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tachacardia
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tachacardia

Hi
I have had nighttime tachacardia, dizziness, shortness of breath, chest and arm pain, and a hard time breathing over the last two weeks. I went to the ER two nights ago where they did EKG and blood work checking the heart enzymes. My blood pressure when I arrived was 206/122. The ER physician said he thought it was extreme stress that had caused the problems. He was right that I was very stressed but that is not the problem. Whenever I have these "episodes" I was completely calm. Two days before that I had the same problem and went to the doctor. She had me on a holter monitor for 48 hours an I have not gotten any results yet. I have also done an oxygen test for my sleep apnea machine, again no results yet.
I have hypertension, sleep apnea and am taking 60mg of  morphine 2x a day for my back. I am not very active because of my back and I need to lose some weight. I also have a history of panic attacks and stress related problems off and on for 30 years and have had tachacardia since my 20's and I am currently 53 years old.
The last two weeks have been extremely stressful. I am currently a student full time online, I watch two of my grandchildren 5x a week, and my beloved Bull Terrier dog Ruby was in renal failure and died last week. So I was very stressed but this has been happening for most of my life. I am very scared because no one knows what the problem is. I feel like crap and am very weak. Help!
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Hi Teresa11144,

No one can diagnose via the Internet.  However, I can try to give some advice based on what you are describing.  First, it is possible that your symptoms are from high blood pressure.  Although high blood pressure can result from stress, you are right in that it often does not get that high from stress alone.  Unfortunately, as patients get older and the arteries stiffen, you may need increased blood pressure medications.  Sleep apnea, particularly if it is not treated appropriately (not using your CPAP every night, wrong settings, etc) is known to further elevate blood pressure.  The morphine for your back may also be worsening your sleep apnea.  Therefore, I would make sure your sleep apnea is appropriately treated.  If you have a blood pressure cuff at home, I would record your blood pressure once or twice a day (and during these episodes) and take them to your doctor.  

The other possibilities are that you have a heart arrhythmia.  I'm sure you have gotten the results of your Holter monitor by now.  The only difficulty with the Holter is that if you do not have those symptoms while the Holter is on, it may not actually capture what is going.  I would discuss that further with your doctor.  I don't know if you have been experiencing any chest pain, increasing shortness of breath, or other similar symptoms during the day or if this only happens at night.  You may want to consider talking to your doctor about further testing to look at the blood vessels of your heart to make sure your symptoms are not from any blockages of these blood vessels and also look at how well the heart muscle is functioning.  Again, I am not seeing you in clinic, so your doctor may feel this is not necessary.

If all else seems to be unrevealing, you may want to consider whether these symptoms are related to your panic disorder, given the amount of stress you are under  If you are on medication for this, you may want to consider dose adjustment.  Psychotherapy can also be helpful.  It may not fully explain the elevated blood pressure, but this could help.

Lastly, if you smoke or drink alcohol (more than 1 glass of wine a day), I would cut those out as they will elevate your blood pressure.  Exercise and diet to get the weight off will help with your stress, your blood pressure, will give you more energy, and help your back.  Swimming or brisk walking tends to be gentle on the back.  I would have your cholesterol checked and tests run for diabetes, if you haven't already done so.  If you are eating right before bed, avoid this as well as acid reflux can sometimes cause symptoms similar to the ones you were experiencing that night.

Hope this helps!
CCFHeartMD20
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