.Panic attacks last for 20 min and are accompanied by fear which I don’t have. my tachycardia will last much longer and in atypical situations (in the shower, after meals) and it hits me out of the blue. Should I pursue further testing like EPS or Cath (given the tach will not clear with the SSRI?)

I would need more information about the holter and event monitor.   Specifically, what is the average heart rate, does the tachycardia start abruptly or does it slowly warm up and how does it terminate.  This helps differentiate inappropriate sinus tachycardia from other causes.  Not all panic attacks are the same and it is difficult to rule that out.  I find that most patients would rather believe the they have something wrong with their hearts than believe that they have anxiety attacks.  I assume the reason is that people incorrectly associate panic attacks with weakness or anxiety.  Taking paxil may help and is worth trying it.  Taking a beta blocker may also help.  The other long term option if all medical options are unsuccessful and other factors is an inappropriate sinus tachycardia ablation -- if this is the cause.


2.The doctors said this kind of tachycardia will not ruin my heart muscle and to ignore. Do you agree? (But when I was at the clinic of the two cardiologists I was in a calm state and my HR was only 65)

This is probably true.  Again, the holter data on average heart rate and seeing your response to exercise is consistent would be helpful.

3. I feel I cannot exercise anymore cause each time I try to, my HR jumps very high & I feel weakness in my stomach, hands

This is more reason to try the SSRI and beta blocker to see if they help.  If they don't, it might be time to meet with an eletrophysiologist for additional management options like ablation if your symptoms are limiting your quality of life.


4. Are PAC and rare PVC in the recovery period a concern?

No, they are not a concern.

I hope this helps.  Thanks for posting.

[kaceyj]

hi, i am a 28yr female and i exper. similiar feelings. my electrophysilogist told me my hrt rate jumps to like 150bpm w little exertion. they rythm is also a sinus rythm. i also get TONS of pvc's. i actually had 65 in a 24hr period. and can u believe the dr's told me that is ok. i couldn't beieve it! i feel almost all of them and it scares me. the thump in the chest and the skipped beat. i hate them. i was put on propanolol 10mg at first, then taken off then recently put back on but on 12.5mf of atenolol daily for the heart rate and pvc'. i did have an eps study done and they could not find anything out of the oridinary. it is hard to except their answers ex. just relax, palps are normal. when they feel so not normal and nerve racking. and when they can not find a reason they will ALWAYS tell u its anxiety and then not want to help u anymore. u need to find a caring cardiologist or be referred to an electrophysiologist.  i also heard coughing will restart the hearts rythm during an episode.  good luck to u and don't give up till u recieve the right help!

[Mark882]

Hello,

Yes i know how frustrating it must be. The PVC feeling, the tachycardia. I did all the non-invasive tests and nothing was found but i still am not convinced (maybe they are overlooking something).

I am curious though that in your case and since you had all the non-invasive tests as well (echo, stress test) normal and with your young age, and the monitor showing only PVC (doctors said some people have thousands a day and are not usually dangerous), What prompt you and your doctor to do an EPS study ? (i mean the two doctors i saw said out of the question in my case since no dangerous arrythmia showed up in the monitor and it has its risks)

[kaceyj]

hi mark... after a few 24hr holters, which didnt show much i was given a 30 day holter monitor. this one finally caught the palpitations i was complaining about. and one was of major concern that put me in the hospital for a week, whcih is when i had my eps study.  i was told it was an irregular beat that lasted 5 beats coming from the upper ventricles but wasn't fast enought to be tach............ so still i am clueless. i had a new palp last night while in bed... felt like a butterlfy was flyin in my chest for about 10 seconds. it was absolutely horrible.. i will check w my electrophysiologist on monday about it.. hope all works out for u

[Mark882]

Hello Doctor,  

First thank you for your response and this forum is truly a blessing.

I wore a holter monitor 8 months ago. My average heart rate in the holter monitor was 74. The minimum was 44 during sleep and the maximum was 185 (but i was exercising at the time). Supraventricular ectopic activity consisted of 48 beats and i think all were either PAC, late beats and 2 atrial couplets. The holter did not record any PVC.

But after the holter the tachycardia got worse so i wore the event monitor and this was 2 months ago. The event monitor caught some PVC's. Usually when i start exercising i will be fine for the first 5 min (heart rate for example 110) then it will start jumping to 150 then come down. The doctor said not to worry about it but during these episodes i feel weakness in my hands and stomach. Sometimes the tachycardia would start abruptly in the shower (did not record that) and sometimes after meals i recorded these and it was Sinus.

Thanks again

[aLiEnBoy]

I am 26 years old and I suffer from Panic attacks. I constantly worry about my heart especially ever since I saw my dad have a heart attack. My panics attacks come on slowly or abruptly. I was rushed to the ER with a heart rate of 240 one time. As soon as we arrived at the hospital it dropped to 130, becasue I felt safe. I also get PVC's, I hate them. I have been to a cardiologist and doctor about this. I have had a tredmill stress test, a sonogram of the heart and a 24 hour holter monitor. Everything was fine except the PVC showed up on the holter, which I was told was normal and not to worry. But when I have a panic attack my heart rate can go from the norm ( which for me is about 79-86 bpm ) to 170-180 in like a few minutes. Why does this happen? I scares the life outta me and I dont know what to do. I keep getting visions of myslf dead on a stretcher when this is happening. I'm going for help. But can these panic attacks with the fast heart rate be dangerous?

[kitcurious]

If your heart is structurally normal, PVCs and a short run of sinus tachy won't hurt you. PVCs are generally diagnostically insignificant. Many people have hundreds, even thousands a day and are not worried. Psychologically, it's doing some damage and you may want to ask for some professional help overcoming the panic.

My father also dropped dead in the living room after my birthday party. I guess all those screaming pre- kindergarten kids were a stressor. He was only 43. He had severe CAD, his heart was not healthy.

I understand that the issue is on your mind, but if your heart is healthy it just is. You are only 26 and the chances of your having a heart attack are incredibly slim. I don't have the heart my dad did. I don't live as he did. He smoked, drank, partied, ate a horrific diet (and I mean ate at 7-11). Sure, some of it may be hereditary and I get regular checks to see how it's going. So far, so good.

The panic problem seems to be a misplaced type of "on guard" instinct (from when we were hunter gatherers?) or something. It doesn't apply in the modern world, but it seems we haven't evolved all that much and still have the same primitive internal system.

Being constantly mentally anxious about one's health is not going to prevent any disease from eventually happening and it can drive people to distraction. In fact, I read that there is such a thing as stress-induced cardiomyopathy, usually found in older women (95% women) so people can actually develop a problem if they stress hard enough.

Better to be consistent in heart healthy behavior. You can use your ability to focus so intensely on things in ways that make your life better. Sublimation I believe it's called.

Someday everyone of us will be on that stretcher. Try to live for now and not anticipate dying. It won't happen anytime soon.

Sometimes the best thing you can do for yourself is to stop fighting the medical knowledge and wisdom and just let them win.

Good luck to you

[Fran71]

Hi Mark, I have very similar issues. I have sinus tachycardia which doesn't start abruptly, but my HR goes up very quickly right after meals - actually it starts when I'm still eating - and lasts for a couple of hours. Also exercising can bring my HR as high as 190 bpm on the treadmill - the guy at the gym thought his machine was broken because he thought I couldn't have such a high heart rate! My hr immediately goes down when I stop so Ive been told this is a very good sign.

I'm on a beta blocker for tachy and frequent PVCs. I take 20 mg Inderal on most days, though lately I feel much better so sometimes I skip it. I'm female and notice my heart behaves much better as soon as my period starts...any girls out there have experienced this?

I get thousands of PVCs a day during bad PVC periods, and they're considered benign if the echo is OK. My cardiologist didn't even prescribe a stress test. BTW the recovery periods after exercise can be hell for me too! Especially because I get many PVCs, but I can get tachy as well.

Hang on in there. These things come and go so they can get better! Do ask your physician if you can try a beta blocker. It has worked miracles for me.

Fran

[Autumnx1003]

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