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.

[MichelleP_3811]

Oh and I visited the thyroid forum once before when I had a pretty low T3 reading and they were all very nice and helpful.  Turns out I don't have a thyroid problem I just tend to be on the low end of normal for my T3 but they were all very nice.  

[Mmp_33]

Whatever ended up happening? I realize this is 2 years later but just curious. I have had a very similar experience these past months and got a diagnosis recently so I was wondering if you ended up getting anywhere with an answer?

[MichelleP_3811]

I think your tests are showing that your heart beat though fast is normal and ramping up and down in response to exertion albeit very fast.  So this generally indicates that something is going on outside the heart to cause it to be beating faster than it should.  The weight loss is also another indication.  Heart conditions don't generally produce weight loss.  That said, if you are not eating as you should because you don't feel well then that could be the reason but if you are eating your normal caloric input and are losing weight then weight loss is a symptoms that needs to be evaluated in relation to the other symptoms.  

[roxydoggy]

I just realised you've already answered that question! So sorry, ignore me!

[roxydoggy]

Thanks for getting back to me Michelle. I'll check out the thyroid forum – I hope they're as supportive as you guys!

I appreciate you're not a doctor, but in your opinion would you say my heart has been ruled out based on the tests I've had? I've read that perhaps the exercise stress test isn't always entirely accurate, but I'd like to think as a generally healthy 22 year old I'm not at risk of CAD?

Thanks again.

[MichelleP_3811]

No one can say for sure online but it sounds like the doctors have done extensive testing to rule it out.  You sound highly suspicious of a thyroid problem to me.  I would seek out an endocrinologist to be fully evaluated.  I would also visit the thyroid forum to see what others who have it say about your symptoms.  I might also see if you can get your adrenal gland checked.  Rare tumors on them can wreak havoc on the body.  Not sure if your blood being tested normal would rule it out but worth asking your GP about it.  As well check out the condition dysautonomia.  I sure do hope you can get to the bottom of this.  Stay strong.  Keep us posted.

[roxydoggy]

Hi everyone – me again.

I just wanted to give a quick update to see if any of you kind people might be able to shed some light on my current situation.

So after the 24 hour ECG, the doctor told me that he'd like me to wear a 7 day monitor and have a stress test and echocardiogram.

While waiting to have these tests, I was getting worse and worse. I was regularly having episodes of fast heart rate, although I stopped checking how fast because it seemed to exacerbate the problem.

I carried on losing weight until I was 13 pounds below what I originally weighed, even though I was trying my best to eat as much as possible despite my non-existent appetite.

I was regularly getting lightheaded and dizzy, and would have these waves of adrenaline rush over me and random points throughout the day.

Anyway, I got the 7 day monitor put on and 5 days into it, I came over really bad. I felt this tightness all over my back and I just felt totally wrong – like I was going to pass out. I got in a bit of a state and went to the hospital.

They did an ECG straight away and the guy said 'if you're sent back to the waiting room, you've got nothing to worry about'. He was gone a while, but then came back to say that the doctor wanted me to go through to the majors department because my heart rate was so fast. They were desperately trying to get some blood out of me, and had a hard time doing so, but got there in the end. They thought I might be septic because my respiration rate was high, my lactate levels were high, and I was shaking... and of course the high heart rate (around 160-170bpm).

They gave me some propranolol (beta blockers) and came back to say my blood cultures and chest x-ray looked normal. The doctor wanted to keep me in though, so I stayed for another two nights in the coronary care unit where they constantly monitored me, taking bloods, blood pressure, temperatures, and ECGs. The lactate levels came back down to normal during this time.

They did an echocardiogram which came back normal and by that point it was time to hand back to 7 day tape (which recorded constantly for the whole week by the way). The 7 day tape showed sinus tachycardia – a max HR of 190bpm (impressive considering I didn't exercise at all) and some ventricular ectopics. No SVT.

As an outpatient I went back to do an exercise stress test. I had a heart rate of 150bpm before I even stepped on the treadmill (with sinus arrhythmia), but they let me start the test, getting up to 202bpm in 11 minutes. They said my heart rate increased as it should and it looked like a normal sinus rhythm. [My heart rate isn't always high. If I'm sat watching TV, it's usually around 70/80bpm.]

I've done a 24 hour urine test to check for pheochromocytoma – waiting to get the results on that next week.

I keep getting headaches and swollen glands in my throat, along with chest and back tightness.

I just feel so confused. Considering the tests I've had done, does this rule out any heart problems? My blood tests showed that my cholesterol levels were borderline high, but I've read that stress can increase cholesterol levels – and I've definitely been very stressed with all of this the past 8 weeks.

As a recap:
- Normal blood pressure
- Now technically slightly underweight
- No family history of heart disease
- 22 years old
- Was going to the gym 5 times a week and eat healthily
- Don't smoke / drink / drugs

One thing to note is that my thyroid was slightly underactive for the past 5 years (never on any meds for it). It's now gone up to 'normal' levels. The cardiologist suggested perhaps this isn't normal for me and is too high for me. Not sure if that's relevant?

Does anyone have any idea what might be going on with me?

I really appreciate all your help, and I'm so sorry for the long post – I just didn't want to leave anything out that may be of use.

Lara

[roxydoggy]

Hi Michelle,

Thanks for your constant responses to me – they really help when I'm feeling a bit anxious about everything!

I decided to pay to see a cardiologist sooner. He was such a great doctor – he initially said that it sounded like SVT but after looking at the ECG's from the day the first (and worst) episode happened, he said that it looks like sinus tachycardia. He wants to cover all basis though, so he's sending me for an echocardiogram, a stress test, and an event monitor.

I also got my holter monitor results back, which said:
'Majority of the rhythm is sinus with infrequent APCs as isolated. Infrequent VE's as isolated, couplet and bigeminy. 23 episodes of sinus tachycardia, longest lasting 88 beats, fastest 146 bpm.
Max HR: 133bpm
Min HR: 51bpm
Mean HR: 72bpm
Patient events correlate with sinus rhythm and an isolated VE.'

I'm guessing that's all okay? I forgot to tell the cardiologist that I was taking a low dose of beta blockers during the holter monitor... I wonder if that would make a difference?

Anyway, I just thought I'd keep you posted.

[MichelleP_3811]

Thyroid levels do fluctuate so you could go back another time and they will be different again but it doesn't sound like it should be the cause of your problem.  It is totally up to you if you want to pay to see the doctor sooner.  I know first hand how stressful and scary issues with the heart can be so it is understandable you do not want to wait.  The wait may actually cause you more symptoms because you are stressing out.  This said, you are exactly right, if anything dangerous was seen on the results you would have been contacted immediately.  Cardiologists seem very disinterested in things that send terror through us.  They have the experience to know that even though the heart is acting up our bodies can handle it without much consequence.  It can sometimes come off as them seeming to be uncaring but it is really just that they are not in fear like we are.  But if getting in to see him sooner outweighs the cost then there is your answer.  There is nothing wrong with you wanting to do that for your own well being.  

As for the meds, no one here can recommend to you what to do with your meds.  Any changes to them should really be discussed with your doctor for potential side effects and dangers.  But I will say my cardiologist did not see a need for them in cases of svt.  He would not prescribe them.  He would for my pvcs but stated svt really isn't helped much by bp meds.  It can slow the heart rate down when one is in svt but it won't prevent it so I personally didn't think the side effects, hassle and costs were worth it in my case.  I went 44 years with my svt not being diagnosed let alone treated.  I was starting to see the effects of an irritated heart but my heart is not worse for wear because of it.  So you can feel relatively confident that the svt is not a danger to you especially since you are able to slow it down on your own.  That is really the most crucial part.  Not letting it go on for hours which could weaken the heart over time but the heart is very resilient and can handle a lot before Permanent damage occurs.  The issues with my heart from the svt are all but gone.  

Well best of luck getting this sorted out.  Keep us posted.

[roxydoggy]

Forgot to add, my blood test results were completely normal... as in the slightly underactive thyroid that I've had for the past 5 years, including up to the blood test I had at the end of August, has all of a sudden regulated itself. I have very normal thyroid function now apparently... Bizarre.

[roxydoggy]

Hello all,

I was hoping you could give me some advice. I was able to move my appointment with the cardiologist a week sooner, but that's still the best part of 2 months away. I also enquired about the results of my holter monitor, but I was told that I would probably get these results at my appointment with the cardiologist. The lady on the phone told me that usually if there is anything to worry about with the results of the holter monitor, they will move my appointment forward... so I guess seen as it's still 2 months away, they can't be too concerned by what they've seen.

I've decided to wean myself off of the beta blockers. I was only on 1.25mg of Bisoprolol to start off with, but it has been making me feel awful – lightheaded, nauseous, and plenty of headaches/head pressure. I took half a tablet for 3 days and now I'm taking half a tablet every other day for the rest of the week. I already feel so much better for it.

My question is, if it were you, would you pay to see the cardiologist sooner? Since I live in the UK my appointment with the cardiologist is free since it's on the NHS, but I can pay £200 for a private appointment with the same cardiologist, and I'll probably get to see him this week.

I guess logically I know that there can't be anything that wrong with me otherwise they would have been in touch much sooner regarding my holter monitor results. The real question is am I happy to pay £200 for peace of mind 2 months sooner.

I feel much better now I'm coming off the beta blockers. My heart rate is completely normal still. Having said that, I'm still not 100% myself with a bit of a stuffy, tight chest and numbness in my left arm that comes and goes – this is the reason why I'm tempted to see the cardiologist sooner rather than later? What would you guys do?

Thanks for your input in advance.

[MichelleP_3811]

the telltale sign of an accessory pathway svt is that it starts and stops in one beat.  If you do deep breathing and it all of a sudden stops then it could be accessory pathway otherwise it may be something other than an extra muscle fiber causing the rapid heart beat.  It doesn't even need to be fear type anxiety but just plain adrenaline from being a high energy person can do it.  If I make sudden moves exerting myself quickly I can notice little runs of something happen.  I don't fall into svt anymore because I had mine corrected but something else does get triggered so something is causing your heart to beat faster than normal.  I would try to assess yourself when you notice it.  What did you just do, were you holding your breath for any reason, running out of breath, feeling even a little anxious or excited in the moment.  The more you can pin down when it fires up the better you will be able to help the doctor so maybe having a little time before you see him would be good you can get some thoughts in order before hand.  Well do let us know what the holter results say.

[Jenn1302]

* get = take

[Jenn1302]

I would call the cardiologist's office at least once a week to check if there were any cancellations. Do the beta blockers help prevent tachycardia episodes? If they do, it would make sense to continue taking them, because once you get an episode the beta blockers probably get a while to kick in.

[roxydoggy]

Hi all,

I've had an update in the mystery that is my heart: my blood tests came back all normal. They checked my thyroid, electrolytes, full blood count, and two other tests for infection (ESR and CRP).

I guess that leaves either a type of SVT or anxiety... or a mix of the two. I have an appointment with a cardiologist on the 14th November!!! Seems like a ridiculously long time to wait. I guess they can't be too concerned by whatever it is. I should also expect the results from the holter monitor within 2 weeks.

Last night I went out for the first time to the cinema and I felt my heart start to race again. I'm not sure how quickly, but within a few minutes and some deep breathing I got it back to normal. If I have this kind of control over it with breathing, does this rule out an SVT?

I'm still taking the beta blockers that the doctor prescribed when I first had an episode, but I honestly don't feel like I need them. When I'm not having an episode my heart rate is completely normal, so keeping my heart rate down constantly seems a bit like giving treatment before a diagnosis has been made. What do you think – if you were me would you be reluctant to stay on the meds?

Thanks

Lara

[roxydoggy]

I'm from the UK so we don't have insurance for health care, we just have the NHS. Although we can pay for private health insurance, which is what I wish I had done! I will keep pushing to see a cardiologist and if I have no luck, I'll just pay to see one.

Thank you so much for all of those links. I have been drinking protein shakes to get some kind of nutrition in me! Yesterday I managed to eat a little and it definitely made me feel a lot better. I guess I just need to keep forcing it down until I get my appetite back!

Thanks again.

[roxydoggy]

Thanks for your advice. Just sharing my experience with people that can relate and give an informed opinion is really helpful. I guess we'll wait and see what the holter monitor and blood tests say! Even if they try to tell me it's just anxiety or panic attacks, I think I'll definitely keep pushing for an appointment with a cardiologist. If it IS anxiety, which I really don't feel like it is, then I can't learn to cope with that until I know for sure my ticker is okay!

Thanks again for talking to me about it.

[Jenn1302]

As achillea said, you should push to see a specialist. If your doctor refuses, you could go to some other doctor (assuming that your insurance allows it) and try to get a referral to a specialist. Also, it can't hurt to get a second opinion.

You mentioned that you're unable to eat and that you've lost weight. A few years ago I had medication/drug-induced tachycardia and I was also underweight and unable to eat for several days. I ate as much as I could (which wasn't much), drank lots of nutritional drinks, protein shakes, gatorade, ginger-ale and broth. I made myself eat a little bit of food (by forcing food down) and and drank as many nutritional supplements, protein shakes and sports drinks as I could. It was really really hard but doable. Also, lying down helped my tachycardia, nausea and dizziness and standing up and walking made it significantly worse.

Here is a list of nutritional supplements and protein shakes:
* Ensure (http://www.amazon.co.uk/Ensure-Plus-Vanilla-Bottle-220ml/dp/B002DQWAE8/ref=sr_1_fkmr1_1?ie=UTF8&qid=1409866191&sr=8-1-fkmr1&keywords=%22ensure+enlive%22)

* Boost/Build Up  
http://www.amazon.com/Boost-Plus-Chocolate-Brikpaks-case/dp/B001D3RRH2
I think the UK equivalent is Build Up Nutrition Shake:
http://www.amazon.co.uk/Build-Nutrition-Shake-Strawberry-sachets/dp/B0045XABAC

* Ensure Enlive
http://www.amazon.com/Ensure-Clear-Mixed-Berry-Brikpaks/dp/B004DJ2ZN4
http://www.amazon.co.uk/Ensure-Enlive-Apple-Brikpaks-6-7Oz/dp/B004HPJ1W2

* Boost Breeze
http://www.amazon.com/Boost-Breeze-Resource-Drink-Orange/dp/B004L5MYP4

* Scandishake (I wouldn't take much of this one because it contains trans fat!, http://www.amazon.co.uk/Scandishake-Vanilla-Mix-Axcan-Scandipharm/dp/B000GG0HM4/ref=sr_1_3?ie=UTF8&qid=1409865310&sr=8-3&keywords=Scandishake)

You should be able to get some of these at your local pharmacy or grocery store.

Dehydration can make your tachycardia worse. Ginger-ale, Gatorade/Powerade/Isostrar, and broth can help keep you hydrated.

You could also try consulting a nutritionist. Nutritionists often know how to give the body what it needs without having to eat much.

[achillea]

From your description of your doc's reluctance to work you up further or refer you to a specialist, I wondered if you were dealing with the NHS.  And you are.

Sigh.

By all means, continue to push to see a cardiologist.  The basic workings of the heart can be understood by anyone, but cardiology is a special business that shouldn't be attempted by a general practitioner, no matter how large his ego.  I I had extremes of heart rate, I'd certainly demand a referral.

Second, when the results of blood work come back, if your white cell count is still up, pin the doc down about details:  There are basically five different types of white cells:

http://en.wikipedia.org/wiki/Leukocytosis

so which were increased and by how much?  Is there evidence of a viral OR a bacterial infection (which would explain your feeling ill, of course)?

Finally, since you know you have a tendency towards anxiety, if you are offered pills for this problem, ACCEPT THEM, even if only to store for emergencies.  I know many people fear addiction or feel a kind of moral weakness about anxiety, but I believe this is an inborn trait that can be crippling, and sometimes a little medication is a great help in a crisis.

[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.