inappropriate sinus tachycardia

my doctor, upon reviewing the second holter monitor i just did, tells me he thinks this is the case. while my average hr for the 24hours was 76bpm, he noticed that every hour or so, my hr would jump to 120 or so, probably from getting up and just walking around. he also noticed that while my hr dropped to 56 while sleeping, there were still these spikes at night as well. he increased my beta blocker from 25mg in the morning to 50mg in the morning, and still 25mg at night (although he has thoughts of increasing it then).

this is my concern. i think this is a high dose. i have normal/low blood pressue, am relatively small in stature, and while i don't feel terrible side effects from this, i do sometimes feel short of breath at night, and my fingers get unreasonably cold and sometimes my nails to blueish at the bed. he said that it's only bad if i faint, which i don't. i mentioned these side effects, and he thought they could be lung issues, which i know they are not because i had a peak flow test that was perfect. my fingernails only turn blueish at night, like 2-4 hours after i take my nightly dose. i am certain that this is connected.

he seems sort of concerned about this condition. he was saying that over time, this condition can wear the heart out, even though now my heart is healthy. this scares me, as i am only 20. my heart isn't going crazy all of the time, and i don't even feel these spike to 120 or so. i do not think they are sustained episodes, just correlating with minor activity.

he also ordered a tilt table test, but i had to cancel it for health insurance reasons. my bp does not fluctuate upon standing, just my hr. i checked it yesterday, and sitting it's around 76-84 and then if i stand and move around slightly, it can reach 96. this is during the day.

so this is my question: is the atenolol working? i know it is in some sense, because i forgot to take one dosage before my dr appointment, and my hr was at 140 on the ekg. i am afraid to wean off it in order to take another medication, if this need be. also, does anyone know much about IST? i looked online, and the criteria is that the average hr is great than 95bpm. mine was 76, but just with those spikes.

[paanda2]

oh, and also a question: when i ask about the medications i am taking, which are doxepin and yaz, no doctor thinks that either of these could be giving me this problem. the time when i began taking these medications correlated to the beginning of this problem. i also read that tachycardia can be side effects for both.

this is what i don't understand. all my life i have had a higher hr than most, but obviously it hasn't concerned any doctor that i have seen. i remember it being, through high school, in the mid 80s or so. now, when i missed a dosage of the BB, it was 140! I just feel really lost about this whole thing, because i don't understand how it's happening.

[jkfrench]

Is your doctor a cardiologist?  Just asking because I have the same thing you do.  I also was in high schools when I found out my pulse was higher than everyones.  In PE, mine would run around 90-100.  Then a few years later, it would spike up to 120 if I would get up to do anything or sometimes if I even raised my arms up in the air.  At the time, I was told 120 is not that high and it won't hurt you but I should take atenolol (tenormin) to lower it.  I started on 1/4 of a 25mg pill at night and it worked for 20 years.  Sometimes I would have a breakthrough and I would just take another 1/4.  Now, I am up to 1/2 of the 25mg pill at night because my pvc's got worse.  It seems to be helping.  I can tell immediately if I forget to take it.  In the morning, my heart will be twice as fast sometimes.  I don't think IST in general is anything to worry about.  My doctor never made to much of it either and he never told me
that it would wear out my heart.  ( I was around your age at the time)
Maybe you need another opinion.  That does seem like a lot of atenolol.

Frenchie

[paanda2]

my cardio said that if your heart beats too fast over a long period of time, it just wears itself out. this is down the line, many years. it makes sense because something going fast and strong will wear itself out quicker than something that is going slow and steady.

people can take up to 100mg of atenolol a day, so i read. i started out at 25mg in the morning, then added another 25mg at night. I was on this for a while, and then i switched cardiologists because i moved. i had another holter then, and that is when he decided to increase it to 50mg in the morning, because he saw the spikes of 120. i think that drugs mean different things for different people, so my dose may seem high to you, but the drug may just affect you differently. i will be talking to him about this though, in about a week.

i would like a second opinion, but i am unable to, because my insurance changes at the end of the month, and i am full time at school.

[Wisconsin2007]

While your doctor may have a point about your heart rate being too high for too long, if the spikes are of short duration, it seems very unlikely that this would present a long-term problem.  My cardiologist recently told me, about people with SVT, that she's seen changes that occurred in the heart because of the fast rate, but when that rate was brought under control, the changes reversed themselves and the heart went back to it's normal function.  

As for your insurance - if you have until the end of the month, then you should try to cram as much as you can into these last couple weeks.  If you have coverage when the tests occur, it doesn't matter when the bills are sent out to the insurance company.  You are covered for the period defined in your policy.  You might tell that to the Dr's office, as they may be able to speed up the process to get you in before your insurance runs out.  You might also consider COBRA coverage at the end of the month (which, if I recall, Pres. Obama was talking about making extremely reasonably priced).  I used to work at an insurance company, so I've learned a few things.  ;)

[blondemiss]

I have Sinus tach myself. And I had a ton of tests for this to be the conclusion. I was told it is a begnin condition and you can live a normal healthy long life with this. While it may be  a worry and pain at times, you should not worry. The fact that your on top of it is a good thing. If yout heart rate is too high then you might want to take a beta blocker  if your cardio doc thinks that may help.

[paanda2]

i am on atenolol right now, and have even been on it since before the diagnosis, and yet he is still concerned. i guess i should not worry myself now, but until the appointment.

[paanda2]

i am actually on COBRA now...or, my family is. however, the insurance for cobra is changing at the end of the month, to a carrier that will only cover in state doctors. this has been a major issue for me as of late, because it is for the state of new jersey, and i live in new york, going to school full time at columbia university. i do not have the time to take a 2 hour commute into nj for this, on top of school and work. i am lucky enough to get an appointment at a time that is good for me (a downside of living in such a populated area). i will see as it plays out: i was told that they will cover 70% for out of state doctors. i am lucky that this cardio is not expensive, and i can afford that. however, my question right now is, is that before or after the deductible is met?

now i am just rambling my concerns. i will be very happy if barack makes changes to this system, although in my situation, i do not know much they will help.

thank you for your help.

[banglamom]

Doesn't sound like a terribly high dose of BB, but on the other hand... your pulse is not to high really either.  IST has been mentioned with my sinus node too, but mine runs 160++ without meds and goes into the 200s and I was wearing out my heart already.  If you haven't yet, see an EP doc to look at your rhythms.  I hate having to take all these meds and if you don't HAVE to, don't go down that road.

[paanda2]

what is an EP doctor? sorry, i'm not all well versed in the terminology yet. :)

i don't have terrible side effects, but i feel weird being dependent on medication. i know i should be thankful that all i need to do for this condition is simply take a pill (or two). i just feel weird because i never had an extremely high heart rate before...and then when i forgot to take it one morning, it was all the way up to 140. my hr was not 140 before i started taking it, which scares me.

[Bon-Bon]

Hi paanda2.   Years back, I was prescribed a low dose birthcontrol pill as the doctor was attempting to slow down endometriosis.  A short time later, I developed new symptoms such as very high pulse and blood pressure reading both diastolic and systolic even when doing nothing as well as leg pain upon walking.  I always had a healthy normal reading before taking birthcontrol and never had leg pain before.  When  I went to see the gyno that prescribed it, my blood pressure reading in her office was around 200/100, pulse arround 132.  I told her it has been running high as well as my pulse, even while sitting since shortly after being on the pill this is now two years later.  She acted agitated and exclaimed that the birth control pills are NOT the CAUSE of it and besides, my reading was NOTHING to worry about!  She dismissed it entirely.  

Months later, presenting the same symptoms, I visit my family physcian.  He told me the same thing, that birth control pills will not cause your blood pressure to go up; however, that this high blood pressure reading and pulse was NOT normal for me; that he suspected its due to anxiety stress, etc.  He did not prescribe any medication to reduce it nor did I ask for any additional medication.  We just consulted about my wanting to get off the BC pill just to see if that was the problem.  He advised me to continue taking it, that it was NOT causing the problem.    

So, I continued on the pill, as they both advised, all the while suffering high blood pressure, high pulse rate and bad leg pain getting worse by the day.  I decided to come off the pill because I felt it was connected and told my gyno what and why I was doing it.  She acted upset and disagreed with my reasoning; but, could not force me to take it.

After completing the month of pills as she advised, I stopped.  

The very NEXT DAY, the leg pain was gone, blood pressure dropped to my normal and pulse dropped to my normal!  However, that early morning I fainted in what I feel may have been the process of it dropping and going through such a fast adjustment; but, afterward EVERYTHING was back to normal and I felt great.  I do understand that it sounds very hard to believe that it was all back to normal the very next day, after spending a few years in that state and not stroking out in the process.

I thought I would mention my individual experience in how birthcontrol pills affected my blood pressure and pulse.  I am not telling you nor anyone else that is what is causing your problem with pressure, but it may be something for you to consider as a possibility due to my personal experience with it.  My doctors didn't believe it had anything to do with it either.  But, as I explained here, in my case, it was the cause!

Months later, when I went back for my routine checkups and they saw that my pulse and blood pressure readings were VERY GOOD and that I no longer was experiencing leg pain they said that whatever it is you're doing keep doing it.  That is when I told them that it all returned to normal the following day after stopping the bithcontrol pill.  Both doctors responses were - no response, whatsoever.  Uhmmm.

    

  

[banglamom]

EP is an electrophysiologist.  That is a cardiologist with a further subspeciality in the conduction component of the heart.  They do rhythms, rhythms, rhythms ad infinitum.