racing heart!!!!

Hi, I don't know where to start. I have had a racing heart for a long time, but in the past year it has gotton worse first they told me i was having panic attacts, but none of the meds worked they only made me feel they were making me feel mentally wrong, I got a new doc.It started when I hurt my neck and upper ribs from over work. anyways My heart will race at about 110 and then I'll feel good for about two weeks then it starts again after this I feel very weak, my doc. ordered an echo and it looked fine then I was still going to phisical therapy and I would have pains in my upper ribs so I haven't been able to have any excersie in probably one year and I used to be very active hiking, horseback cause my neck would hurt bad if I tryed to walk even so I haven't had a life in a long time I have been a little better then when I told the doc. about the chst pains in my upper fibs, he sent me to a cardio. doc. and he ran a stress test and now he wants me to go have a angiogram and I'm scarred. why would the echo be ok and not the stress test ? could it be because I haven't had any excersice? he also gave me a halter to ware when I left, I'm 36 years old and have had enough should I get a second oppion or get the angiogram please help also when I lay on my right side I get shaky? and what is pvc's that everyone talks about? thank you very much and I'm sorry to be so long winded

[Cleveland Clinic, MD]

Dear  Joyce,

Thank you for your questions. I'm not sure I would rush to have an angiogram unless your doctor strongly recommends it.  A PVC is a premature ventricular contraction and is very common.  As far as the tachycardia, there are many causes and they can be divided roughly into sinus (originating from the sinus node or heart's natural pacemaker) and non-sinus tachycardias.  Nonsinus tachycardias are either  supraventricular (coming from the upper chambers of the heart) or ventricular (coming from the lower chambers of the heart).  Supraventricular tachycardias include:  paroxysmal supraventricular tachycardia, atrial flutter, atrial fibrillation and AV nodal tachycardia. Ventricular tachycardias are more serious in nature and are due to a rapid depolarization of  the ventricles.  

Sinus tachycardia is defined as a heart rate of greater than 100 beats per minute originating from the sinus node.  Sinus tachycardia is classified as either appropriate or inappropriate.  There are many causes of appropriate sinus tachycardia such as exercise, anxiety, panic attacks, dehydration, deconditioning, volume loss due to bleeding or other loss of body fluids, hyperthyroidism, electrolyte abnormalities and many other conditions.

Inappropriate sinus tachycardia can only be diagnosed when all causes of appropriate sinus tachycardia have been ruled out.  It is not clear what causes inappropriate sinus tachycardia but possible etiologies are an increase in the rate at which the sinus node depolarizes and an increased sensitivity to adrenaline.  Once the diagnosis has been made by ruling out all of the potential causes of appropriate sinus tachycardia  there are several treatment options.  If the symptoms are not overly concerning no treatment needs to be done.  There is no increase in morbidity or mortality in persons with this condition and they can expect to have a normal life-span.  For persons in whom the symptoms are unbearable medications such as beta blockers or calcium channel blockers can be used, usually with good results.  In the rare person unable to tolerate medical treatment catheter ablation (burning) of the sinus node with insertion of a pacemaker or surgical removal of the sinus node have been used in the past.  Newer techniques are being developed using catheter ablation to modify and not destroy the sinus node thus avoiding the need for a pacemaker.   This procedure is still in it's infancy and should only be undertaken at a major medical center after consultation with an electrophysiologist.