PSVT or MAT?

[rolie16]

I'm 30 years old, male. Five months ago I experienced paroxismal supraventricular tachycardia. After a big meal and two drinks of alcohol, in the evening i took famotidine, which, as I read it, it could cause an irregular heartbeat. Over night, I felt arrhythmia, I panicked and my heart start pounding. After infusion of amiodarone, the heart returned to sinus rhythm. I didn't have any other symptoms. Diagnose - PSVT or MAT. (This is not afib?) I did all the tests - blood test, thyroid gland, heart echo, x-rays of lungs and stomach, Coxsackie virus test, Holter ECG, and everything is normal. My left atrial is 39mm, the limit is 40mm. My doctor prescribed me 20 mg propranolol, 3 times a day, and Cardiopirin (Acetylsalicil Acid 100mg). After four months, Cardiologist weaned of propranolol to a quarter a day and Cardiopirin one pill in the evening. I have a normal blood pressure, except when I get scared because of white coat syndrome, it jumps at 140-100, and it happened only three times. I do not know what to do next - should I continue to take 1/4 Propranolol and Cardiopirin? Do I have to take Cardiopirin as prevention of thrombosis? Should I take 1/4 propranolol in the evening too? There are no heart and brain diseases in my family, levels of holesterol are glucose are normal.

[rolie16]

Thanks everyone for advice. I have an appointment next week with another cardiologist so I'll let you know how it turned out.

[is_something_wrong]

It's a shame that a young man is treated for high blood pressure just from having (borderline) white coat hypertension. It will cause unpleasant symptoms of low blood pressure - just as you've experienced.

Anyway, to your question.

MAT (multifocal atrial tachycardia) is a specific type of supraventricular tachycardia which is impossible, without an EKG tracing, to differ from atrial fibrillation; meaning, it feels exactly similar. However, it is not the same and does not contribute to the same risk of blood clots as atrial fibrillation does, because the atrial:ventricular ratio is usually 1:1 or close to that, meaning that most of the atrial beats are conducted. Three or more irritable atrial spots are firing PACs, with or without an underlying sinus rhythm.

MAT is a rare condition in young males. It usually happens with a variety of lung diseases, and the reason why it may happen in young males is usually extreme stress or similar conditions when a lot of adrenaline is pumping. I've had a run of MAT once - extremely unpleasant, it happened when I had a panic attack WHILE exercising.

I must admit, I have no idea why your doctor is making such a big deal out of this (however, I'm not a doctor and there may also be reasons I don't know), with IV Amiodarone, beta blockers three times a day, BP meds, blood thinners, etc., when you've only had this one run of MAT, and MAT itself usually is a benign arrhythmia. To me it sounds like this was sort of an one time happening, probably triggered by a large meal, alcohol and H2 antagonists.

My best advice is: Seek a second opinion with an EP doc. We can't advice you on meds. But it sounds too bad for a 30 y/o to be medicated like an old man with coronary artery disease just from having one run of MAT. If you do have an arrhythmia that needs treatment, you may consider ablation (though it doesn't sound necessary to me)..

[MichelleP_3811]

I am not a doctor so please do follow your doctors advice and what you feel is appropriate for you. I don't know much about MAT but it sounds like it is a bunch of pacs occurring from different focal points causing your heart to beat irregularly and fast. It is possible drinking alcohol dehydrated you and then your panic caused the pacs to jump in.  Stress will cause ectopic beats to flare up.  That said, if this only happened once and your heart is generally healthy you may not need all the meds. Unless your bp is consistently high from stress and anxiety it seems that you may be over medicated.  Especially if your bp is now consistently low.  As well the Cardiopirin from what I read is similar to aspirin which can cause stomach irritations though I think they coat it to try and prevent that but not sure one episode of MAT would warrant it.  To be honest, in my opinion, if I were in your shoes I would ask the doctor the necessity of the meds and/or seek a second opinion.  Do not stop any meds without your doctors approval because stopping them cold can have bad effects but I would follow your gut if it is telling you that you don't need these meds.  In the minimum try going to lower doses. And really ask the necessity of the Cardiopirin in relation to MAT to see if it is necessary to take that one at all.  From what I understand from my cardiologist bp meds may help a person with pacs or pvcs but not always. If your heart is generally overall healthy then neither conditions are necessarily considered a life risk.  In any event, really follow what your gut is telling you on this.  You are very young to be on meds the rest of your life.  But it is important that you address your stress and anxiety issues because they trigger and aggravate your pac issues.  As well make sure you drink lots and lots of water, before, during and after a night of drinking to help avoid dehydration which will possibly send the heart into arrhythmia. So follow up with your doctor and have them explain the necessity of the meds in relation to your conditions and see if you can't get off them if you feel they are doing more harm than good because you don't really need them.  Take care and keep us posted on how you are doing.

[rolie16]

No, i feel great. Three weeks ago, my doctor wanted to wean me off propranolol, he said that i'm young and healthy. But, as a result of white-coat syndrom, i had BP 140/100, but it got normal after ten minutes. Nevertheless, he decided to put me of nebivolol to treat high BP! After two days of taking it, i felt very dizzy, my pulse went down at 60 bpm, BP 100/60, so i decided to get back at propranolol. It's not a problem for me to take this quarter of propronalol every morning, but i feel side effects from cardiopirine - dyspepsia and nausea, i want to stop taking it, but i don't know what to do.

[DeltaDawn23]

Do you feel like you need more treatment?  If so, perhaps you should discuss with your doctor.  I have come to believe over 10 years of afib that "less is more."  If you can get by with minimal medication, I think you are better off. The "big gun" meds I am on have a lot of side effects.  I am think ablation to get away from them.  Good luck with this - let us know how it turns out.