atrial tachycardia

[sue]

Hi! I am a 24 year old female who was diagnosed with SVt (a-tach) in oct of '98.  At that time a eps lab was done but the rhythm could not be induced.  I was placed on tenormin 25 mg/day.  In April of '99 I was back in with more episodes and put on Cardizem CD 120 mg/day.  I was taken off Tenormin due to possible asthma developing.  In Oct '99 I had another EPS which showed possible left a-tach but since the MD was not 100@ positive he would not ablate due to increrased risks.  I was then placed on flecanide but I do not wish to take such a potent drug.  I have had echos which were negative, stress test with and without thallium which were negative.  I have had 2 holters both which showed the a-tach but still it cannot be induced during the ep studies.  During my episodes I pass out, get hot and then cold with blurry vision and when my rate goes above 150 I feel it.  My heart rate goes from 70 to 190 in 3 seconds and then breaks with a cough.  Then ina few minutes to 1/2 hour it goes back up I cough and it breaks again.  I also get chest pain, short of breath and nausea with or without an a-tach episode.  My MD was going to cath me but since the thallium stress came back negative they are not at this time due to my age.  However, the chest pain gets so bad at times I cannot move and they are aware of this.  The cardizem controls the a-tach but about once a week I break through it.  What would you suggest at this point?  esp about the chest pain.
***@****

[Cleveland Clinic, MD]

At this point you have several choices.  1) just live with it the way it is (not a very good choice) 2) Try the flecanide and see if it helps. 3) Get a second opinion from another EP doctor with more skill at ablations.  I would probably go for #3 myself and would look at one of the major EP centers (e.g. Oklahoma University, Indiana University, Cleveland Clinic, etc.)

[Carrie Shelton]

I was reading your problem in the forum and wanted to let you know you are not alone.  I too have the same problem that started when I was 22.  I just turned 40.  I too have been diagnosed with PSVT or SVT.  In fact, I just had a bad attack a couple of nights ago.  My heart rate will be in the the 60's most of the time and then without warning shoot up to 230 beats per minute.  Sometimes I will get really short of breath and my chest will ache.  After these episodes I feel really funny for about an hour or two.  Do you also get PVC's or PAC's?  These are premature contractions.  I have a prescription for Tenormin(Atenolol) but I'm afraid to start taking it.  Did you have bad side affects from this drug?  Please e-mail if you like at ***@****
Thanks, and take care; try not to worry too much, but it's hard!

[Cleveland Clinic, MD]

Thanks for your comments.

[Corey]

I have had PAT since about ten years old.  Now 27, I have been increasing my physical activities to include sports such as mountain climbing, rock climbing, etc.  An episode would be dangerous under severe conditions.  I have been seeing a Dr. to find out if there are options.  After tests, I have been prescribed Tambocor.  I was shocked that he would put me on this.  I have a very mild condition only induced by strenuous activity.  I have heard that beta blockers can be used to achieve exactly what I need which is suppression only during exercise.  I refuse to take Tambocor for the rest of my life and probably will not start taking it. (prescribed yesterday).  Has my doctor totally diregarded my situation, or is this the option that I am left with.  No medicine at all is better than being on 2 a day pills for me, seeing as I have made it this long without anything.

[Cleveland Clinic, MD]

Corey - ablation may be an alternative for you if medication is not an option.  Please be sure to communicate with your doctor so he/she knows what you want.

[sue]

I was wondering what you would do about my chest pain.  I can get it with or without the SVT.  It gets so bad I get nausea, vomiting, short of breath and my back aches in the upper middle.  I am still not sure about the Flecanide.  Thallium stress test was negative.

[Cleveland Clinic, MD]

Could just be due to the strain caused by the high heart rate.

[sue]

I think I will try the flecanide 50 mg 2x/day with the cardizem 120 mg 1x/day.  I break through about 2x/week.  I am still worried about mixing the two.  I still get the cp with or without an episode.  I trust my md but thanks for all of your input.  Do you feel mixing cardizem with flecanide is safe. Thanks.

[sue]

I think I will try the flecanide 50 mg 2x/day with the cardizem 120 mg 1x/day.  I break through about 2x/week.  I am still worried about mixing the two.  I still get the cp with or without an episode.  I trust my md but thanks for all of your input.  Do you feel mixing cardizem with flecanide is safe. Thanks.

[sue]

The flecanide is controlling it but I fel very tired.  I am going to see if my md will let me stop the cardizem.  Also, I was diagnosed with post mi syndrome.  What is this?????

[Cleveland Clinic, MD]

There can sometimes be inflammation of the lining of the heart following a heart attack.  This can cause pain and is usually treated with antinflamatories.

[sue]

I was never told I had a heart attack.  I think I am mimicking post mi symtoms.  Also, my potassium has been 3.1.  It was 3.3 and my md retook it and it went down to 3.1.  My bp was 140/100 to 130/90.  How can this be with the cardizem.  The flecanide is working but I feel very tired with it.  My next appointment is Jan so hopefully it will go away by then.  I also have yellow spots on the whites of both of my eyes.  Should they be checking my liver and kidney functions with all of this medicine I am on.
The flecanide works, no attacks in 2 weeks but I am concerned over all the other things.  Let me know.  My bp was always 110/70 my entire life until oct of '99.

[khan]

I have been suffering from Paroxysmal Atrial Fibrillation for the last about ten years. Finally Flecanide 100mg twice a day and Sotalol 20mg bd kept it under control for about five years till it was changed to Atenolol in May this year following coronary bypass operation.Since then Propefenone was tried but control is not satisfactory and there are side effects. Because of a large scale study that showed increased morbidity in post myocardial infarction cases , Flecanide is not advised even though I did not have myocardial damage.
Any comments from a cardiologist with special interest in Atrial Fibrillation will be very much appreciated.

[sue]

I had my cp again this am.  I woke up at 8 and it started at 8:30.  I threw up once and was sob for about 30 minutes.  What is causing this.  I have had no svt episodes for 1 month- the flecanide works great but this cp is scary. thanks. Sue