Tachycardia?

[roxydoggy]

Hi,

I'm a 22 year old female who goes to the gym 5 times a week. I've had palpitations on and off for the past 5 years. My resting heart rate is around 65bpm.

Last Wednesday (five days ago) I was at my usual spinning class when I checked my heart rate monitor because my head all of a sudden came over very light. It said 200bpm (where I usually never exceed around 185bpm), before dropping to 120bpm, going back up to 190bpm, dropping back down to 90bpm, and so on. My arms and legs were going numb and I felt like I was going to pass out. I left the class and went home, where the episode carried on – I was shaking, I felt numb all over, was having strong palpitations, lightheadedness, and my heart rate was continuing to fly up and down.

I phoned a paramedic who couldn't get my heart rate to come down past 145bpm, even though I was sat resting for 2 hours or so. He phoned an ambulance and they took me to the hospital where they took multiple ECG's, a chest x-ray and a blood test. I know that my heart was palpitating during one of the ECG's, but when I saw a doctor I'm not sure he was looking at that one in front of him.

My chest x-ray was fine. My blood tests showed no problems, except a slightly underactive thryoid – something I know about and don't need medication for – and a reasonably high white blood cell count. He said that my ECG showed that my heart rate was regular, if a bit fast, but again I'm not sure whether I was experiencing any palpitations during that ECG. He said that it doesn't look like atrial fibrillation, since the beats are regular, and requested a 24 hour ECG and an appointment with a cardiologist the following Wednesday. He also gave me beta blockers to take: 1.25mg of Bisoprolol every day.

I left the hospital and felt totally drained, but I expected that since my heart was racing up and down, well above 140bpm for around 4-5 hours. I wasn't feeling well a couple of days later, but decided to get up and go for a short, slow stroll with my dog. Once I got back, I sat and watched TV and I had another episode – the same symptoms as before. Again, my heart rate was flying up to 170bpm, back down to 80bpm etc, along with the same lightheadedness, shortness of breath, etc. I went back to the hospital, where they basically just monitored me until it calmed down a bit and told me that there were no signs of damage to my heart, so I didn't have a heart attack, and to wait until my appointment with the cardiologist.

Ever since Wednesday I have been feeling really ill. I have no appetite whatsoever, I've lost around 9 pounds in one week, which is quite a lot for a 5ft 8, 126 pound (now 117 pound) girl. I am constantly exhausted. I have other feelings that come and go too: tightness in my chest, numbness in my left leg, pressure on my head and jaw, and still palpitations every day. I also get waves of what feels like adrenaline wash over me.

I'm sorry for the really long post, but my real question is – what is going on with me? The doctor wrote on my discharge form (from Wednesday, the first episode) 'ECG sinus tachycardia' – but could he tell if it were another kind of tachycardia if I wasn't having an episode during the ECG? I appreciate I should probably just wait until Wednesday and see what the cardiologist says, but I feel so ill and I've had what feels like two more episodes about to come on, that I've 'breathed away' – I wasn't measuring my heart rate then but I think it stayed pretty normal, nowhere near as high as the previous two times when I went to hospital.

I'm desperate to know why I'm feeling so poorly with such odd symptoms. People have suggested it could just be anxiety, but I'd love to know whether it's likely to be panic attacks, or a form of tachycardia, or could it possibly be a fever that's causing these episodes?

Thanks for reading and thanks in advance for your opinion.

[roxydoggy]

Hi Jenn

I went back to the doctor today and he's sent me for another blood test to look at my electrolytes, blood count, and thyroid function.

Although as I said to achillea, he said that my thyroid function is actually fine. Perhaps they did more in-depth tests previously than I realised. He seems to have results of the antibodies.

Thanks for sending that link over. I had a quick look but I'll look into it properly, although the symptom of a high appetite definitely isn't one I have! Maybe the blood test will shed some more light on this.

[roxydoggy]

I went back to the doctor today who totally wasn't interested. I actually sat and cried in front of him! He still wasn't fussed.

I explained that I can't eat and I'm not due to hear back from my holter monitor for another 2-3 weeks, and I can't wait that long to sort out my appetite. He completely dismissed me with anxiety and depression and even offered me tablets for these! I guess the crying probably didn't help my case. I suggested perhaps it could be due to a viral infection since my white blood count was high...

Anyway, I didn't leave until he gave me another blood test that's going to look at my thyroid, blood count, and electrolytes. Apparently my last thyroid test showed that my antibodies have no problems, so although my levels are a little all over the show, my actual thyroid function is not underactive.

He said if it's been going on a while then it's probably sinus tachycardia, due to my age and gender, but if it's just recent then it could be a viral infection. I tried explaining that although I've had PVC's/PAC's for 5 years, I've never had the racing heart rate that jumps up and down with all the numbness/lightheadedness until last Wednesday and Saturday.

I asked him if sinus tachycardia could cause these jumps in heart rate during these episodes. His response: 'errr yeahhhh'. Doesn't fill me with much confidence. I think I need to keep pushing for an appointment with a cardiologist. Bloody NHS!

[Jenn1302]

Also, have you had your electrolytes checked (including magnesium! Doctors usually don't check magnesium). Electrolyte imbalances can cause heart related issues, especially sodium, potassium, calcium and magnesium.

Your tachycardia and high TSH could also be caused by a pituitary problem, because your TSH is high and your Free T4 is closer to the high end (see http://www.pathologystudent.com/?p=2031). You may want to have an MRI done to rule out TSH secreting adenomas, just to make sure. TSH secreting adenoma is a rare condition, so you probably don't have it, but it's better to be safe than sorry. TSH secreting adenomas can cause increased TSH levels, tachycardia, weight loss and palpitations(see http://www.mskcc.org/cancer-care/adult/pituitary-tumors/tsh-producing-tumors and http://pituitary.mgh.harvard.edu/pitsympt.htm for additional information and symptoms).

I'm not a doctor so I don't know much about this, but based on Wikipedia (http://en.wikipedia.org/wiki/Thyroid_function_tests#Free_thyroxine), The upper bound for Free T4 is 18 or 23 (pmol/L), so maybe your Free T4 could be related. You may want to get your Free T3 checked just to make sure that's not causing your heart problems.

[achillea]

IST is treated both medically and surgically.  It can be difficult in that each case has is different and has to be approached individually, but you are *not* just left alone to deal as best you can.  There are support groups on the internet, which you can find by googling IST.

However, before you rush off in that direction, let's get back to that 'reasonably high white cell count.'  We have different types of white cells designed to do different jobs, but a significant elevation of any them should always be investigated.  They can signal infectious diseases, autoimmune phenomena, and assorted inflammatory conditions.

Based on your other symptoms, I think you should call your doctor back, especially describing your 9 pound weight loss in one week--plus your sense of being ill--and ask for a much earlier appointment.  Yeah, your ticker is behaving strangely, but there may be something else going on.  That white cell thing needs to be addressed.

[roxydoggy]

From what I've been reading, I think you're probably right. I've got the 24 hour monitor on now so we'll see if that shows anything.

To be honest, the doctors haven't mentioned any kind of possibility as to what it might be. I've just been told I don't actually have an appointment with a cardiologist, but another doctor will review my holter monitor and get back to me in 2-3 weeks. I can't stand to lose any more weight for another 2-3 weeks! I'm desperate to get some answers.

Do you know if it is Inappropriate Sinus Tachycardia, do they leave you or do they treat it?

Thank you again for your help.

[achillea]

"The only thing I can't really explain away with anxiety is the fact that my heart rate was jumping up and down like crazy...If they can't pick up anything in the 24 hours, do you suggest I ask for a monitor for a longer period of time? "

If you have more episodes like this, yes, I think it would be a very good idea.

Frankly, I doubt your estrogen dosage has much to do with it.  Most steroids such as estrogen are slowly effective (take hours to days to have an effect) and long-lasting.  

A hyperfunctioning thyroid can cause weird heart rhythms, but your numbers pretty convincingly point to hypofunctioning.

What you have sounds more like some malfunctioning of your heart's pacemaker.  Have your docs mentioned 'Inappropriate Sinus Tachycardia'?  With this problem, because the beat arises in the sinus node, the pattern on an ordinary EKG looks normal, but longer monitoring will show strange fluctuations, the kind of thing you describe.

Some experts think IST is a manifestation of a condition called "dysautonomia" rather than a heart problem per se, but whatever the root cause, I do think IST is something that should be investigated in your case.