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ER Visit

I am on here because of a episode I had the other day. I woke up with what I thought was a heart skip. My heart started to beat a little fast but slowed down. I turned on my right side to try and go back to sleep and I felt like I couldnt feel my heart beat or really couldnt feel a pulse like my heart was beating weird and I felt nauseated. Then my heart started racing (part of it I am sure was anxiety) but I checked my pulse and it was 157 my blood pressure was a lil high but not bad. I drove to the ER which is about 5 minutes away and they ran blood test and chest x-ray EKG and they said although I was somewhat tachycardic it was a normal sinus rhythm while I was there. Now the lady who first did my blood pressure said it was irregular (I dont know if she meant irregular from the skips or irregular cause it was fast).The only problem I had was low pottasium 3.2 (normal is 3.5). What in the world could be going on? I had an echo in 2011 and all was normal. I had a holter in August no problems there. I am very concerned that this was some type of episode, but as I said the whole time I was there I was in sinus rhythm. except for that one comment by the nurse. What are the odds that something has changed with my heart in one year?
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Avatar_dr_m_tn
It is often difficult to diagnosis rapid palpitations if they occur rarely and last a few minutes at a time.  Based on your description, while it is certainly possible that you were in sinus rhythm the entire time (even when HR was 157), and that anxiety was the trigger, I don't think we can exclude the possibility that your episode started as an ABNORMALLY fast rhythm (SVT of some sort), which is well-known to CAUSE anxiety --this rhythm could have then changed into sinus by the time you showed up in the ER.

My recommendation would be to see an MD as an outpatient and obtain an EVENT monitor which could be kept longer than a holter could, and allows you to trigger recording when you feel onset of palpitations.

Also, the potassium being low is known to trigger arrhythmias, and if you have low potassium most of the time you should take a potassium supplement with your doctor's approval (available OTC).  Magnesium is another important player in heart rhythm health, so make sure to exclude the possibility of a low magnesium level.
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1124887_tn?1313758491
Excellent advice from the cardiologist that answered your post.

A normal echo does not rule out supraventricular arrhythmias (except atrial fibrillation, more or less), supraventricular tachycardias often happen in the absence of any heart disease (or regardless of any heart disease).

The rate itself can't determine what rhythm you had, I've actually experienced sinus tachycardia above 200 bpm (at some point I had panic attacks during exercise and the effects mixed together). I've also had short "runs" of atrial tachycardia (or rather ectopic atrial rhythm) at 70-80 bpm in bed when my base heart rate was 50 and I suddenly started to stress because I noticed I had overslept.

As the doctor said, you could be in the middle of panic, and runs of SVT could mix into your normal sinus tachycardia, just as PACs and PVCs can (and obviously did, but that's common during stress).

What often happens is:

1. You are a little stressed
2. You notice a PAC or a PVC caused by the stress.
3. The premature beat increases anxiety and heart rate
4. You get more PACs or PVCs
5. Your heart rate increases further
..etc.

At rate 157 bpm it's actually not a bad thing that your blood pressure was a little high. If it was too low with a rapid heart rate, that would be far worse (and telling that your heart would not be able to maintain your blood pressure at high heart rates..) assuming that it was within "normal range during stress" and not in the 180-200s..
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214529_tn?1333307219
I have been prescribed atenolol would this help with these episodes 25 mg. These things keep happening during sleep
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214529_tn?1333307219
I took my blood pressure before I left to go to ER it was 145/85 the monitor did not show an irregular rhythm just that my pulse was 157 does that mean it was sinus rhythm or can a monitor really be able to pick up some sort  irregular rhythm other than sinus. My pulse ox stayed at 99
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214529_tn?1333307219
I have been prescribed atenolol would this help with these episodes 25 mg. These things keep happening during sleep.I took my blood pressure before I left to go to ER it was 145/85 the monitor did not show an irregular rhythm just that my pulse was 157 does that mean it was sinus rhythm or can a monitor really be able to pick up some sort  irregular rhythm other than sinus. My pulse ox stayed at 99
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1124887_tn?1313758491
Unfortunately, no.

A blood pressure monitor can not directly tell if your rapid heart rhythm is a supraventricular arrhythmia or sinus tachycardia which both origin in the upper part of the heart.. If you had a blood pressure of 145/85, ventricular arrhythmias are extremely unlikely, cause they would likely not produce that pressure, but I don't think anyone suspected you had those anyway.

Blood pressure monitors can only pick up irregular rhythms (premature beats, sinus arrhythmia or A-fib), as they only analyze the peripheral pulse.  To know where a rhythm origin, an EKG is needed.
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214529_tn?1333307219
Ok went to visit my cardio and he wants to do an event monitor and echo. Says it could be just pvc's, afib or SVT. I never imagined it could be afib
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214529_tn?1333307219
My cardio worked me in today will put me on an event monitor and do echo on Wednesday. Said it could have been afib, svt or just simple sinus rhythm. My blood pressure never dropped was actually a lil high 150/85 and there was no irregularity on my blood pressure monitor right before I went to er. Now the whole time during my episode I was up moving around just scared. Could this really have been afib. I got to the er about 10 minutes after episode they hooked me up really fast whole time sinus rhythm. I have had several pvc's in a row lately too my bp monitor caught the irregularity but my bp actually rose and didnt drop then either
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214529_tn?1333307219
My cardio worked me in today will put me on an event monitor and do echo on Wednesday. Said it could have been afib, svt or just simple sinus rhythm. My blood pressure never dropped was actually a lil high 150/85 and there was no irregularity on my blood pressure monitor right before I went to er. Now the whole time during my episode I was up moving around just scared. Could this really have been afib. I got to the er about 10 minutes after episode they hooked me up really fast whole time sinus rhythm. I have had several pvc's in a row lately too my bp monitor caught the irregularity but my bp actually rose and didnt drop then either
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Avatar_f_tn
I have had a couple of episodes of afib and I was very aware both times that my heart was beating very irregularly.  And the one that started at home my BP monitor showed the irregular heartbeat symbol.  But according to my cardio there is nothing wrong with my heart, so having a normal heart does not rule out afib.  I wouldn't worry too much though just because he bought it up.  He is only going on what you are telling him.  Only way to know for sure is if you can catch it on the holter.
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1124887_tn?1313758491
Rapid atrial fibrillation can be fairly regular but this would really surprise me. Though everything is possible, I think it's highly unlikely. A supraventricular tachycardia would usually turn on and off like a switch, but there are variants that don't, and of course, a supraventricular tachycardia causes a lot of anxiety, is often triggered by anxiety, and may be followed (and preceded) by a rapid normal rhythm.

No one can tell you for sure what this was and wasn't. But it doesn't sound dangerous at all to me, at least..
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