Vagal Tone, Tachycardia, Chest Squeezing

[momto3girls]

Hello,

Thanks so much for your time. For the last 3 years I have suffered from some form of tachycardia. It's been caught on holter several times and cardio. dr. says she thinks either svt or pat. Monday I saw an EP doc. (recommended by my cardio.dr.) and the EP says it's not svt or pat but rather increased/weak vagal tone. I'm confused. My tachycardia always shoots up to 150's in 2 beats and can last off an on for a week. (my dad had SVT as well) I'm very sympotomatic when it happens ie: I feel lightheaded and jittery like I'm hopped up on caffeine even though I've not had any. When this tachycardia originally happened, I'd just had my 3rd baby in a row and woke up one morning with a horrible case of hyperthyroidism. Now my thryoid is fine but tachycardia persisits.

Questions: 1.Can the vagal nerve stimulate tachycardia like mine? I was told to go on high salt high fluid diet. Does that sound right? The EP says I have problems with my vagal tone since at times I do have low BP and low HR. 2.But does that apply to tachycardia episodes too? 3. I do have pac's and pvc's and the EP said she's concerned that over time it'll trigger AF. 4. Is that true? I've been told they're benign in a structurally normal heart. I also have reflux and chest squeezing (squeezing gentle not painful and lasts only 10 sec.) 5. Would that be related to vagal issues as well? I'm very tired of feeling dizzy nearly everyday, some days worse than others. 6. Does dizzness from cardiac issues present itself this way, dizzy nearly everyday? Thanks so much for time. You all are so helpful and kind!

[CCF-M.D.-MJM]

Hello,


Questions:
1.Can the vagal nerve stimulate tachycardia like mine?

When the vagus nerve is active, heart rates slow down.  Tachycardia can come from decreased vagus tone or increased sympathetic tone.  Tachycardias can come from either mechanism -- including a list of causes too long to list.

I was told to go on high salt high fluid diet. Does that sound right? The EP says I have problems with my vagal tone since at times I do have low BP and low HR.  2.But does that apply to tachycardia episodes too?

Increased vagal tone can cause low heart rate and blood pressure.  It does not necessarily fit that the tachycardia is from increased vagal tone.   There cases often take months to figure out in clinic by looking at monitor studies and correlating with symptoms.  I am not sure that I can give you a definite answer int his forum.


3. I do have pac's and pvc's and the EP said she's concerned that over time it'll trigger AF.

Everybody has PVCs and PACs, no everyone has AF.  Becareful not to start worrying about developing problems that you don't have.  Until you see AF on a monitor, this should not be a concern for you.



4. Is that true? I've been told they're benign in a structurally normal heart. I also have reflux and chest squeezing (squeezing gentle not painful and lasts only 10 sec.)

This is true.

5. Would that be related to vagal issues as well? I'm very tired of feeling dizzy nearly everyday, some days worse than others.

Increased vagal tone can cause symptoms like this, but I think the reality is that we aren't 100% sure what causes these symptoms -- we do know that they are very common.


6. Does dizzness from cardiac issues present itself this way, dizzy nearly everyday?

The easist thing to do is put on a holter monitor if it happens everyday.  If the dizziness does not correlate with an arrhythmia, it is not cardiac.  In my experience, dizziness and feelings like this are not solely cardiac -- in fact, I think of it as an issue of the autonomic nervous system (sympathetic and parasympathetic) that affect the heart.  These symptoms are very difficult to treat.  Self awareness is about as important as any medication or procedure -- by this I mean understanding that you are not going to die from these symptoms and you need to push through them, try not to let them control you.  I know, this is easy for me to say because I don't have the symptoms,

I hope this answers your questions.  Good luck and thanks for posting.

[momto3girls]

One more thing, the EP doctor said that after looking at my strips she considers the fast tachycardia to be sinus tachycardia with normal variations. Is it normal for your heart to just shoot up to 150 in only 2 beats?  Plus during the ekg they took at her office, my heart rate was only 53 and bp 100/58 (I was lying down for it). She did recommend a tilt table test if the high salt/fluid don't work. Thanks again.

[micheller]

Hello, I was wondering what pat stood for?  The Dr. who took your holter couldn't tell which one it was?  I sympathize with you.  My holter told me two brief episodes of svt, but then my mom who is an RN said it is very easy to confuse SVT and just Sinus Tach, I have no idea?  I need to get a second opinion, but for right now I am taking the Inderal, need it anyways regardless I guess.  I'm curious to hear what your answer will be.  I am very dizzy all the time too, but I know it's from the beta blocker and Xanax.  Was your beta blocker not helping you?  Take Care, Michelle

[anacyde]

Hey, I have that too ;)

My GP has mentioned the vagus nerve being involved in my episodes of bradycardia.  He said, "You're one of the few, if not the only patient I would tell to be bit liberal with salt."  My BP runs low and my pulse does too.  But I hate salt, lol

I have reflux.  All day yesterday I felt like I had a cramp in my chest, back, neck and jaw.  It's scary when digestive issues mimic cardiac ones so closely.  This also gives me PACs and slows my heart rate.

I asked my cardiologist if my PACs put me at a higher risk of a-fib, and he says possibly but not probably.  Most people have PACs, but most people don't have a-fib.

I have dizziness issues too, nearly every day also, and my cardiologist has ruled out a cardiac cause.  It gets so bad I feel like I am losing my balance.  They think it's in my head, lol  No, really physically in my head.  I have TMJ and it can affect people that way because the TM joint is right at the ear.

Hope all that helps you to know you're not alone :)  I know where you're coming from, this stuff can be annoying on the best day.

[momto3girls]

Hey there (:

Did your doc. explain your tachycardia to you?  I understand the bradycardia part in relation to the vagus nerve but I couldn't really find much on tachycardia and the vagus nerve.  

Wow, we really are similar then!  I hate the dizziness/loss of balance feeling.  Sometimes it's feels like I might pass out but never do and other times it feels like I'm falling over.  I've seen an ENT doc. and they thought I might have a mild case of meniere's disease (I have ringing in the ears too).  I don't know.  It seems like so many of symptoms overlap in many different categories.  Why can't it just be black and white?  

I get very frustrated when the tachycaria happens.  I feel so lousy when it comes on and many times my heart will pound really hard at the same time.  Hey and how about a few pac's and pvc's to go along with that tachycardia?  I sure didn't order that!!  Oh well.  

TMJ?  Interesting.  I have lots of jaw pain and my dentist says I grind my teeth at night which is probably why I wake up with horrible headaches.  My jaw pops all the time and this may sound weird but I can't chew a granola/breakfast bar for long because my jaw gets tired!  I actually have to stop chewing for a minute!  

It does help to hear of someone else who's experiencing things like me.  I hope you're feeling better.  It just plain sucks when you're having all the tell-tale signs of a heart attack/cardio problem and it's not related.  I was rushed to the ER back in May from my gym.  I'd been on the treadmill working out and I had lots of chest burning.  I got off and then my arm started to hurt and I panicked.  The gym called an ambulance and they whisked me off which was highly embarrassing as lots of people were watching me at the gym leave.  I was more upset about that I think.  

Hang in there yourself and enjoy your little ones.  Mine are growing so fast it's scary.  I made them promise not to grow anymore but they're not listening (:  Best wishes!

[anacyde]

Haha, they mentioned the meniere's (sp?) to me too!  I hate the ear ringing.  Though it's usually short, it can go on for a while.

I've had tachycardia issues since my teens.  For the most part, I'm not too troubled with it anymore.  After my son was born, I developed a very mild case of PPCM (had the heart enlargement, but my EF was hanging in there at 49%...and I've recovered fully now, EF 65% and heart shrunk considerably back to completely normal).  I was always reassured about the tachycardia, since it was either very short PSVT runs or sinus tach - even with my enlarged heart the PSVT didn't concern my cardiologist.

I *very* occasionally have runs of sinus tach in the range of 200 bpm, typically triggered by anxiety.  It feels like I'm going to pass out and is really frightening, but I've never passed out.  My doc says it's probably andrenaline making me feel bad and not my actual heart rate.  I had one run during my PPCM pregnancy, several runs during my normal pregnancy and one since.  It happens more frequently around hormonal times (pregnancy, periods).

I used to get tachy when waking up in the morning, for absolutely no apparent reason.  My docs shrugged it off.

It would be nice if things were black and white.  For seven months this year I didn't know what my heart diagnosis was.  I had to wait until my follow-up echo (which showed a dramatic size shift back to normal) before a definitive diagnosis could be made.  In this case, it was probably best I didn't know.  It only would have scared me.

The little ones sure do grow fast!  My daughter turned three on the 24th and my son will be 1 at Christmas!  Hard to believe, heh.

[momto3girls]

Hi,

Wow, that's funny about your meniere's diagnosis too.  From what I've read though, meniere's usually involves pretty nasty vertigo and people will literally drop to the ground.  That hasn't happened to me yet.  Occassionally I'll get the feeling like the room is spinning but it's usually because I turned my head quickly.

Geez, you developed ppcm after your baby was born?!?!?  How terrible.  You must have been terrified, I would have been.  Thank God it's resolved itself.  Like you don't have enough to deal with having a newborn, right? (:

For me, the highest my HR ever went was 180 before the BB.  Really not fun.  All I did was walk up the stairs and up it went lickety-split.  I'm just so tired of the tachy and dizziness.  It's been 3 years and no definitive diagnosis...the GP sends me to the cardiologist, the cardiologist has no idea, sends me to an EP, the EP says it's mostly likely vagal tone.  

I did have a nasty headache and dizziness last night but after I liberally salted my supper, it went away.  Weird.  I almost felt normal after adding the extra salt (took like 40 minutes to feel change).  My bp though was 130/77 after the salt.  Great, so I guess I can trade dizziness for high bp now!  What to do!


Oh, I more often than not get tachy right when I wake up too.  I really think my autonomic system is screwed up.  Who would I see for that?  Neurologist?  I was reading up on dysautonomia last night.  Some symptoms fit, some don't.  It'd be just my luck to have the degenerative dysautonomia.  Can you hear the frustration in my voice?

Well, take care and have fun with your kids.  Mine are lots of fun, they make me laugh everyday.  They're always making up games and stories where each of them is always in some kind of peril, you know, like a damsel in distress!  Have a good day and thanks for sharing your experience (:

[micheller]

Hi girls, some of the things you talk about are what I seem to go through too.  I'm trying to get my "svt" report looked at by another Dr.  It was caught on the holter as two brief episodes, rate 154.  I have tachycardia all the time tho, usually arond 100-130, but if it gets to 145, then instantly starts skipping.  Does your guys hearts skip when it gets real high?  I know during an anxiety attack it's gotten up to maybe 180 or 200, but not positive exactly how high.
I have the dizziness too, was told it had something to do with my ears, sometimes it's worse than others.  And the ringing.  I also have tachycardia EVERY morning now, even on the beta blocker.  I wake up at 6am every day and take my Inderal and go back to sleep, then about 8am I get up, but still my heart rate is 100, just standing, which I know is better than the 125 it used to be without the bb. But I know if I was moving around and trying to get ready it would go higher than 100.  My Dr. thinks it's all my mental anxiety over this that is keeping me in the tahcycardia.  Have you ever heard of that?  This is all weird.  I've always had pac's and pvc's, and they have always bothered me, but this "svt" has got me scared, because I called the electrophysiologist yesterday and talked to his assistant and he said that my Dr. is doing the right thing with the BB, they always try drugs first, but she told me almost EVERYONE who has svt has to get it ep/studied and/or ablated at some point in their life because the meds eventually quit working and the episodes get worse.  Well, that sure made me feel 100% better.  You mentioned your dad had svt, did he get his ablated?  I'm just confused, and I would love to hear back from you guys who are experiencing the same thing.  How come your Cardiologist can't tell the difference between the SVT or PAT?  I'm just curious.   Are you guys taking your bb's all the time? Thanks guys, take care! Michelle

[micheller]

I was also going to tell you that I too just walk up the stairs and within a few beats my heart rate is sky high, I know what that is like, so now I avoid strenuous activity.  No fun.

[anacyde]

momto3girls: yes, ppcm is scary.  I was a little fortunate...I didn't know just HOW enlarged my heart was compared to my normal until my follow up when he told me what it shrunk back to.

As far as who to see for dysautonomia, probably a combination of an EP and a neurologist.  From my understanding it's a fairly complex disorder.

micheller: SVT and PAT are usually used interchangably, both mean the upper chambers of the heart are firing ectopics.  I don't know who told you everyone with SVT needs ablations, in fact many young women get it and then it resolves as they grow older.  I had it worst when I was 16, then it mostly went away until I developed ppcm.  Now it came back, but still it isn't as bad as when I was younger.  I'm 28 now.

Dizziness seems to be a common female complaint.  Mine does get worse with hormonal shifts, so I wonder if it's just one of those lovely things about being a lady.  Heh.  Yay.

[micheller]

Hi there, actually the Electrophysiologist's office yesterday told me that it usually gets worse with time.  I told her that I was under the impression that some people can live with it, and even asked if it can ever get better, and she said "it never gets better, and some people can live with it, but most need to eventually get it ablated"  So, I was kind of bummed hearing that.  She was super sweet too, and even said they don't jump right into the ablation tho, that they always try meds, and lifestyle changes, etc. first, but at some point it usually always gets more frequent and the meds quit working.  I'm confused now, I wish I could ask the Dr. here that.  Is that what you researched about it, that it can get better?  That would be nice.  It's not like we women have anything else to worry about in life.  
Thank you for telling me what the difference is between SVT and PAT.  I was told that it was very easy to tell the difference on an EKG strip, is that not true now either?  This is so new to me, so I'm sure I sound dumb as I try to learn it all.  Take Care, Michelle

[anacyde]

I definitely can't say what is true or what isn't.  I could be wrong about what SVT stands for...I'm assume you meant supraventricular tachycardia, which is often used interchangeably with PAT (paroxysmal atrial tachycardia).  

Certainly never take advice from a forum over what you hear from your doctor.  If you doubt your doctor, get a second professional medical opinion.  The forum members like myself can only offer our personal opinions and perspectives and share our experiences - decisions should never be made based on this.

Even if you do develop afib, it's not terrible.  Many people with it are well controlled with medications.  Worrying about this will only stress you out, it doesn't do anything from a preventive standpoint.  Trust me, I'm a certified over-worrier!  lol

Hang in there.  It sounds like a second opinion might offer some peace of mind to you.  Reading the archives here may help too.

[micheller]

Hello, I was talking about the supraventricular tachycardia.  I also am going to get a second opinion at some time down the road, to make sure it was really svt instead of sinus tach.  Either way, I do believe I'm onthe right road, starting a beta blocker.   So you have PSVT?  What does that mean, that it comes out of the blue?  Is that a form of SVT?  How high does your pulse get?  Do you noticed your heart skips a lot when it's high? Mine gets to about 145 and starts skipping, I hate it.  Do you also know, or anyone reading this, how long it takes for Inderal to quit making you dizzy/lightheaded/tired?  I am on day 5, and still can't function.  I for sure wouldn't drive very far because I don't feel it's safe.  I know the Dr. and pharmacist said to give it at least two weeks, but this is horrible.  Michelle

[anacyde]

PSVT just means "paroxysmal supraventricular tachycardia", or "occasional".  Mine comes on rapidly and stops just as rapidly, usually with what they call a vagal maneuver.  I cough very hard or bear down like I'm going to cough hard, and that works for me.  Cold water to the face is also effective.

Per my cardiologist, beta blockers would be used to treat both sinus tach and SVT since they slow the heart rate.  We've discussed this, as I have both.

Adrenaline and high heart rates can trigger my PSVT, even exercise.  I've gone as high as 200 just getting an adrenaline rush while sitting down.  It typically breaks within less than five minutes at that rate for me.  That's just sinus tachycardia when it does that.  My PSVT seems to consistently level at 180.  If I feel my heart skipping at a high rate, it's usually scattered PACs or full PSVT.

Honestly, the best medicine for me has been learning to manage my stress better.

I've never taken any medications, but my dad has gone through a few beta blockers.  Each time, there is about a two week adjustment period where he feels basically lousy, tired and...did I mention tired?  It gets better though, and before long he is back to his normal complaints ;)  Just give your body time to adjust.

[micheller]

Thanks again for talking to me.  If you figure out how to manage your stress, and it works, let me know!!  So you don't take anything for your tach or psvt?  How do you know when your in st or psvt, when your rate is over 150?  Can you actually feel the difference?  Are you in tach everyday then?  Like for instance, what is your "normal" pulse rate for an average day?  I'm sure I could get away with the beta blocker, if I could figure out how to manage my stress, but for me, I can't, and everytime I feel my pulse get a little fast, the anxiety attacks come out, and I can't get out of my viscious cycle, and then that leaves me waiting for another one, so I'm always waiting for my heart to go out of control.  Thus, the Inderal.  I am on a long road to recovery, mentally and physically.  But I'll get there.  Tell me, if you have it exercising, like me, how do you exercise and keep it from happening?  How often in a month do you get a psvt episode?  Your Cardio hasn't recommended you see an EP?  I'm guessing your dad has svt, by what you were saying, how long has he had it, and how well has he responded to the bb's?  :)  Michelle

[anacyde]

Managing stress for me has been making sure to exercise regularly (at least three times per week, at least 30 minutes each time), eating right (avoiding sugars and fats, getting plently of vegetables and fruits - fresh) and taking a time-out at least once a week (I have kids, so this is generous) to do something just for me.

I have the joyous pleasure (note sarcasm) of having scoliosis.  This basically turns my chest into a drum for my heart, and I feel every beat.  I need only sit still or have a high heart rate to feel every beat.  PSVT feels like a string of PACs, while sinus tach is just super fast but regular.  The sinus tach for me actually goes higher (around 200) than the PSVT (which almost always hits and stays at 180 until it breaks).  

I experience sinus tach very rarely (the inappropriate variety anyhow).  The PSVT is become more rare as my heart heals from PPCM.  I hadn't had any PSVT episodes except during pregnancy for about 6 years prior to my diagnosis.  This isn't a common thing for me, but it is not fun when it happens.  As I said, better stress management has helped, as has a better diet and regular exercise.

My normal resting heart rate is about 60-75.  Certain things affect it: sugars, carbohydrates, not enough water...these all raise my resting HR as high as 90.

I understand the vicious cycle of anxiety and palpitations/tachycardia.  I was stuck in it for YEARS myself and I do sympathize.  Know that you can beat it.  My cardio told me that beta blockers can help the adrenaline response you get with anxiety, so maybe this truly is a good path for you to be on.  I hope so, I wouldn't wish this stress on anyone.

My dad is on BBs for post-bypass management.  My mom is the one with PSVT.  She has not been treated with medications, has had it since her teens and her heart is still perfectly normal aside from some unrelated trace mitral valve regurgitation.  My cardio hasn't recommended an EP because occasional PSVT that breaks with vagal maneuvers is typically more benign than the medications used to treat it, and EP studies aren't indicated for the minor stuff we've seen on my Holters.  As I said, I even managed to heal 100% from PPCM with a TON of these palpitations and the PSVT...in mere months with no meds.  If nothing else ever convinced me they're benign, that did.

Exercise was very hard for me from an anxiety standpoint when my PSVT was being caused by exercise, but my cardiologist stressed the importance of keeping the course so I did.  Eventually everything got better.  The palpitations became fewer, my heart became stronger, my mind became clearer and I just felt stronger (mentally and physically) overall.  There is a freedom that comes with knowing you can make it through a 3 mile rollerblade session or 40 minutes of intense kickboxing!  Avoiding exercise only fuels the anxiety, at least for me.

Hang in there!

[sb786]

Hi, i just wanted to ask how things are with you now? I read your msgs and your symptoms are alot like mine. I have a low bp 95/60 and heart rate 50-55bpm at resting, i also have had that ringing in the ears you mentioned. the weird thing about all this is that all these symptoms only started as soon as i started having the PVCs! (I also have svt too)and the pvcs started when i noticed the acid reflux!! also just like you i get that squeezing feeling too. I have been told by a doc that all of this may be due to vagal nerve irritation. I have no idea what this means and how to treat this. i went back to the docs but the doc that told me about the vagal nerve has apparently left and the doc replacing him doesn't seem to agree.