Evening Tachycardia

Dr. McWilliams,

I am a 35-year-old male with a PVC/PAC history.  In 2003, I began awakening @ night with a rapid pounding heart rate (180+ bpm).  A trip to the ER and ensuing EKG revealed an elevated pulse (and HBP) but no other findings of note.  A follow-up echocardiagram showed no structural abnormalities.  A holter showed isolated PACs and PVCs.  I began attending therapy and, with deep-breathing exercises, contained the tachycardia.

In early 2007, the same symptoms began to occur anew with increasing frequency.  I have been under constant stress (new job, home sale, moving, separation from partner), so I have attributed the tachycardia to nocturnal panic attacks.  However, on New Year's Eve, I drank and ate to excess.  In the early morning hours, I fell asleep but was awakened by what felt like a "skipped" beat followed by the immediate elevation of my heart rate.  I immediately panicked (trembling, sweating, more skipped beats) and hopped in my car in an effort to find the closest ER.  I was not faint at any time, just scared.  

By the time I got to the hospital, I had calmed myself slightly, renewed my breathing exercises, and my pulse gradually declined.  I did not go inside the ER and was fine for the rest of the day (save for the emotional trauma and hangover). I am a bit skittish to go to sleep now and have a few questions: (1) Does this episode sound like ventricular tachycardia? (2) Should I see a doctor ASAP? (3) Is it noteworthy that these episodes crop up only @ night?

Thank you for your time and consideration.  

[Michael J. McWilliams, M.D.]

(1) Does this episode sound like ventricular tachycardia?

No, it sounds like a panic attack.  If you can talk yourself down and your heart rate slowly returns to normal, it is much more likely to be panic attack.  I would venture to say the frequency of panic attacks to VT with a structurally normal heart is in the range of 1000's : 1.

(2) Should I see a doctor ASAP?

If you experience a change in symptoms, it is worth seeing a doctor.  The only way to know for sure is to capture the tachycardia event on a monitor.  If it happens monthly or more frequently, an event monitor will probably help.


(3) Is it noteworthy that these episodes crop up only @ night?

I have seen a few people recently with this exact same issue -- panic attacks that only happen only at night.  It might be worth seeing your doctor about anxiety medication to see if it helps.  

I hope this helps.  Thanks for posting.

[LukeL]

It could be worth noting that your dreams (even if you don't remember them) can trigger a panic attack. Other attacks occuring during non dream sleep and just seem to be a missfire from your brain.

[Manhattan]

I have something very similar where i bolt out of bed while i am in that stage of falling into a deep sleep. It always happens within about an hour of going to bed. A monitor showed that it was a tachycardia and once I almost fainted within the first thirty seconds my heart was beating so fast. I really can't chalk it up to panic attacks... why would I only have them at night and not during the day? Plus my heart is beating so fast, it shakes the whole bed sometimes. Anyway, this has been going on occasionally for years and I am still ticking so hopefully it's nothing serious.

[tigi321]

A related discussion, How to distinghuish between arrhythmia and panic disorder? was started.