Sinus Tachycardia - When a Pacemaker is needed?

[Twigster]

I was diagnosed with Sinus Tachycardia four years ago.  I have suffered with tachycardia on and off for the last 20 years.  I also suffered with anorexia nervosa from the same time, age of 15.

In the last year, this condition has exacerbated tremendously.  HR 184/5 with moderate daily activity (I am a home Mom) together with low BP.

A 48 HR ECG monitor showed at night sleep my HR is close to 80.  Upon waking up shoots to 126 then shoots to 184 without effort or exerting myself.  Cardio advised increase sodium, magnesium and calcium intake.  A pace maker is in question now.

Cardio is concerned about my age for a pacemaker, 35 years.  Why does my age matter when it boils down to living a normal active existence with my life, body and family.  I love being physically active.  The tachycardia is not enabling me to.

What is the great concern?  I get severe fatigue where I have to put my body down, i feel i cannot carry on.  I am out before my head can reach the pillow.  I have not mentioned to the Cardio that I have been having episodes of black phases.  It is very unnerving and scary.  

Ironically when I had two long periods of tachycardia episodes, I have been eating properly and on track and my consumption increases but fatigue and weakness still persist.  My weight does not alter.  Cardio said it as though i am running all the time from the ECG results.  Beta blockers do not help, i have tried for years.

Cardio said that the tachycardia can damage my heart muscle?  Is this right?  What else does the tachycardia affect.  I was advised it lessens the ability for blood and oxygen to be sufficiently circulated through the body and heart.

Please can you advise, suggest, clarify or explain more or better?

[MichelleP_3811]

If you think that the rapid beat started and stopped in one beat then that is very possibly accessory pathway svt though a run of pacs may do that as well but not sure a run of pacs can get the heart going that fast.  The main reason I ask is if you do have an accessory pathway svt it could be adding to your sinus tachycardia issue.  The heart gets over excited from the svt and then is easily stressed afterwards.  Anyways, if you haven't had an ep study done I would insist on one to check for extra pathways before a pacemaker was implanted.  I wonder if it gets to a point to put one in if they can do it at the same time.  But either way I would push for an ep study to check and make sure this isn't just inappropriate sinus tachycardia.  Best of luck.

[Twigster]

Thanks.

Ordinarily my avg heart 99-144 ; maximum between 126-154 for almost every day without exercise.  During sleep period max 154.  Some days it goes up to 185.

On the particular day mentioned, .  
I felt like an extreme onset of rapid heart rate that lasted 10 minutes.
It was not gradual.

[MichelleP_3811]

I know you mentioned in your other post that ablation was off the table but when your tachycardia shot up to 216 did you sense it started in a single beat.  It was normal and then shot up all of a sudden and then stopped just as suddenly?  Even if the heart in general is elevated it is a distinctive jump as opposed to it ramping up and down more slowly.  I had an svt called avnrt and after I had a tachycardia episode my heart rate stayed fairly elevated for days afterwards. I have experienced both myself, the sinus tachycardia happening after a night of drinking and getting myself dehydrated.  The svt is very distinctive in its start and stop and the sinus tachycardia I would wake up with it and then after drinking lots of water I would notice it eventually slowed down.  It was a sudden start or stop like my svt was.   If you have accessory pathway svt mixed in with your other issues it could be compounding the problem.  Though it does sound like you do have some sort of inappropriate sinus tachycardia as well.  I understand the heart rate can get that high from sinus tachycardia but it is important to rule out all types to make sure you have exhausted all avenues before you put a pacemaker in.

[Twigster]

Hi,

I apologise for not replying sooner.  I have been very very busy.  Thank you for your note.

The cause root is from the effects of Anorexia Nervosa.  Suffered since 15.  Now 21 years later,  it is a daily struggle but I make an effort to maintain.  Been doing well for a year now.

Thank you.

[Twigster]

Hi,

Thanks so much for your response.  I have been hectic since my last communication.

I am grateful for your advice.  I had returned to my cardiologist at that stage heart rate went up to 216.  I am now on medication three times a day and see how it goes from there.  My pulse is still high as it goes to 135 in sleep period.

I am strong.  I will keep head up.

Take good care

[Twigster]

Hi, I am awful at responding since I have been in hospital for the last two and a half weeks, so I do apologise.  The root cause of the tachycardia is from suffering with Anorexia Nervosa for far too long.  Doctors picked up the physiological condition when I was 15 (when the anorexia was at its worst in my adolescent years).  What has happened is that my heart's natural pacemaker is firing too early and hence the fact that there is not enough blood circulated throughout the body as well as oxygen.  So the heart is working hard all the time.  Cardio said it is as though I am consistently running.  With the premature firing of the natural pacemaker,  I also have prolonged waves (sorry I forget the name).  Cardio advised that with the tachycardia being and having been a consistent issue to the age I am at now, 36.  I am damaging the muscle of the heart.  Lifestyle changes need to be made first I think, then after say two months I will see the cardio and take it from there

[Twigster]

Thanks so much for your good advice.  I agree there are many a lifestyle change I need to make in order to make the correct decision later if need be.
I do apologise for the delayed reply, I have been in hospital for the last two and a half weeks.  Your advice is very sound and clear to give an objective opinion, thank you.

[itdood]

I feel it very difficult to offer advice without knowing what the root cause is.  There are a few sources for inappropriate tachycardia and each comes with its own set of options.

Were you told what the root cause is?

[MichelleP_3811]

Sustained tachycardia in the 180s can damage the heart by causing it to fail so it is something you will want to get a handle on.  It is possible the anorexia stressed the heart and caused some sort of issue with the sa node or creating extra spots in the heart that are causing the heart to beat fast.  I would try a few lifestyle changes first before agreeing to a pacemaker.  I would make sure you are eating enough, getting lots and lots of water, as well add the sodium and supplements like he suggested.  Low bp from the fast heart rate may be what is contributing to the black outs.  Water and sodium may help alleviate this.  I might also try adding some yoga or something to help calm your body as well if you can add some cardio into your routine before things get too high it may help you get your heart conditioned better to handle the tachycardia as well lower the rate but you really don't want to have rates in the 180s day in and day out.  I would suggest you DO inform your doctor you are passing out.  That is a big deal.  And then just do your best to get as heart healthy as you can to see if that helps.  If all else fails then consider the pacemaker.  I don't have much advice in that regard since I don't have one myself but I am sure others with one can jump in to offer their advice.  Well best of luck, I do hope you can get a handle on this and feel better soon.  Stay strong.