Unexplained and persistent Tachycardia with a pulsing headache

[wishyouthebest]

hi



I'm a 25-year old male, smoker, healthy, underweight. I have never been to a hospital except for a flu or something.



Two months ago, three symptoms started together, yet, I couldn't obtain any diagnosis. I started having a headache which is becoming more severe with time (pulsing headache in which I can count my pulses from there), high blood pressure (which I still think it's the white coat, since I have never had a high reading at home), and a persistent tachycardia (it's very uncommon to have a resting pulse rate less than 100 pulse/min). Also, vision problems are there.



I have noticed when the pulse rate is very high (120+) the headache becomes very severe, still, blood pressure is normal. At the ER, I get readings like 140/100, 150/110, 130/90.



I can't say I have a shotrness of breathing, but when the heart rate is severly high, respiration rate is higher than usual.



I have taken Inderal to treat these symptoms, no improvement at all. I have taken an anti-depressent, the internist thinks it's due to anxiety, no improvement.



I had an EKG, chest X-ray, thyroid function, CBC, electrolytes test, all came back normal. Except that the magnesium level has been slightly lower than normal. No pain in other areas except that headache. I have been finally referred to a neuro, who requested a brain MRI. He will also refer me to a cardiologist.



1) Can the headache be related to the tachycardia?

2) Is it common for normals to have this type of tachycardia?

3) Should I further investigate or just ignore the issue as recommended by the ER dr.?



Thanks

[CCF-M.D.-MJM]

Hello,



These are very tough situations.  We see them often in clinic and it is very difficult to find an absolute explanation.  There are several things that come to mind that already haven't been excluded ranking most common to least common.



1. anxiety

2. depression

3. inappropriate sinus tachycardia / fibromyalgia like syndrome

4....

5....

20. pheochromocytoma



The first three diagnosis are the most common and are followed by many stereotypes that I think are unnecessary and unfair.  Many people are so turned off by the mention of these syndromes that the look for any possible other diagnosis to hold onto and I think these leads to more mental anguish and unnecessary testing.





1) Can the headache be related to the tachycardia?



It is common for people with pheochromocytomas, an endocrine tumor that secrete epinephrine or norepinephrine, can cause increased heart rates, headaches and hypertension.  The problem is we have to screen hundreds of people with similar syndromes to find one person that has it.  It is very rare.



2) Is it common for normals to have this type of tachycardia?



Resting heart rates over 100 are not normal or common.  There are people that live with heart rates like this but they often have low exercise tolerance and their heart rates increase rapidly at low exercise levels.  We do not fully understand inappropriate sinus tachycardia.  Interesting, IST often overlaps with fibromyalgia and fibromyalgia like conditions -- this is another condition we do not understand that well.  Beta blockers are ofthen the first line therapy but are also recongnized to only help some patients.  I would recommend a cardiologist, perhaps even at a referral center where they are more likely to see conditions like this.



3) Should I further investigate or just ignore the issue as recommended by the ER dr.?



I think you should have this worked up further and probably by a cardiologist.  These situations are difficult because the answer are often not found, but important diagnosis should be excluded.  If it is IST and you are very symptomatic, there are procedures that may help with some of the symptoms, but not all.



I hope this helps.  Thanks for posting and good luck.

[woodruff]

First, I want to emphasize that I am not a doctor.  That said, has any doctor mentioned the possibility of a rare condition called pheochromocytoma?  I remember reading that pounding headaches and high blood pressure are associated with it--and that it is treatable, once diagnosed.

[woodruff]

Just one question:  Has any of your doctors mentioned a very rare condition called pheochromocytoma?  It's pretty darned unusual.

[Fran71]

I had 24-h urine test for pheo but only because I asked for it. I only had palps, no high pressure or headache so I agree it was very unlikely that I had it. It turned outnegative.

[Fran71]

I was re-reading the doctor's reply. The first explanation for symptoms like tachycardia seems to be anxiety. I guess most of us with palps have been told at some point that anxiety is causing our symptoms, or at least making them worse, still most of us look for other causes. I wonder, how is anxiety defined? I tend to live everything intensely: when I'm happy I'm REALLY happy, when I'm angry I can be very annoyed, when I worry I can feel miserable, etc. But I don't have panic attacks, I don't sit there in fear, I live my life to the fullest, though yes, I tend to be very uptight about myself and the ones I love. I think this is just a normal attitude of someone who lives life intensely. But now I wonder: would this be considered anxiety? Is this not normal? I'm trying to figure out the definition of anxiety that can cause palps. I don't mind accepting a "diagnosis" of anxiety - actually it would kind of put my mind at ease - but I also don't like to dismiss my symptoms with that word without a reason. I took Lexotan for palps and it did nothing, but maybe this doesn't rule out anxiety as the cause of my palps, at least sometimes. Beta blockers do work for me, but they act on the heart I think, not directly on anxiety.



Thanks for any feedback!



Fran

[Jennie47]

I also have problems with persistent tachycardia... I've had a pulse of about 120-140 bpm for almost a month now. I also have some extra beats thrown in there. However, I don't share your headache or high bp symptoms. In fact, I don't seem to have any other physical symptoms at all! I only know about this problem because I tried to give blood at my school's blood drive and they wouldn't let me because of my high pulse rate. Since then, the school nurse has had me coming in every day to check my pulse and blood pressure. I do have anxiety issues, but these have been controlled with medication (Paxil CR) since seventh grade, and I'm really not stressed out, as this is an easy semester in school. Since this problem started, I have not had any caffeine, and I don't drink. I'm going to the doctor on monday, and will probably get an ekg and a blood test for thyroid function. I'm a seventeen year old girl, very slim, and fairly active. Any ideas on what this could be?



~Jennie

[fearfactor]

I'm not sure what it could be other than anxiety or inappropriate sinus tachycardia. Do you have it all the time or just the fast pulse sometimes. When they find out what it is, let us know!

[tickertock]

I often wonder why some with a pulse of 120bpm isn't aware of it and other with a pulse of 80bpm feels as though their heart is racing or pounding out of their body, sure leaves me wondering.

[Jennie47]

It's definitely all the time..... what would/could IST indicate? My mom is a doctor (neurologist, not cardiologist) and she is thinking perhaps hyperthyroidism because of the tachycardia, my weight (i'm in the underweight-but-healthy range), and my hands (which have always been shaky). The thing is, the weight and shaky hands have been basically all my life, and the cardiac symptoms are new. At least, they weren't there about 5 months ago, when I gave blood for the first time (I don't know what my pulse was, but it had to be under 100bpm for them to let me donate). Anyway, I'll let y'all know what the doctor says on monday!



~Jennie

[Fran71]

Yeah that's weird. Sometimes I think my HR must be 120 or so and when I check it it's  around 90! But when I exercise, even when my HR goes as high as 180 I feel great, whereas my friend with very slow HR at rest feels out of breath when her heart is 130 or so during exercise...Weird stuff!!

[wishyouthebest]

Thank you all for participating and helping.



I will mention these possibilities only if the MRI does not show any abnormality. I don't want my doctor to be influenced by me ;)



For the last 3 days, my headache was not that bad. Also, for the first time in 2 weeks after stopping Inderal, heart rate has been significantly lower, which as a result, made the headache less painful, although it's still there.



Thanks for every one.

[Jennie47]

just an update.... I went to my GP today and got an ekg, blood tests for thyroid function, and a referral to a cardiologist. She (the GP) said that I don't look like I have thyroid problems (no bug eyes, etc), so she is calling my tachycardia "atrial flutter until proven otherwise." I have an appt with the cardiologist on April 24th. I wait a month for today's appt, and now I just have to wait three weeks for another! sooooo annoying! grr.



~Jennie

[fearfactor]

Hi, Jennie - I'm glad that they found out what it could possibly be.  I'm sure they will be able to treat it.  I had tachycardia episodes beginning in 2004 but it was off and on.  After many holters, testing, etc. they found out it was sinus tachy and put me on beta blockers.  I no longer have the tachycardia (only when having a panic attack!).  I'm sure the doctor can help you too!  Take care!

[cdausman]

Allergic reactions have been known to hike up the heart rate and inflict pounding headaches. Just a thought.

[Yodu1432]

A related discussion, Need help!!! was started.