Bradycardia & Tachycardia - is it possible to have both?

[gesch]

Since the last time I asked a question, I have seen three cardiologist and am now currently seeing the attending cardiologist at OHSU.  This is the story:  I have a history (at least a year) of Sinus Bradycardia, with an average resting heart rate around 46.  They say I am not a candidat for a pacemaker until I begin passing out.  My current Cardiologist ordered records from the last cardiologist, but didn't get them, so they ran a quick ekg, here is the information:


VENTRICULAR RATE 56  
ATRIAL RATE 56  
P-R INTERVAL 164
QRS DURATION 78  
QT 436  
QTC 421  -
P AXIS 50  -  degrees
R AXIS 3  -  degrees
T AXIS 27  -  degrees
EKG DIAGNOSIS Sinus bradycardia; Possible Left atrial enlargement; Left ventricular hypertrophy
Abnormal ECG


So, today I was asked to go in for a Nuclear Stress Test - NON-Treadmill, here are the results:

They used Dipyridamole Infusion - 50 mg over 4 minutes

Reason for testing:  Detection of Myocardial Ischemia ( RO/CAD)

AT REST:
VENTRICULAR RATE 44 bpm
P-R INTERVAL 170  -  ms
QRS DURATION 88  -  ms
QT 466  -  ms
QTC 398  -  ms
P AXIS 57  -  degrees
R AXIS 44  -  degrees
T AXIS 60  -  degrees
EKG DIAGNOSIS Sinus bradycardia


At completion of the 4 minutes:

VENTRICULAR RATE 104  -  BPM
P-R INTERVAL 192  -  ms
QRS DURATION 82  -  ms
QT 344  -  ms
QTC 452  -  ms
P AXIS 57  -  degrees
R AXIS 44  -  degrees
T AXIS 45  -  degrees
EKG DIAGNOSIS Sinus Tachycardia
Possible Left atrial enlargement
Low Voltage QRS
Non Specific ST abnormality
Abnormal ECG

Predicted Maximum heart rate for my age is 163 and  Predicted 85% for my age is 137.  My max was 110 bpm.  This was 67% of predicted heart rate.

During this test I reported a headache at 1 min quickly followed up with chest pressure/pain and then at 4 minutes I had an overwhelming sense and broke into tears.    At 5 minutes they administered the aminophyline - 75 mg.

So, I can't figure out how you can have bradycardia and tachycardia at the same time...is that weird?  What exactly does all of this mean?  Does it explain why I am so exhausted all of the time.  Why I reported inconsistantly with the holter monitor?  Any one have any ideas on this????  Anything you can help me to understand would be helpful.  Thanks!~

[bobad]

During the testing, they are administering drugs that raise the heart rate. That could account for the tachy.

It is possible (and not real uncommon) to have tachy and brady without diagnostic drugs. In fact, those who have tachy-brady syndrome can experience both tachy and brady within seconds.

[dolfnlvr]

I agree with bobad.  In your particular case, I would bet that the tachy part was caused by the drugs that were administered.  Those drugs are used for the sole purpose of raising your heart rate.

[RimDragonfly]

Well I have a natural genetic bradycardia rhythm and I also have a SVT which is a tachycardia condition. My heart rate can go from 44 beats per minute to 229 beats per minute in the matter of 1 heartbeat. I've never heard of tachy-brady syndrome but I think what I have is different.

I would say in answer to your question though - yes someone can have both.

I think if you had anything to really worry about they would have said something to you in response to your stress test. Usually good doctors will take a little time for you to ask questions when conferring with you about test results. You seem a little anxious about the results still though so I would sggest another appointment to talk it over with him/her.

Mary