Unexplained Tachycardia IST or POTS maybe both?!

[Callentay]

I am a 23 year old male and fairly healthy. After 7 months of severe panic attacks my anxiety has finally settled. But I seem to have developed wierd unexplained daily tachycardia especially when standing up, doing physical activities and other minor stuff. My heart seems to race very easily like going up a flight of stairs because I'm already out of breath. I have had 2 ecg's a holter moniter and a echocardiogram, all seem to be normal. I did some research and it seems that I'm showing symptoms of IST and POTS with inconsistency between them. I recently went to a cardiologist and I'm not really happy about it. So after I went into the room they did a standard ecg test and that turned out normal according to the doctor. So that would make my 3rd ecg test. Its seems that all my ecg's are normal. So after explaining my condition such as the constant tachycardia and shortness of breath he listens to my heart and takes my blood pressure etc. He did notice that my heart rate did seem to increase when I stood up and suggested I may have pots but he didnt technically diagnosed me with the condition so I'm not sure where I stand. He finally tells me basic stuff like caffeine smoking and anxiety will cause tachycardia. So basically all he did was check my vitals, look over past tests which are the ecg's echo and holter and told me nothings wrong. The other day I took a walk with my dog around the block which is a very short walk and I was already short of breath and my heart was beating out of my chest. I would guess a heart rate of at least 180bpm and all I was doing was walking. I know at this point this is not normal especially considering most of the time I'm not anxious. I just felt like my doctors didn't rule out every possibly to my problem to give me some closure. I haven't had a chest x Ray, a stress test yet or,even a tilt table test so there are answers waiting for me. I will try another cardiologist and hope fully they give me all the test to find out what is wrong with me.

[MichelleP_3811]

I am not so sure it is about controlling it. It is more about learning how to acknowledge and process it.  It is normal to feel fearful.  It is when we try to run away from the fear and push it aside that we get ourselves into trouble.  So it is more a matter of recognizing how you feel, what your body feels like and allowing the emotions to run its course while focusing on more positive angles.  Well I am not a therapist so seeing one or reading up on the subject may give you practical things you can do to learn how to cope with fear and any other difficult emotions.  Again, it isn't something that will happen overnight.  Give yourself some time and leeway to learn new skills.  Take care.

[Callentay]

Thank you both for your feedback. I will try to see what I can do to control my overactive fight or flight response. I'm really having a hard time dealing with this. Up to this point I am willing to speak to a expert on anxiety. It just drives me crazy how big of a problem this has gotten. You guys are right though. I need to fight this anxious feeling head on and receive as much help as I can get but I will at least try to confront this myself first. I feel like this is my last hope. Hey Tom I'm glad your wife is doing good. Michelle thanx for your advice I will try focus on controlling my daily anxious feeling. I will let you know how things turn out once I make progress. God Bless.

[tom_h]

Sometimes, learning to find your way out is through psychological counseling that deals specifically, perhaps solely with anxiety neurosis.  In dealing with my wife's panic and anxiety attacks, we learned there is a reason she experienced them.  The key was finding the cause.  I suspect the psychologist knew very early on, but allowed my wife to discover the cause herself. Her discovery was like a light switching on.  My wife learned to confront the cause in the proper manner.  Once she learned that, her personal cure happened.  There was lots of tears along the way, but she's doing great today.Some twinges every now and then, but she knows how to deal with it.

[MichelleP_3811]

I spent most of my life nervous and anxious without really realizing it.  I tried to pretend I was fine and convinced myself I was but now that I am not looking back I see how stressed I was all the time.  What it came down to was fearing emotions and really not having proper coping skills.  Ultimately our bodies respond by force of habit.  Do something long enough and the body thinks it is natural and how it should act.  We have to take steps to break the habit.  I suggest maybe going and talking to someone who can help you learn how to over come your flight or flight response and develop coping skills or even just buy some books to see if you can work on this independently.  The important thing is to try and find your way out of fear and the anxious feelings will dissipate and your heart may settle down as well.  Best of luck it isn't something that will happen over night so be gentle with yourself as you work through it all but it is doable.  Stay strong.  

[Callentay]

So I have come to a conclusion that my daily tachycardia is mostly confused by my anxiety. I didn't know that even being slightly anxious causes the release of epinephrine and cause rapid heart rate. But it still seems that I'm having symptoms of Inappropriate sinus Tachycardia. The real problem is neurological because I'm anxious all the time when I'm really not. Its like I'm stuck in flight or fight mode 24/7 and because of this my heart is taking pounding everyday. It seems that even the slightest negative thought or being worried about something very minor releases these stress hormones. Basically what I'm trying to get at is that somehow my brain is perceiving things that aren't even a threat as if my fight or flight response is broken. I'm just worried overtime that I will developed heart problems. What makes this worse is that people with IST have an exaggerated effect to adrenaline and makes the heart go crazy. I just want this anxious feeling to go away.

[MichelleP_3811]

These sort of things can be hard to pin down and diagnose for certain.  Would you say that you feel your symptoms were caught on the holter?  If so then they have enough to see what is going on and they perceive it isn't a worrisome issue for you.  If not then you may need to just be persistent about the issue.  I would first say don't try and guess what your rate was, either try and count or get yourself a sports watch of some sort that will read your heart rate.  Then keep a journal of what the rate was, the time of day, and what you were doing prior and during the episode of tachycardia.   Were you anxious, did you just eat a big meal, was any acid reflux acting up.  This will help the doctor pinpoint a possible cause or see that the cause has no reason.  

But if you are in a position of needing to just deal with the fact you have a faster than normal heart rate, they can prescribe beta blockers to help slow it down for you if you are not tolerating the situation well.  Unfortunately there isn't a whole lot they can do about IST and POTS beyond meds and compression socks and possibly having you add more sodium to your diet.  But maybe to at least get a definitive diagnosis the next cardiologist you choose try to find one that deals with POTS they will be better able to test you for the condition.  But either way you don't necessarily need to go to different doctors.  Just be persistent with the one you have and let them know you are struggling.  Sometimes it does take a few visits.  


Out of curiosity how is your blood pressure?  People who are on the small side can sometimes have low blood pressure and this can lead to some tachycardia but is usually accompanied by feeling light headed or presyncope (almost fainting) when one stands.  Cutting back on caffiene, carbohydrates and sugary foods may help as well make sure you drink lots of water.  Water will help your heart function better no matter what is going on.  I know it can be frustrating getting a handle on tachycardia but just try to do your best not to stress out as that will make things worse.  Best of luck getting this under control.  Keep us posted on how you are doing.