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Tachycardia Episodes
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Tachycardia Episodes

Hi, I'm looking for a second opinion - actually I'm looking for anyone that may be able to help.

I'm a 45 year old male, non smoker (ex-smoker of 8 years), and I'm slightly overweight. In April 2013, I was doing my lunchtime walk with a couple of workmates when I had an attack of some sort. I was calmly chatting and walking when all of a sudden I experienced a sharp pain at the top of my abdomen an inch or so below and to the right of my sternum followed immediately by serious dizziness that forced me to sit on the spot. I don't recall if I felt it in my head or throat, but I checked my heartrate and it was about 160-180bpm.I normally excercise on the treadmill at home daily and monitor my heartrate so I have a reasonable idea of what my heartrate was. This freaked me out, and I asked my workmates to call an ambulance. I thought I was having a heart attack. At the hospital they did all kinds of tests and they confirmed that it wasn't a heart attack but they could not explain what was going on with me.

In the weeks prior to this event, I had noticed that I was getting various chest pains that I perceived to be muscular cramps, some were dull some were sharp but all were transient lasting only a few seconds. These pains were not limited to a single muscle, they appeared in random locations in my chest area. Prior to this, I had noticed some unusual things in the preceding months. I was feeling generally fatigued and occasionally I would get very itchy eyes and blurred vision with what appeared to be some kind of milky white substance that would be relieved with persistent blinking, and I also developed a burst lood vessel in my left eye. The other unusual thing was once when I was driving I felt a strange lightheadedness that lasted perhaps 5 seconds which was concerning enough for me to contemplate pulling over, however it seemed to pass quickly enough and so I noted it simply as a strange occurrance and moved on.

Now, back to the tachycardia episodes.

Over the next 8 weeks I ended up at the emergency room 9 more times suffering from tachycardia events. Now,
however, I had started to notice a pattern and the development of additional persistent symptoms. Approximately 40% of the time these tachycardia events would happen within an hour of eating and whilst I was sitting down or reclining, another 40% of the time they would happen within 10 minutes of lying down for bed at night and the rest of the time they would appear to happen randomly. Also, in every case I noticed the tachycardia events would
immediately be preceded by a kind of full body adrenaline rush that I could hear and feel in my head and sometimes blurred vision as I described before as well as intense lightheadedness. Now, however, I was lightheaded all the time, with constant pressure in my head, and at times my voice was weak and hoarse and I seemed to be having to clear my throat all the time. Every day I also experience multiple periods of varying duration of breathlesness and slight difficulty breathing. Clearing my throat and coughing does appear to help at times. The final persistent symptom I have developed is that I often get a blood rush to the head when I stand from a sitting position, and I get heart palpitations that I feel in my neck when I urinate.

The emergency staff at the hospital were always really great, so were the ambo's, however nobody could give me more than an anecdotal diagnosis - Stress, they said, or anxiety...cut down on coffee and drink more fluids. Since my second episode of tachycardia I had not had a single coffee and I was ensuring I was drinking at least 2 litres of water a day. This may sound cynical, but my experiences of the last year have left me with the opinion that the
'stress' or 'anxiety' diagnosis is a copout and a tag used as a convenient exit strategy because it can neither be proven nor disproven with clinical testing.

My GP tested me for pheochromocytoma, these tests were negative. I saw a cardiologist who also tested me for pheochromocytoma, again negative. The cardiologist sent me for an echocardiogram and a treadmill stress test. I had a holter monitor and then an event monitor that I wore for a week. None of the tests the cardiologist sent me to revealed anything to be a problem. The event monitor did capture one tachycardia event (165 bpm), this seemed to
excite my cardiologist slightly (he actually called me on a Saturday to tell me about it) and he then prescribed that I take corolan, a drug that keeps your heart rate down. When I take it, it does keep my heartrate down and I experience less dizziness thankfully. I also had a pulmonary angiogram that came back negative. I was tested for diabetes - negative. I have normal cholesterol. I saw a gastrenterologist and was diagnosed with eosinophilic oesophagitis, but this was taken care of with a corticosteroid (actually, my eosinophil count is back up again now since I stopped the steroid 5 months ago). I don't have celiacs disease. I had a CT scan looking for carcinoma in my bowels - negative. I had a CT brain scan to look for a brain tumor - negative.

My GP then referred me to a physician. The physician diagnosed me with some kind of vasovagal problem. He talked alot about 'tone' and how he thought that the messages in my autonomous nervous system were not strong enough from my brain. The physician referred me to a psychiatrist who then put me on Clobemix - a psychotropic drug intended to keep amines alive in your system for longer. This was in September 2013. The psychiatrist told me that given my symptoms and presentation, I didn't present as a patient that could be helped with his field of expertise. Anyway, he said he should try something and I tried these drugs with increasing dosage over a three month period, and there was no change at all to my persistent symptoms. In November I stopped
these drugs altogether (after consulting my psychiatrist) because they did nothing for my persistent symptoms.
I was also referred to a psychologist to work on my apparent 'anxiety'. As I expected, the psychologist tested me for depression and anxiety and found that I was definately not depressed, but I did have anxiety - BUT - he said the anxiety was definately a RESULT of the uncertainty around my current medical problems, NOT the cause of them.

From July through to November 2013, the interval between tachycardia events lengthened and I perhaps only had 2 episodes, my chest pains gradually faded away also. I still had mild adrenaline rushes from time to time, preceded by a kind of 'dipping' feeling in my chest that felt like my heart had built up alot of pressure and then resumed buisiness as usual, but these were momenary and not anything to write home about really.

That being said, my persistent symptoms have never recided, and they're driving me crazy. I still feel light headed most of the time with slight pressure in my head, I get tingling in my hands and feet, I get palpitations when I urinate, I get a blood rush to my head when I stand from a seated position, I have multiple periods daily where I feel I am not getting enough oxygen and my breathing feels laboured (I could be sitting, standing, walking, there
does not appear to be a pattern here), and I am constantly trying to clear my throat - it feels like mucus build up. I tried stopping the corolan for a few days and the intense lightheadedness returned so I won't be doing that again for a while.

So, if you've made it this far, you've been very patient, thank you. If anyone can suggest anything I would be very grateful. Second opinions, suggestions for further testing, anything really...
11 Comments Post a Comment
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Did drs told you what kind of tachycardia do you have?
A diaturbance in The hearth rythm has to be evaluated by a specialist in The electrical part of The heart: an electrophisiologist. You should Get copies of all your exams and have an appointmment with an EP
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Also. Did you had a tilt table test? If not, how they diagnose you with vasovagal?
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Avatar_m_tn
Hi alejandradr, the cardiologist reported that my tachycardia was sinus tachycardia. Thanks you for your comment, someone else also suggested that I get a complete electrical test of my heart function - unfortunately there is only one here where I live and the waiting list is rather long.
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7014780_tn?1395591257
EKG captured your Tachy at 165 bpm. How long do the Tachy episodes last? Does your heart revert with manoeuvers or do you need Adenosine at the hospital Emerg? What is your resting HR, 10 minutes after waking up while lying in bed?

I think you should start daily, for 7-days a week, swimming or cycling for 40 minutes at lunch hour and this should condition your heart and circulation system and lower your heart rate.

Don't take drugs to lower your heart-rate, start swimming instead, and that will lower your heart rate naturally without the terrible side affects of Beta Blockers and Calcium Channel Blockers.
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Avatar_f_tn
Another thing. Until you Get your apppintment please take care of yourself. Stay hydrated, eat bananas (potassium, good for The heart rythm), stand up slowly,from bed, from a chair.
Do you have copies of your ekgs? Know The meassures?
It dosent matter how long The appoinment tales, go for it!
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Avatar_m_tn
Hi, no, I haven't had a tilt table test. I asked my GP if he thought I should get one and he said 'why?'. I would have thought the answer was obvious, to get more information thats why. The problem in Australia is that the government scrutinises GPs and they can get in trouble if they 'overtest' people. So, in my view, this biases GPs in seeking diagnosis, especially in cases more difficult than the common cold.
I know where you are coming from though, I could have POTS, but the physician who diagnosed me with vasovagal problems said that I didn't have POTS.
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Avatar_m_tn
Oh also, the vasovagal diagnosis was given from a verbal medical history I gave to the physician and some very rudimentry physical examination to rule out dizziness caused by imbalance. In other words, anecdotal evidence.
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Avatar_m_tn
Hi John, thanks for your comment.
My tachycardia generally lasts about 5 minutes at the very fast rate, followed by an hour or two at 110-120 bpm while resting. No drugs were ever administered to me at the hospital to reduce the heart rate, it just comes back to normal of it's own accord.
Whilst I am overweight, I do normally excersice for at least an hour every day and have done so for at least the last 8 years. I don't do any muscle building excercises at the moment, and my confidence is down since I get a little heart discomfort (it seems like a build up of presure and then a burst release) at around the 45 minute point after starting to excercise. However, I am soldering on and I won't be stopping the excercising any time soon.
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7014780_tn?1395591257
What is your resting heart-rate, taken 15 minutes after waking in the morning, or sitting at your computer at least 3 hours after eating? This is very important as it will tell you if you need meds. to bring your heart rate down to 57 beats per minute, or if you can do it with exercise.

Don't run as the constant jarring does more harm than good, and will upset the delicate balance between your electrical currents moving along pathways, and the heart's contracting muscles. Swimming or stationary bicycle are better and lap-swimming every day is the best.

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Avatar_f_tn
Hi AussieAdo,
I totally understand how you feel, I have experienced all of your symptoms, I have been to many cardiologist over many years and made to feel like I was going mad.
I was so lucky to have found a new Personal trainer at my gym that referred me to a Dr that specialised in Cardiology, he preformed yet another heart exercise stress test and VO2 max, which all came back normal (yet again) Although he did notice that when I did high intensity weighted training such as squats my heart rate would rise to a crazy height, I would get dizzy, and extremely out of breath, and chest discomfort, he believed this was because I had a congenital hole in my heart ASD/PFO and blood was shunting from one side of the heart to the other.  He then refereed me on further to a Cardiologist who specialised in this. A bubble test was preformed and it was confirmed that I had a large hole in my heart, all of my symptoms were relevant to this type of congenital hole in the heart and symptoms don't appear until 30 - 40 years of age.  
I was so excited I had finally found an answer!!!
I had my closure of a 'patent foramen ovale' (PFO) 10 days ago, this was a nonsurgical procedure performed under sedation in a Cardiac Catheter Laboratory, a device was implanted into the heart through the femoral vein. No pain, just some bruising around the groin area where they placed the Sheaths.
I will have to follow up with my cardiologist for 1-3-6-12mths then yearly for a few years after for bubble and echo testing. A easy price to pay for a symptom free life.
I can't believe how easy it was to fix and that so many cardiologist had missed it for so many years.
Have a good google on Patent foramen ovale' (PFO) and atrial septal defect (ASD), if you feel these symptoms are what you are experiencing, I can pass on my cardiologist details to you, he may have a good cardiologist in your area he can refer you onto as Im in QLD.
I totally understand your anguish and frustration, I hope I have found your answer. Cheers,
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Just one other question, do you suffer from migraines at all? as ASD/PFO can cause migraines. I got diagnosed by a neurologist with migraines, my migraines cause stroke like symptoms, dizziness, face numbness, nausea, only a small head ache, but very debilitating.
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