Aa
Abnormal heart rate
Coming on 26, Female.. History of severe AVNRT, had ablation, avnrt has been inactive for 3 years. low blood pressure (80/40-90/50), not symptomatic, family history of low side BP), minor palpitations clean echo last year.. medical student and extremely stressed out.
Although no more SVT, Still experience alot of tachy upon standing, sometimes up to 160, sustained until I sit down, at which point pulse drops dramatically. Resting heart rate is fine, low 80s-90's,also have extreme exercise intolerance, sometimes feel near syncope due to high heart rates with minimal exertion.Had a stress test a few weeks ago, reached max heart rate in less than 30 seconds of walking, no chest pain or other symptoms except shortness of breath and other typical symptoms of someone with a 190 pulse. Exercise intolerance is interfering with life dramatically.I also compete in equestrian competitions and have not physically been able to ride for months. My EP and cardio arent sure whats going on. EP told me to take salt pills for awhile as he thinks it might be attributed to BP, didnt help.. We're now at a crossroads of starting more serious medication, but im leery because of my BP history and i cannot afford to feel tired and drag about all day long, while unsure of exact cause. Right now the EP is considering BB's, MAOI and anti-arrhythmic. POTS has been mentioned but weve had no real discussion of it.My questions are, Given my symptoms described, What do you think could be going on here? i dont expect a definitive answer obviously, maybe just a few options, given my BP state, is there any particular medical treatment i should try/ avoid?.For awhile i was all for waiting it out and seeing what happens, but life is getting too busy and ive been out for too long to be satisfied with this sit and wait approach any longer..Any tips to improve exercise intolerance would be great, ive been working with a trainer for 6 months and have shown no improvement..Thanks for your time
Although no more SVT, Still experience alot of tachy upon standing, sometimes up to 160, sustained until I sit down, at which point pulse drops dramatically. Resting heart rate is fine, low 80s-90's,also have extreme exercise intolerance, sometimes feel near syncope due to high heart rates with minimal exertion.Had a stress test a few weeks ago, reached max heart rate in less than 30 seconds of walking, no chest pain or other symptoms except shortness of breath and other typical symptoms of someone with a 190 pulse. Exercise intolerance is interfering with life dramatically.I also compete in equestrian competitions and have not physically been able to ride for months. My EP and cardio arent sure whats going on. EP told me to take salt pills for awhile as he thinks it might be attributed to BP, didnt help.. We're now at a crossroads of starting more serious medication, but im leery because of my BP history and i cannot afford to feel tired and drag about all day long, while unsure of exact cause. Right now the EP is considering BB's, MAOI and anti-arrhythmic. POTS has been mentioned but weve had no real discussion of it.My questions are, Given my symptoms described, What do you think could be going on here? i dont expect a definitive answer obviously, maybe just a few options, given my BP state, is there any particular medical treatment i should try/ avoid?.For awhile i was all for waiting it out and seeing what happens, but life is getting too busy and ive been out for too long to be satisfied with this sit and wait approach any longer..Any tips to improve exercise intolerance would be great, ive been working with a trainer for 6 months and have shown no improvement..Thanks for your time
MEDICAL PROFESSIONAL
What do you think could be going on here?
You have a tough problem. I see a lot of this clinic, all to different extremes. It is tough to tell if this is inappropriate sinus tachycardia or POTS, but they often behave in similar ways.
I will often start with a beta blocker to see how people respond. People with these symptoms tend to be very sensitive to medications and also tend to get stressed very easily. It is common to prescribe the medication and have patients be very reluctant to take the medications -- I think this has something to do with their baseline high anxiety state.
Inappropriate sinus tachycardia is found predominantly in female health care workers and it is not clear why this is the case.
You will know best what to avoid because it will make your symptoms worse. Things that might be on your list are caffeine, tea, chocolate, stimulants, cold medications, and staying well rested. Staying well rested will be a problem in medical school and especially as an intern. If the problem persists, you may need to choose a program that is lighter on the call hours. You are fortunate now because they require that the longest you go without sleep is 24 hours. I am sure you heard that this is new over the last 5-6 years.
I am not sure what else to say beyond this. It is always a tough problem when I encounter this in clinic.
I hope this helps.
You have a tough problem. I see a lot of this clinic, all to different extremes. It is tough to tell if this is inappropriate sinus tachycardia or POTS, but they often behave in similar ways.
I will often start with a beta blocker to see how people respond. People with these symptoms tend to be very sensitive to medications and also tend to get stressed very easily. It is common to prescribe the medication and have patients be very reluctant to take the medications -- I think this has something to do with their baseline high anxiety state.
Inappropriate sinus tachycardia is found predominantly in female health care workers and it is not clear why this is the case.
You will know best what to avoid because it will make your symptoms worse. Things that might be on your list are caffeine, tea, chocolate, stimulants, cold medications, and staying well rested. Staying well rested will be a problem in medical school and especially as an intern. If the problem persists, you may need to choose a program that is lighter on the call hours. You are fortunate now because they require that the longest you go without sleep is 24 hours. I am sure you heard that this is new over the last 5-6 years.
I am not sure what else to say beyond this. It is always a tough problem when I encounter this in clinic.
I hope this helps.
Hey Kit! Nice to see youre still around :) Thanks for the support and the kudo's on my spelling, LOL..
Hi College Girl! I am so sorry that you are having this problem with HR and exercise tolerance and hope you get some good advice.
My cardiologist is also suggesting "dysautonomia. I call it the "d" word :-)
Oh, I also want to congratulate you- you are the first person on a message board I have ever seen spell the word "leery" correctly. ;-)
My cardiologist is also suggesting "dysautonomia. I call it the "d" word :-)
Oh, I also want to congratulate you- you are the first person on a message board I have ever seen spell the word "leery" correctly. ;-)
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