atrial tach and atrial runs

[LynnSB]

Thanks as always for this wonderful service. I'm back on an event monitor because I began having runs of skipped and fast beats around the clock WHILE ON BETA BLOCKERS. I took them for a month and was so fatigue I thought I was going to croak. The dosage was reduced ( i was still having some palps). don't know if that had anything to do with it but I have never in my life had such awful palps, so my doc ordered another event monitor(had one in June showing many PACs, few pvcs,non-sustained PSVT for a few seconds and lots of sinus tach just standing up or doing anything).Had a normal thallium stress a year ago. questions:
1. all i know is my internist took a peek and said i was having some atrial runs ( cardiologist is on vacation)what are atrial runs? I hear runs of fast beats when I send my events via the phone.. those are the ones i correlate with feeling really bad.. they are 3 to 30 rapid beats in a row like you turned on a switch. they start and stop suddenly.
2. I feel my heart skipping a bit when I exercise and afterwards for a minute or two.. I've heard different things -- dangerous or not? of course, on a stress test not one skip.
3. my cardiologist doesn't think an ep is warranted based on last monitor of non-sustained PSVT, etc. what DOES usually warrant an EP study. I WANT TO GET THIS PROBLEM FIXED! tired of it after 20 years.
4.theoretically, could being on metoprolol for one month and stopping altogether have caused me to be extra sensitive to adrenaline and have horrible palps for a while? they started calming down after about a week to 10 days.

[Shroom]

hey, thanks for the reply. The problem is that this is caused by an autonomic disorder and so the cardiologists say to go see a Neurologist and the Neurologists say this is a cardiac problem so go see a cardiologist! I've been up at MAYO to see the Neurologist. I'll see if I can get in with one of the cardiologists. Thanks for the input. Do you have any tips on how to deal with life in general as this goes on? I have to tke medications eight times a day. It is starting to tke over my life. How do I just "act normal"?
  thanks, Bernadette

[Shroom]

hi,
  You guys seem to be old hats at this heart game. Can you give me any advice on how to deal with life as all this goes on? I'm 20, female and been having problems with sinus tachycardia for about 1 year. I get sudden onset of tachycardia at 150-170 bpm which last from 1-3 days (basically until I finally break down and go to the ER). This happens everyday to every third/fourth day. Needless to say, I'm sick of this. I had endless echos done, (all ok, slight murmur), EKG's, monitors and hosital stays. It seems that my natural pacemaker doesn't regulate very well and goes too fast at times. I can't take beta blockers due to a genetic oversensitiveity to them. Now it seems to me, that the smart thing to do is zap out my natural pacemaker and give me a new one. This is my GP's idea but he can't find a cardiologist to agree with him. In the meantime, how do I keep from going insane? I can't excersize, go anywhere alone and once almost died b/c I passed out in the shower. I can only take two classes at college b/c I miss so much. I've even been in the hospital b/c the meds made my heart rate get too low. Its hard to keep going whe I don't see much hope in the horizon.

[LynnSB]

>>>atrial runs could be a number of things depending on what the rhythm is. Atrial fibrillation/flutter with rapid repsonse, reentrant pathways, even sinus tach. <<

My cardiologist said ( about my last month long event monitor results) , and I quote, " there is no suggestion of a fib at all and we don't see any signs of a reentry tachycardia. In fact, I ran by one of the PSVT rhythm strips to Dr.___, (an EP) for another opinion and the more we look at it the more it looks like sinus tachycardia. You do have a lot of sinus tachycardia and a lot of PACs and rare PVCs."

BUT how on earth can an even monitor show things like reentry tachy? maybe the best question, in hopes you can answer this, is CAN it show if a rhythm is reentry or not?

and one more -- if you can please answer -- isn't it true that sinus tach does NOT come on and stop abruptly? there's a "warm up" phase? so runs of 3 to 30 fast beats that start and stop suddenly couldn't be sinus tach? or could they?

Thanks  so much.

[Linda123]

Lynn if you look back at my posts it details my heart problems!  If you leave your email address I'll drop you a line.
Best Wishes

[Cleveland Clinic]

Lynn,

You should work with your doctor to come to a satisfactory conclusion.  There are certain things an EP study will not help with.

An EP study is an invasive procedure that defines the electrical anatomy of the heart. Once areas are defined to be abnormal, subsequent procedures are done (like radio frequency ablation) to fix the 'faulty wiring'.  An EP study in itself is not curative.  Before having an EP study, there needs to be some evidence that the wiring is abnormal. This would be determined by your event monitor.  If it shows an abnormal wiring connection, or other rhythm problems that are ammenable to ablation then an EP study is warrented.

I'm a very big patient advocate but demanding a procedure is not the solution (Linda, I'm sorry to hear about your ordeal). You should approach your relationship with your doctor as a team, if the answers you are recieving from your doctor are not reassuring or satisfactory, seek a second opinion.


Thanks.
I hope this helps.

[LynnSB]

thanks, Linda. And, if you don't mind my asking, what WAS wrong with you that the EP study revealed? Did you have an ablation?

Thanks so much for your time.

L

[LynnSB]

YEEEEHOOOO!!! just talked to my cardiologist and finally, FINALLY, he and the EP doc he consulted with saw atrial tach and I'm going to have an EP study and hopefully an ablation. They think it is an ectopic tachycardia from the , i think he said, pulmonary vein or something like that which should be amenable to an ablation. I am scared a bit but so thrilled this might be curable!!!!!

thanks again for "listening" and answering so many questions.

[Linda123]

Hi - just to clarify, doctor - I most certainly did not demand an EP study from my cardiologist, it was only when my cardiologist said to me at one consultation "there's no point in us talking about your symptoms any more - don't come and see me again until you know what you want me to do" that I realised he wanted ME to to make the decision as to how to go forward.  Once I understood what he was saying it didn't take me long to make my decision and so I went back to see him and asked if it was possible to see if I was a candidate for ablation.  My cardiologist said he was very pleased at my positive attitude and so booked me in for an EP study.  I would have had my 'positive attitude' much sooner had I understood in the first place that it was up to me.  
I have wondered since if doctors leave patients to make the decisions because of the "compensation culture" that exists nowadays.  I would say if this is so it is very understandable.
Hope this explains.
Best Wishes.

[Linda123]

Lynn - my (faulty) heart goes out to you and my advice is to get an EP done.  I messed about for 30 years until eventually I asked for an EP, had it, and and now I know what is wrong with me.  You need to tell your doctor what you want - not the other way round - it took me a while to understand that.
Beta blockers made my palpitations worse too.
By the way - you know what they say - "if you don't like what your doctor says - change your doctor"!
Best Wishes, Linda

[Cleveland Clinic]

ALynn,

trial runs could be a number of things depending on what the rhythm is. Atrial fibrillation/flutter with rapid repsonse, reentrant pathways, even sinus tach. It would depend on what the rhythm is on the monitor. The rhythm will determine what the treatment options are.  

The symptoms of palpitations you have are not dangerous. Not to say they are not an annoyance however.

An ep study would be useful if you have a fixable problem causinf your symtoms. This would be something like an extra pathway that connects the top of the heart to the bottom. This could be localized with and EP study, then potentially ablated using radio frequency energy.  

Some people experience rebound symptoms after stopping beta blockers suddenly.  

Hope this helps.