Tachycardia

[mis596]

I've had an echo stress test and holter monitor done for
fast heart rate.  I was supposed to wear the holter monitor for a week
but everytime I put it on it would go off because of my elevated heart
rate so was told to stop.  The stress test showed nothing either
except fast heart rate (180 bpm at 5 minutes).  Doctor put me on 25 mg
of Toprol XL to slow heart rate.  I have a history of fast heart rate.  Sometimes
when I roll over it clicks on and beats over 220 bpm.   I can always bring
it back to normal by taking deep breaths and holding  it.  Twice my heart
went into a quivering or fluttering action which really scared me.  Nothing
I did would make it go back in.  It went in by itself.  This was before the
Toprol XL.  I still have palpatations and mild fluttering with medicine.  
My question is if the doctor couldn't really find anything wrong do I
need to stay on this medicine forever or get a second opionion.  I know I
have different problems going on but since they always stop is it really
serious or not?

[CCF-M.D.-CRC]

Dear Mis,
There are many causes of fast heart beats.  The first step is to determine what type of fast heart rate you are having.  Given your history I suspect you may have a condition called AV nodal reentry tachycardia (AVNRT).  The best way to diagnosis this is with a Holter monitor or event recorder.  Alternatively you can go to the ER the next time you have an episode and get an EKG.  Once the diagnosis is made the treatment can be determined.  If it is AVNRT this can be cured with a procedure called an ablation or treated with medications.  The type of doctor who deals with these problems is a type of cardiologist called an electrophysiologist.  I would suggest seeing an electrophysiologist for further evaluation and treatment.

[VALERIA]

The first thing I ever noticed with my heart was a fast heart rate. This happened in 1993. Since that day it happened everyday since. I was 32. I never saw a doctor about it because after a while I just became use to it. It  would seem to bother me more in the A.M. after getting up, and especially after eating breakfast or other meals. When it starts it feels like my stomach tightens up or something, just an uncomfortable feeling. Then I usually know  by the way my stomach feels, my pulse it taking off. In 1998, this one day it statred up as usual, but nevered slow down. I couldnt get up from the chair to go a few steps without it taking off. I finally went to the E.R. and has blood work and a electrocardiogram, and was told it was sinus tachcardia. Since then I have now a cardiologist, and had echo test, monitors everything. Was started on Toprol in 1999. On 25mg. to start noticed immediate relief, but since then the doctor has increased the Toprol to 3 tablets (150mg) daily. Still get the fast rate, but I guess better than before, also I have the pac
s or the pvc's, it was never caught on a monitor, but by my symptons  that is what the doctor said they most likley are. My mother, sister and nephew have this. My sister and nephew had ablations for wpw, although my nephew problems are starting to return.
Also my symtons come much more around that time of the month.
It is frustrating for sure.