Tachycardia 160+ ST-T wave changes

Hello, I'm a 29 year old female.  I have just received a holter monitor test and I would like assistance interpreting the result. This has been going on for over and year and the increases usually happen if/when I get out of bed and walk around the house.

The comments from the report say the following:

Basic rhythm was sinus with no AV-IV conduction delays.
Sinus tachycardia (41.1%) with maximum rate of 166 bpm (at hookup) and
lowest rate of 56 bpm (asleep), averaging at 90 bpm.
Only one PVC and one PAC seen. ST-T wave changes noted.
No significant pauses.
Patient's reports of "lightheadedness", "breathless" (x2) and "fast heart" all correlated with sinus tachycardia at rates from 135 -146 bpm with ST-T wave changes.

What are ST-T wave changes?  Is this dangerous? I saw a cardiologist last year and did a 24 hour holter monitor and there were no ST-T wave changes then, but rates up to 146 bpm. He was not concerned at all. He also did an echocardiogram that showed mild (within normal limits of regurgitation on the mitral and tricuspid regurgitation, "the estimated RVSP was 26 mmHg.)

Cardiologist was not concerned at all.

Should I be? I have had such a high heart rate for over a year ( and other issues, too), which they just can't seem to figure out.

Any advice / information would be much appreciated.

Thanks!

[Mom2four85]

Ahhh I figured you might have more going on.  

First you need to see about the ANA being positive - did they DX you with Lupus or another autoimmune disorder?  Alot of us in the DYS spectrum have disorders that cross over or are mixed, which certainly sounds like it in your case.

I would suggest looking up doctors on the DYS forum or dinet [dot] org that treat ANS problems and ask in the AI forum about your ANA test if you haven't already, also the National Lupus foundation has a lot of great people who will listen and help you greatly (they did me).

It sounds like you're like many of us and in the mix between ANS/Heart/Auto Immune, if so it's important to find the right doctors who can treat you and get you on the road to feeling better.

btw, my neurologist is the one who thought I had AI problems but you may just want to ask what type of dr you should see - alot of patients are treated by Rheumatologists.

[Jerry_NJ]

I understand you to say you have periods of tachycardia every day.  That being the case it seems reasonable to me to discuss the possible benefits of using a beta blocker with your primary care or cardiologist.  

I don't like to suggest someone go on medications long term, but that may be an effective and economical relief.  Generic beta blockers that are not extended or slow release or not expensive.  Some heart medications can get expensive if one has to pay the full cost out-of-pocket.  I take a slow release BB.  This allows me to take one a day.  I have given some thought to taking the regular release which would have to be taken in smaller dosage twice a day and would cost about 1/2 as much.  I bring up the cost factor as one consideration in stepping up to taking medications long term. In your case you may be able to get relief just taking as needed, not on a daily basis.  Discuss with you doctor.

[oona]

Thanks for the advice, Jerry. Last year, I was taking Propanolol for the same problem before I went to see the Cardiologist. After having the stress test (w/ resting 140 bpm) and echocardiogram (with mild regurg in two valves), he advised me that I did not need to take the Beta Blocker anymore.

So, I haven't been taking it. But after this recent monitor, I expect that I will probably be back to see him again.

What I really want to know is what  ST-T wave changes are. My heart rate is usually fine when I'm laying down, but as soon as I stand up, it shoots up more then double the rate (i.e. 140 bpm).

I wonder if these ST-T wave changes have something to do with that?

There's got to be a reason for this abnormal (and consistently high) heart rate.

Thanks again ;)
oona

[PikaPika88]

My EP programmed the pacemaker to be paced once it detected "I wake up".  I feel my chest like an express train is running.  I found that out from the holter monitor then I questioned him.  He said, it supposed to be like that.  Every one need to top up the heart rate when they wake up.

I'm sorry, I can't answer your ST-T wave changes.  You can google it.  It explained a lot there.    

[is_something_wrong]

I notice something very important in your post.

"Cardiologist wasn't concerned at all".

You need to pay some attention to this. If a cardiologist, who is the one with greatest knowledge about this, wasn't concerned, why are we?

ST-T changes can be "everything and nothing". They may indicate ischemia (angina) in some cases, but if you're 29 years old, this is really unlikely. They can also indicate benign conditions such as hyperventilation. Blood pressure changes (especially in the pulmonary arteries) that often occur with high heart rate and deep breathing, can cause ST-T changes. The list is really long.

If your cardiologist isn't worried, neither should you. Your avg. heart rate is a bit high, though. Are you anxious or is it caused by something else?

[Mom2four85]

If you haven't, get copies of your tests & reports from your dr's read them over and make notes with anything on them, then ask the dr specific questions as you've asked here.  It may be absolutely nothing and not to worry over, but from my experience it's always better to ask and if you don't get answers or still feel like something is wrong, get a 2nd opinion or even 3rd if needed.

A doctor saying "everything is fine" isn't always the case (check my journals about my journey).   What other issues are you having? those could point to something else entirely.  

What comes to mind first off is you're having ANS issues (autonomic nervous system). Your BP and HR should follow the 20/10/20 rule - When you're laying down and then stand, there should be a decrease in the top number (systolic) of up to 20mmHg an increase in bottom number (diastolic) of 10mmHg and an increase in heart rate of 20 bpm, however patients with ANS problems such as POTS and NCS or OI have patterns of problems with bp/hr's. (hope I explained this right)

20/10/20 rule:  http://www.skippinghearts.com/articles/normal-heart-test-values/#pulse-pressure
check references [10] [11] and [12] at the bottom of the article for info.

You have rare pvc's which is a good thing and only mild valve problems and your rvsp was within normal limits (Elevated RVSP would be 50 to 60).

If this is ANS problems it may take the right doctor to figure it out; alot of dr's do not know or understand about ANS problems.  Sometimes it takes years to find the right one who does.

Read the Dysautonomia - Autonomic dysfunction forum; there's a list of dr's; cardiologists & ep's who treat/diagnose these problems - there a huge "umbrella' that many many conditions fall under this DYS spectrum.

[oona]

Thank you Lisa,

I am having so many issues! Weird numbness, tingling, twitches and pain all over my extremities, and pressure in my head. Problems digesting food (i.e. when this started it was all about urgency to go to the bathroom), the heart rate thing is a biggie, that's been going on for a year and everyone just thinks it's anxiety, but I know it's not. It happens as soon as I stand up, and sometimes it doesn't race at all in the evenings, but I have felt like blood pressure drops/ fluctuates a lot.

My blood pressure while resting is usually 120/70 (good!), but I have seen it at different moments go to 130/90 and drop to 64/46. All different emergency or doctors' visits. I don't have a monitor at home, of course.

Extreme fatigue and weakness is daily. Have not been out of bed in the daytime since Oct. 11. (almost a month). I have had these really bad episodes in the past (since 2006), but with the heart and head stuff, I'm starting to get really scared, and not much closer to an answer.

The hospitals are filled to capacity where I am, so they can't admit me. I'm just suffering through it.

I have an appointment with a GI/Internist this Wednesday for the first time. I do not have a family doctor.

The things that have come up abnormal in my tests so far are:

a) Positive ANA with titre 1:160 and speckled and homogenous pattern (big one!)
b) Liver hemangioma
c) High Neutrophils (on CBC)
d) Low Lymphocytes (on CBC)
e) and slightly elevated bilirubin, but not by much
f) also this 48 hr. holter / ekg report, which does show that my heart rate is fast 41% of the time (up to 166 bpm), I know from that when I'm not laying down, it's racing. And it was done while I was walking around in my house. I didn't actually leave the house when I did the test, the rest of the time I was in bed.

That's what I've got thus far.  I will check out the ANS / Dysautonomia forum. I've been worrying that it might be LUpus or MS.

I just need some answers, thanks you for taking the time to write me back.

[Mom2four85]

Ahhh I figured you might have more going on.  

First you need to see about the ANA being positive - did they DX you with Lupus or another autoimmune disorder?  Alot of us in the DYS spectrum have disorders that cross over or are mixed, which certainly sounds like it in your case.

I would suggest looking up doctors on the DYS forum or dinet [dot] org that treat ANS problems and ask in the AI forum about your ANA test if you haven't already, also the National Lupus foundation has a lot of great people who will listen and help you greatly (they did me).

It sounds like you're like many of us and in the mix between ANS/Heart/Auto Immune, if so it's important to find the right doctors who can treat you and get you on the road to feeling better.

btw, my neurologist is the one who thought I had AI problems but you may just want to ask what type of dr you should see - alot of patients are treated by Rheumatologists.

[oona]

I have not been diagnosed with anything yet. I have been through at least five doctors who thought that I was just stressed out (this is over the past 5 years, since I turned 25).

I am Canadian, so I think that I'll have to look up information re: assistance / services here.

I am very limited in what I can do because I've been so ill and unfortunately I'm also not rich ;)

There is definitely more than one thing going on here, and hopefully it's not going to kill me while I look for a diagnosis! I'm not even 30 yet!

I think a rheumatologist is not a bad idea and maybe a neurologist, too. I'm just having trouble convincing doctors that that should be the next step. Once I actually do get the referral, it will likely take a few months to get to see the proper doctor.

I really hope nothing really bad happens to me in between this!

There are times when I feel ok, but other times where it's very scary!

Thanks so much for your help!

[Mom2four85]

Most AI and ANS problems (unless heart related) may take years to manifest to that point depending on what is wrong, but you do need help for your daily life and to treat your symptoms.

I am not a dr and only going by my limited knowledge that I've researched for myself.  You need to see a dr for Lupus; in the Lupus forum on MH,  there's 11 criteria and you meet some of them.

Just some Lupus info; how correct or up to date it is I can't say:
1:16 is considered positive and if SED rates and Complement tests are positive, Lupus is considered

Homogenous Pattern -- Systemic Lupus Erythematosus (Very specific)

Speckled Pattern  -- Most common, least specific this can indicate:
1. Systemic Lupus Erythematosus
2. Mixed Connective Tissue Disease
3. Scleroderma
4. Sjogren's Syndrome

I would def start with a Rheumy and Neuro; skip cardio for now unless you have more pvc's and symptoms - the high HR could be caused by one of the other disorders; but also could be POTS/NCS etc as I wrote earlier.  You have to get your other things diagnosed and treated and see if those are causing the high HR's first.

Call a RH and tell them you've had a positive ana or find another GP who will refer you to one.

Hope you find a doctor soon so you'll start feeling better =)

[nana65536]

I hav a maintained Pulse rate between 120 to 160 and some time 170.. I am Diabatic 69 years old and am suffering from Emphysema (COPD).. I hav a tumour which has damaged 58% of my lungs... How long can I survive more...?? Please be frank.. My doctors wont let me know...