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What causes inappropriate sinus tachycardia to begin in the first place?

I am a healthy 37 year old woman, who went through surgical menopause two years ago. [Other than many repeated viral illnesses in the past six months] I am at an ideal body weight, I exercise 3-4 times weekly, and I don't smoke.  I take Premarin and progesterone daily.

This past winter, after suffering a fairly severe flu, I began to experience what has been diagnosed as inappropriate sinus tachycardia for the first time.  For the 37 years prior, I never had any cardio issues whatsoever.  Then I suddenly began to experience unexplained bouts of rapid heart beat and shortness of breath.  At first my symptoms abated when I increased my estrogen replacement, only to return again in a more severe form about two months later.  I began to have bouts of rapid heart beat and "skipped beats" daily from about 1:00 to 3:00 p.m. -- bothersome enough to prevent me from being able to do anything, with a BP of about 150/95 during these episodes.  Advice to just ignore it really wasn't helpful -- I was too short of breath during the episodes to be able to really function.  Chance in diet, relaxing, completely avoiding caffeine, alcohol, etc. made no real difference.

I have run the gamut of tests, holter monitor, echocardiogram, stress tests, VQ scan, blood work, pheo testing -- all has come back normal.  Event monitors captured my rapid beats and premature beats.  Now I am taking 25mg of Toprol each day, which seems to really help, although I still feel the side effects a bit -- sleepiness, etc.

Two questions:

1.  Does anyone have any idea as to what causes this condition to begin in the first place?  I'm very frustrated by suggestions that it "must be stress" in the absence of an obvious physical cause.  I know myself well, and stress is not the answer, nor is caffiene, alcohol, etc.  Could a virus have triggered this?  If so, is this type of condition generally life long, or time limited?  I somehow feel either hormones or a virus must be the underlying culprit.  My doctors seem more interested in just treating the symptoms and not getting to the cause, and I haven't been able to find any info on origins of inappropriate sinus tachydardia.

2.  My cardiologist advised me to continue to exercise as much as possible.  When beta blockers slow the heart rate, does that bar the aerobic benefits of exercise?

Thank you so much!

Julie
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Avatar universal
Your situation is one which is very similar to mine.  Until this past June, I have enjoyed good health.  I had an early menopause, at about age 41-42, the same as my mother.  I began HRT at that time with premarin and provera.  About 5 years ago, the premarin was changed to estratest (estrogen plus testosterone) to help with a complete lack of libido since menopause.  Then I changed the way I receive my hormones as of June 1.  I began taking daily estratest and 2.5 of the medroxyprogesterone (Provera) with no break at the end of each month.  Within two weeks, I began experiencing slight chest and left arm ache, but ignored them since there is no history in my family of heart problems and the symptoms only lasted about a half-minute.  Over the two weeks, the symptoms gradually increased in frequency and duration until, on the evening of June 13, I had my first rapid heart incident which lasted for about two hours.  I finally told my husband what was happening and he made me promise to call the doctor the next day for an urgent appointment.  I made an appointment for 2:30 p.m. on June 14, but never made it, since I had another attack after lunch at work where I actually felt I was going to pass out and the paramedics were called to transport me to the hospital.  They kept my overnight, taking blood regularly and doing EKG's, also a treadmill test.  But all results indicated that I had not had a heart attack.  The doctors kept suggesting esophageal reflux or hiatal hernia, but I had not had any previous symptoms of such.  I was released the next day, but had to have my husband take me back to emergency (at a hospital closer to home) the following Sunday.  They, too, said I had not had a heart attack and referred me back to my own doctor.  I am now taking Ativan and daily aspirin, and Prevacid (which I don't feel I need and the doctor has said I can stop after the end of this prescription).  I am awaiting my first appointment with a cardiologist in September, unless something drastic happens in the meantime.  My doctor has also suggested that these are stress-induced panic attacks.  But I don't feel I have any stress in my life.  Our kids are happily married and out of the house.  My husband and I are in a happy, healthy 31-year marriage and economically comfortable.  My job is fantastic and I am under no stress there.  This is a mystery to me, and the only connection I can made is hormonal.

After talking to the nurse who prescribes my hormones, I went back to taking them on a cyclical basis:  estratest from days 1-25 and medroxyprogesterone from days 16-25, each month.  Five days after I started the medroxyprogesterone, I had another attack at work, but was able to quiet myself down enough to drive home, and didn't get back to feeling normal until mid-morning the next day.  During my previous years on hormone therapy, I did notice that about 3 days after starting the medroxyprogesterone each month, the hot flashes would come back and I would several times awaken in the middle of the night or in the morning with the feeling that I could not breathe enough air.  I would need to get up and do something to burn off some excess energy, go outside or near a window to get fresh air, and then prop myself up in order to get back to sleep after about a half an hour.

I definitely feel all of this started hormonally, but that I might now be caught in some kind of syndrome where the tachycardia will start by itself.  I have cut out all caffeine (I never had much anyway), drink only water, have started taking magnesium, calcium, potassium, etc.  I am also now afraid to take any hormones ever again, and I'm only 52.  I had hoped to have another 50 years!  

There must be some connection to hormones somewhere.  I just feel it.  I'm sure there are many other women out there who feel the same.
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Avatar universal
Does any one know if birth control pills could cause sinus tachycardia. I am 30 and never before had heart problems, all of sudden I have been diagnosed with Sinus Tachycardia. I am currently wearing an event monitor, after three trips to the er. I have a cardiologist who states stress or anxiety could be the cause. I disagree nothing in my life is too stressful. I also am trying to figure out why this problem occurred out of the blue. I was on Buspar for a couple months and discontinued two months ago. I started having wierd feelings a few weeks ago: chills up and down my spine and feelings of being very scared. I have never had a panic attack before, always have been a little anxious. I also was put on a different birth control pill (Desogen) about three months ago and was wondering if this could be related. Cardiologist put me on Lopressor .25 mg a day, I have had to increase my dosage, because in less then 4 hours heart rate increases to 110, my normal is 74. The doc took me off the meds and within one day hr went to 136 down to 104, then in less than 10 minutes another attack hr 140 and experienced chest pains. I feel like this is taken over my life and want it to stop. Any information would be most helpful. My BP also rises to 160/90 when I am having an event, normal is 134/76. The medicine is helping a little, but am still experiencing weird feelings that occur out of the blue. Thanks.
Helpful - 1
Avatar universal
This is to both Diane and Julie --  I, too, have had a rather sudden onset of tachycardia and can pretty much trace it back to starting after a bout with the flu and strep throat.  I feel pretty strongly that there has to be a corrulation somewhere, but all my doctors disagree with me.

I also went through surgical menopause in Feburary 1998 and up until May of this year, was not on ANY type of hormone replacement therapy.  Only after I insisted on hormone testing and my doctor determining that, although my hormone level seemed ok right now, my body WAS in fact, sending out massive signals to try and produce hormones (even though it couldn't because I no longer have either of my ovaries), was I put on Premarin .625 daily.  I have not, as of yet, however, found that this has helped much -- certainly not with the tachycardia and fainting (yes, I have had LOTS of fainting spells along with my tachycardia) - but it has helped a little with the night sweats and mood swings.

My doctor also has me on Prilosec for reflux, but, like you Julie, I do not have any of the symptoms of reflux such as heartburn or excessive gas, etc.  I do know that sometimes when the stomach is irritated, it can give you some of the same symptoms as your heart, but like you - I feel the doctors are just trying to treat the symptoms (or grasping at straws) rather than trying to get at the main cause.

I will say, however, that my current doctor (just a plain old family doctor) IS pursuing the cardiac symptoms and complaints.  I have already had one 30-day event monitor and she wants to have another one done because I continue to have problems and the first one did not give them enough information to be able to determine exactly what the problem is.  She does seem more "in tune" than a lot of the other doctors out there.

Helpful - 1
238671 tn?1189755832
1. A virus can damage the heart, but this usually show up in an echocardiogram. An EP study performed by a cardiac electrophysiologist can determine whether you really have inappropriate sinus tachycardia and what part of your heart may be causing it. Potentially, it could then be treated with an ablation procedure.
2. People taking beta blockers still get the benefits of exercise, though they may not be able to raise their heart rate to as high a level as when they were not taking the medicine.
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Avatar universal
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Avatar universal
A related discussion, Inappropriate Sinus Node Tachycardia was started.
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Avatar universal
I am a 45y/o female with IST.  I also have a congenital heart defect, mild pulmonic stenosis. Apparently, 3 of my valves now show some regurgitation per echo,with the pulmonic valve showing the most, but not enough to require surgery.  In fact my EP Cardio calls my valve status "red herring".  The diagnostic process was long, drawn out and filled with dissention among at least 5 cardiologists.  The process was filled with stress for both me and my family.  This made it difficult to know how to respond when a dr. would ask about stress. I had 2 event moniters, 4 separate holter moniters {on various levels of beta blockers], 2 heart caths, 3 EP studies and 2 sleep studies. Always the same results were found-continual IST and some other minor arthymias. Noone could decide on what was the most approprate tx. I took lanoxin, high doses of beta blockers, and diazide for 5 years.  The interventions would work initialy, but the IST always returned. I grew weaker, profoundly fatigued and was unable to take good care of my kids or perform my job duties well.  I was in cardiac rehab for 5 years also, which seemed to be of some help.  The good news is that in the past yr. I have had 2 sinus node modifications that have been very helpful. I felt dramatically better after the first one but the IST gradually returned. The atrial fib that dr. L ablated at the end of the procedure however stayed away.  The second SNM however seems to be working per cardic stress test. I no longer take any beta blockers. These were hard for me to tolerate because I have normally very low blood pressure to begin with.  I hope that someday drs. will be able to dx this more easily. I could go on forever about how difficult this was for me and my family. I am thanful my cardiologist never stopped looking for answers.  I will be forever grateful for Dr. L's knowledge skill and courage.  I hope this story helps someone.
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Avatar universal
I wasa fine untill I had a back injury in 1979 when I had to sart having myleograms and other test for my back I had to fight the workmen's compensation insurance company at every turn. Finally after 6 mo. of severe pain I was rushed to the hospital with heart rate of 290 min. I was give digitalis and had allergic reaction, then the dr's started different heart meds. I was like that for 16 hrs. not expected to live. Finally the cardioligist gave me pain medicine for my back and valium for my nerves.Heart rate went down to 160 and then the heart medicine corogard took over and the attack broke back to 82 min. I took the corgard for 6 month then started tohave severe chest pain and was hospitalized again. I was havin main artery to the heart spasms which cut of the blood supply. The dr. put me on procardia with the corgard. Man, did i feel bad with the meds. In 1980 I had back surgery which took care of the pain.  Found out later the corgard was causing spasms and procardia was making me feel bad.  I had a hear cath. and the new Dr. took me off of all meds.  Said tachycardia I had was caused by stress and pain.  I was fine untill 1999 when I was again injured and in a lot of pain and stress. Tachyardia again. Dr put me on zannax after a stress test was normal .  Haven't had an attack since.  There is a fairly new procedure that the dr's can go in non-surgically andpin-fire the little wire looking thing that makes the heart beat. This causes scarring at that point.  You are never bothered with tachyadia  agian.  I am considering this because a lot od doctors do not like giving valium or zannax and they say it's not stress or pain but I don't really know what to do.  Stay on the pills are have the procedure which does have risks. anyone that has had this procedure please write me. Sincerely and love to all u out there.     Connie
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Avatar universal
Hi,

My eight year old son has been diagonised as having Sinus Ventricular Tachycardia. I live in Sydney (Aust) and am looking for more details regarding this condition. Nicholas first had an SVT episode at 12 months of age and his heart rate on ECG was monitored at 320 bpm. He was injected with Digoxin and was on this for over 6 months. Since then he has seemed to be fine until 4 days ago when he had a fever. A visit to our GP saw him in the Emergency Dept with a heart rate of 245 bpm. He was injected with another drug which brought his rate to 80-90 bpm.
Two days later he was again in ER with 195 bpm. He is currently on medication to slow his heart rate (Sotalol Hydrochloride 40mg)
and this seems to have an effect on him. I will be seeing a cardiologist in 2 weeks but at pesent am trying to find out as much as I can re this condition. Any information will be very much appreciated. Thanks.
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Avatar universal
Andrea, Just read your post. How long have you been on BC pills? If it is recent, you may want to try a time off them to see if your heart rate improves (if you can change to another BC method). I do think there is some link to hormones and increased heart rate. Otherwise from what I've been reading here and in talking to my cardiologist, no one really know what starts IST. I'm still working on trying to find the right mix of meds to treat IST and my hypertension. It is taking a while. Don't give up hope. And DON'T let the doctor tell you it is from "stress." or anxiety. Take care - Sue
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Avatar universal
I am 45 f in an allied med profession. I have had 2 radiofrequency modifications of my atrio-sinus node in the past year, as well as an ablation of an atrial flutter. PRIOR TO THESE PROCEDURES, my life consisted of mind-numbing, bone deep fatigue, nausea, SOB, and SVT 24/7. Since I was born with pulmonary stenosis I was already followed yearly by a cardiologist. After 5 yrs of cariac rehab, lanoxin and ever higher doses of beta- blockers Iwas dx with IST after EP studies.  The meds and rehab always helped initially, but after a few months the symptoms would return. I lost 40 lbs. Even when I was Sleeping [per sleep studies] my heart rate was 115bpm and up.  The diagnostic process was excruciating and took 7 yrs. My children suffered, my marriage suffered and my career suffered. I am eternally grateful to my cardiologist and the 2 EP CARDIOLOGISTS  who were finally able to find effective treatments.  The EP doc who did the rf modifications has quietly developed a way to map the sinus node and phrenic nerve to avoid complications. He has done ~40 with no major complications.  I only wish the dx process could be made easier and shorter for others with this problem.  My life has been drastically altered by the YEARS of fatigue etc and uncertainty. I have a few suggestions gained from my experiences. Is research continuing?What can be done to keep this from happening to everyone with debilitating IST?
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Avatar universal
jan
Hi Sue, Some have referred to the all the initials as cardiac alphabet soup. Usually you can go under the search option and find out what they mean and what they are all about. NCS is neurocardiogenic syncope, POTS is postural orthostatic tachycardia syndrome. You can see why initials are used. :o)  Hope this helps.
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Avatar universal
sue
I have just been diagnosised with IST. I am also a nurse with over 20 years of critical care background. However some of the initials being thrown around are unfamilar to me. What does NCS and POTS stand for? I finally figured out that TTT is for tilt-table test. Just thougth there may be others out there who also are unfamilar with these terms.

For Leslie and others who have a doctor that tells you its "just stress". Get another doctor that takes your symptoms seriously!
There are studies out there that women are vastly undertreated when it comes to cardiac symptoms. Ask you doctor if he would do anything different if you were a man with these symptoms.

As far as the role of hormones with tachycardias, yes this can cause some stimulation of the sympathetic system which causes our "fight or flight" reaction. With the peri-menopausal period there are wild swings in hormones as our bodies go though these changes and some of the symptoms are just now being recognized as being related to this. Is this the cause of IST? I don't know but feel it contributes to it.
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Avatar universal
Hi,
I am 33yr. female who is a nurse and i had crushing chest pain last wednesday. EKG showed elevated T-wave, sinus tachycardia. My doctor started me on atenol. My BP was running 160/110, pulse 120-140bpm. Shortness of breath and tightness of my chest. On doctor said it was stress. Didn't like that answer alone. Maybe stress is related to it, but my BP and HR should not be elevated all of a sudden and stay that way. The day my BP was so high I was having a good day. My md scheduled me for a echo on monday. Had on in 94 that showed mild tricuspid insufficency. Even though none of the doctors can hear the murmur.Any one have any suggestions on things i need to follow up with. Even though i am a nurse, i still want everyones opion on this. Because we are the worst patients and neglect ourselfs the most.

Thanks
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Avatar universal
Hi,
i was diagnosed with IST after an EP Study with ablation to the AV Node for RE-ENTRY TACHY.  I had severe chest pain and cycles of IST ;through out the day.  I am curious if any one else has experienced this or other side effects from an EP study the doc said he usually sees this kind of arrythmia after an EP Study of this nature.  I went on Atenalol for about Two monthes and have recently stopped it and am doing much better.  I still have palpitations often. but i am better.  the doc had told me that it takes time for the heart to heal and could take monthes to get better.  just  curios if anyone has had an experience the same.  thanks for any input.
melody
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Avatar universal
I had TTT and had a negative result. HR was 120-150 most of the time , but they still call this negative.  Had a doctor visit test right after Tilt Table test. HR was 150bpm of EKG. I am going to wear a holter monitor tomorrow and have an echocardigram done. My doctor did say he doesn't know what to do with me. I asked about Radiofrequency ablation, he has only done 2 and 1 was sucessful. He wants to lay this high HR on stress, caffeine, He asked me about caffeine, I did have a time Hr went very high after drinking coffee andf I got very sick but I don't drink it now. I am hoping monitoring will show this , that I am not drinking coffee all day. What I have been told is that you can't tell between stress, excercise and caffeine on EKG readings. I hope this isn't true.

Leslie
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Avatar universal
jan
Hi Leslie, Sorry to hear you don't have any answers, yet. Your tilt table test was probably neg. because on changing your position it didn't bring the results they were looking for.  Such as your heart rate being lower while laying down and then upon tilting up it rising. It's true that they can't tell the difference between stress, exercise, and caffeine causing tachy. It was how I responded to the IV medicine that they knew mine was IST (the tilt table test was to diagnose NCS, which I do have). Did you say your dr. was an electrophysiologist? How old are you? I can't understand why he doesn't know what to do with you. If you have an ablation please go to someone with a whole lot more experience!!!
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Avatar universal
Sorry.  Change the preceeding message....my druggist switched me to a generic Ogen (Estrogen) not the other.  Also note that Premarin (the estrogen that seems to be pushed by most doctors) is from horses' urine and not as close to the natural our body produces as the Estradiol.
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Avatar universal
jan
Leslie, I think POTS is more like IST than NCS. NCS your blood pressure and heart rate drop simultaneously causing syncope or near syncope. Have you used the "search" option? You can find out so much. Just type in "POTS" or anything else you want to know about. I believe I have read that beta blockers can cause weight gain, but I don't know where I read it. I do know I've heard others complain about it. By the way, how old are you? I ask because I have learned (through reading on this forum and questioning the dr. about it)that they don't take things too seriously if you're younger. SVT's are more common in young people and they seem to grow out of it. Also, if it doesn't happen often they won't do much about it. My heart rate doesn't change because of my position changing, it just races whenever for no apparent reason. So I know what you mean when you say it isn't from what you eat or drink or stress. From what I read in your post I have to wonder if I wouldn't want another dr.  I hope you get the answers you need and the proper response from your dr.
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Avatar universal
I didn't have time to read all the replies to your question, but, I too had a rapid heartbeat of about 100 bpm that would start when I was at rest, for no reason at all.  I was on HRT (Ogen & Medroxyprogesterone) and my druggist had switched me to a generic Medroxyprogesterone (from Cycrin).  I talked to a friend who had had similar episodes from her hormones.  I went back to the brand name Medroxyprogerone and the rapid heartbeats never occurred again.  During that time I also started to suffer bouts similar to severe anxiety attacks whenever I took off in an airplane (Severe sweating, etc.).  I usually take Actifid for my sinuses when I fly and somehow this mix caused the attacks.  I now take the patch Estradiol (the most natural form of Estrogen) and Prometrium (the most natural form of Progestin from the Mexican Yam) and have had absolutely NO problems.  I keep forgetting that hormones, too, are drugs.  It is also known that Medroxyprogesterone negates the benefits that Estrogen gives the heart.  That is another reason to switch to the Prometrium that has been O.K. for HRT use in this country.
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Avatar universal
jan
I have read somewhere that lyme disease can cause arrhythmias.

Leslie, How does your dr. know if you don't have an extra elec. pathway if you haven't had an ep study? Is he going by an ekg or something?  They found out mine was inappropriate sinus tachy. primarily by the tilt table test, only because it happened during it. When they got the holter results back it was caught then, too. I wasn't aware of my heart beating fast. I experience palps when it occurs now, the palps are very weak because of the atenolol. I had those symptoms you mentioned plus fatigue, dizziness and brain fog, but I don't know if these symptoms were from IST or NCS. The light headedness could be from either. The nausea is from the NCS. My ep said he felt my IST was triggering the NCS. I, also, have mild mvp w/mild mr and mild tr.
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Avatar universal
My HR goes into a SVT range as soon as I stand up. Laying down HR can be 100bpm, 170-200bpms as soon as I stand. HR will continue this high until I lay back down again. So physical activity is very tough. I am on lanoxin and pindolol, 120bpm is the lowest HR I can get while standing or doing any activites. Is there anyone else out there that has symptoms when HR gets this high. I feel lightheaded, short of breath, nausea. All tests showo no heart disease. My electrophysiologist has not found any electrical pathway problem so far, I have not had an EP study. Monday I will have a Tilt Table Test.


Leslie
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Avatar universal
Jan,

   My doctor seems to think he can look at premature beats before my SVT while on tilt table. I passed out in April, only thing I could remember was going up 4 steps heart rate going up and feeling nausea. I believe the doctor feels my syncope was anixiety. I have not been seen since passing out. The day I passed out my husband called doctors office and talked to another doctor who didnt seem concerned. I didnt get a call from my own doctor after this happened.  I called my doctor after 3 weeks, to see if I could find out about why I passed out and have had waves of passing out since, he said I could have a TTT. I can tell you when HR is high it is not because of, what I eat or drink, or any kind of a mood swing. Just get me in an upright position and HR is high.  I noticed BP going lower and lower while laying down. I called doc and told him I felt lighthheaded, and short of breath while laying down, BP was 75/55 at that time. When I stand BP is 150/100.  I do not like taking beta-blockers, I gainned 100lbs in 10 years. Doctors will say that they dont make you gain weight , I would have to debate them on this. Is NCS like POTS? I have wondered that I could have something liek this.

Leslie
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Avatar universal
Hi folks. I am a 39 year old male who has had a history of a-fib over the past 10 years. It occurs only when I have been startled from sleep and my system is thrown out of whack. I had read somewhere that a-fib is caused by a sudden rise or drop in blood pressure and believe this is the cause in my case. As usual I have heard all the excuses from the doctors that it is stress, alcohol, depression, smoking, blah, blah, blah. I was wondering if anyone else has noticed this correlation between being at ease and then experiencing a sudden shock or fright to trigger their a-fib?

John
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