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myocarditis/atrial and sinus tachycardia/pause in heart beats
Hello, i am a 26yr old non smoking female, weigh 125 pounds, 5' 7" and until 6 month ago in v good health, regular runner and was training for a half marathon.
Well last July I had been for a 90 min run and a couple of hrs after i started having horrendous palpitations (160 bpm), went to the ER and was kept in for a few days whilst I had an Echo, treadmill test, various ecg's. (All normal). The whole of this week i had awful chest pain, felt incredibly fatigued, and every time i moved an inch my heart rate bounded 100+. I was eventually told i was having anxiety attacks even tho i hadnt been stressed in the slightest. A week later i went to see a cardiologist who said i had had Atrial tachycardia, and sinus tachycardia and that i had most likely had a viral myocarditis or had an electrolyte inbalance (all my bloods were fine tho). SInce then I have also had an MRI scan which showed fibrosis on my heart (my cardiologist says i dont have enough for it to be a big deal and that should shrink in time). I was put on Ivabradine 5mg a day as was still having daily sinus tachycardia with any exertion, and i am deemed unsuitable for bet blockers as my bp is on the lower side.
So fast forward 6 months, and I am still having probs, i had a bad episode of tachycardia in Dec where my hr reached 180, my doc said it would def have been atrial tachycardia if it were that fast and that they could cure that with ablation. I also have incomplete right bundle branch block, which in the first few months would not be there at all and other times would, it currently seems to always be on my ecg's. And I am having episodes where I feel my heart "pauses" in between beats, I know in these instances they are not PVC/PAC's aS I have those also and with the pauses i do not have the thump and headrush that you have with ectopics. Also, I have having frequest feelings of dizziness, difficulty breathing, and a few months ago i had what felt like an electric zap through the head. My cardiologist thinks my latter symptoms are caused by my constant worrying about all this and so anxiety, but i am not convinced,
So my questions are,
1. Are inappropriate sinus tachy and atrial tachy two separate probs? Were both caused by the so-called myocarditis? Would ablation get rid of one but not the other?
2. My cardiologist says it is unusual that I have incomplete right bundle branch block that comes and goes, but that he is not concerned by it, given the fact that I have experienced what feel like pauses in my hearts rhythm does this mean my sinus node could be dysfunctioning? 24hr ecgs show a heart rate of minimum 52 when i am asleep.
3. What could my dizziness and difficulty breathing be from? I get it even when my heart is being well-behaved and isnt racing! Could the myocarditis still be causing this or have returned?
Any help at all is appreciated!
Thanks
Well last July I had been for a 90 min run and a couple of hrs after i started having horrendous palpitations (160 bpm), went to the ER and was kept in for a few days whilst I had an Echo, treadmill test, various ecg's. (All normal). The whole of this week i had awful chest pain, felt incredibly fatigued, and every time i moved an inch my heart rate bounded 100+. I was eventually told i was having anxiety attacks even tho i hadnt been stressed in the slightest. A week later i went to see a cardiologist who said i had had Atrial tachycardia, and sinus tachycardia and that i had most likely had a viral myocarditis or had an electrolyte inbalance (all my bloods were fine tho). SInce then I have also had an MRI scan which showed fibrosis on my heart (my cardiologist says i dont have enough for it to be a big deal and that should shrink in time). I was put on Ivabradine 5mg a day as was still having daily sinus tachycardia with any exertion, and i am deemed unsuitable for bet blockers as my bp is on the lower side.
So fast forward 6 months, and I am still having probs, i had a bad episode of tachycardia in Dec where my hr reached 180, my doc said it would def have been atrial tachycardia if it were that fast and that they could cure that with ablation. I also have incomplete right bundle branch block, which in the first few months would not be there at all and other times would, it currently seems to always be on my ecg's. And I am having episodes where I feel my heart "pauses" in between beats, I know in these instances they are not PVC/PAC's aS I have those also and with the pauses i do not have the thump and headrush that you have with ectopics. Also, I have having frequest feelings of dizziness, difficulty breathing, and a few months ago i had what felt like an electric zap through the head. My cardiologist thinks my latter symptoms are caused by my constant worrying about all this and so anxiety, but i am not convinced,
So my questions are,
1. Are inappropriate sinus tachy and atrial tachy two separate probs? Were both caused by the so-called myocarditis? Would ablation get rid of one but not the other?
2. My cardiologist says it is unusual that I have incomplete right bundle branch block that comes and goes, but that he is not concerned by it, given the fact that I have experienced what feel like pauses in my hearts rhythm does this mean my sinus node could be dysfunctioning? 24hr ecgs show a heart rate of minimum 52 when i am asleep.
3. What could my dizziness and difficulty breathing be from? I get it even when my heart is being well-behaved and isnt racing! Could the myocarditis still be causing this or have returned?
Any help at all is appreciated!
Thanks
Hi,
Sinus tachycardia can have about as many causes as there are stars in the sky. Yes, a cause can be dysautonomia, and it can also be caused by the myocarditis, if the heart muscle has a somewhat impaired ability to contract, and the heart increases the rate to compensate. About the same happens with poor exercise condition, and several other more or less serious diseases, so you can't necessarily blame the myocarditis. But exercise is strenous to the heart (as well as the other muscles you use), so in the setting of myocarditis, exercise is only allowed as prescribed by your cardiologist.
Other more common causes of sinus tachycardia is dehydration, of course exercise, hyperthyreoids, malnutrition / electrolyte imbalances, stress, and of course anxiety.
Atrial tachycardia can occur with adrenaline surges. The atria are highly vulnerable towards stress, and high adrenaline levels can cause about any atrial arrhythmia in the book, including atrial fibrillation. You can think of the atria as a rabbit and the ventricles as an elephant, stronger, slower and more difficult to annoy. But if you are able to do it, the result isn't good.
Take care!
Sinus tachycardia can have about as many causes as there are stars in the sky. Yes, a cause can be dysautonomia, and it can also be caused by the myocarditis, if the heart muscle has a somewhat impaired ability to contract, and the heart increases the rate to compensate. About the same happens with poor exercise condition, and several other more or less serious diseases, so you can't necessarily blame the myocarditis. But exercise is strenous to the heart (as well as the other muscles you use), so in the setting of myocarditis, exercise is only allowed as prescribed by your cardiologist.
Other more common causes of sinus tachycardia is dehydration, of course exercise, hyperthyreoids, malnutrition / electrolyte imbalances, stress, and of course anxiety.
Atrial tachycardia can occur with adrenaline surges. The atria are highly vulnerable towards stress, and high adrenaline levels can cause about any atrial arrhythmia in the book, including atrial fibrillation. You can think of the atria as a rabbit and the ventricles as an elephant, stronger, slower and more difficult to annoy. But if you are able to do it, the result isn't good.
Take care!
Thanks for the comments guys!
In whether there is a difference between Atrial and sinus tachycardia, i wondered if Sinus tachycardia is caused by a neurological imbalance (dysautonomic caused) or if it is as a reult of the myocarditis. As i have had mixed answers to this from docs. Whereas i guess atrial tachy has nothing to do with the nervous system.
About the myocaditis - it will be 6 months in 4 days time so hurrah hope things get back to normal soon, altho i was told it can take up to 12-18 months to totally recover.
My cardiologist did a treadmill test a month ago which was fine and so they have said im ok to go running but i am a bit too nervous to!
Espesh as over the last week i have had some chest pain return just above left breast muscle, and a feeling of pressure/tightness/breathlessness, have also felt generally a bit unwell. Saw my cardiologist last night and he pressed on my chest which made it hurt and he said that meant it was prob muscular altho he said it could be pericarditis, tho he said it was unlikely the myocarditis has returned. He did an ecg and it was fine, so he advised me to just take anti-inflammatories. He is also going to do blood tests to check I dont have anything inflammatory going on like Lupus etc.
I did have flu a month ago, i hope that hasnt manifested in my heart again!
And about the pauses, no i dont think any of them were over 5 seconds! Think i woulda fainted if they had been! Thanks for the info tho!
Take care
Emma
In whether there is a difference between Atrial and sinus tachycardia, i wondered if Sinus tachycardia is caused by a neurological imbalance (dysautonomic caused) or if it is as a reult of the myocarditis. As i have had mixed answers to this from docs. Whereas i guess atrial tachy has nothing to do with the nervous system.
About the myocaditis - it will be 6 months in 4 days time so hurrah hope things get back to normal soon, altho i was told it can take up to 12-18 months to totally recover.
My cardiologist did a treadmill test a month ago which was fine and so they have said im ok to go running but i am a bit too nervous to!
Espesh as over the last week i have had some chest pain return just above left breast muscle, and a feeling of pressure/tightness/breathlessness, have also felt generally a bit unwell. Saw my cardiologist last night and he pressed on my chest which made it hurt and he said that meant it was prob muscular altho he said it could be pericarditis, tho he said it was unlikely the myocarditis has returned. He did an ecg and it was fine, so he advised me to just take anti-inflammatories. He is also going to do blood tests to check I dont have anything inflammatory going on like Lupus etc.
I did have flu a month ago, i hope that hasnt manifested in my heart again!
And about the pauses, no i dont think any of them were over 5 seconds! Think i woulda fainted if they had been! Thanks for the info tho!
Take care
Emma
Just to add something to the excellent answer above (great answer, Itdood!)
Most of the statements below are quoted from my cardiologist (I was at some point afraid of myocarditis)
Myocarditis is often a diagnosis that is given by ruling out other conditions. There are cases of severe myocarditis that cardiologists can see clearly on echo, that manifest with heart failure, severely dilated heart and serious (ventricular) arrhythmias, but those are rare.
My cardiologist told me that with every viral infection, you'll have some affection of all vital organs. The headache you get with a flu is caused by an inflammation of the brain membrane, without having a diagnosis of meningitis, the stomach is upset because the virus affects it, and it's harder to exercise because the circulation (heart and lungs) are affected. There is a fine line between this "normal" condition and a light myocarditis.
You can get an inflammation of one spot in the heart. This can cause lots of PACs (if it happens to be in the upper chambers) or PVCs (if it happens to be in the lower chambers) but no signs of heart failure. There are a lot of variants. Some are benign. Some are not.
Some symptoms of myocarditis (that can also be caused by other things, incl. anxiety, poor exercise condition, etc):
- PVCs that increase with exercise. In theory, PACs too, but PACs are more normal during exercise and will happen anyway if adrenaline levels are too high.
- Sudden unexplained drop in exercise condition.
- Elevated heart rate for hours after exercise.
- Shortness of breath
- Signs of heart failure
- Chest pain, often similar to angina / MI
Medical tests:
- Dilated cardiomyopathy on echo
- Signs of inflammation on echo
- Elevated cardiac enzymes (NT-proBNP/ANP, troponine)
- Inverted T waves or ST segment changes on EKG.
- Elevated CRP, WBC and fever
I believe I answered the specific questions in the other post.
If you have myocarditis, you should definitely ask your doctor before you exercise!
Good luck!
Most of the statements below are quoted from my cardiologist (I was at some point afraid of myocarditis)
Myocarditis is often a diagnosis that is given by ruling out other conditions. There are cases of severe myocarditis that cardiologists can see clearly on echo, that manifest with heart failure, severely dilated heart and serious (ventricular) arrhythmias, but those are rare.
My cardiologist told me that with every viral infection, you'll have some affection of all vital organs. The headache you get with a flu is caused by an inflammation of the brain membrane, without having a diagnosis of meningitis, the stomach is upset because the virus affects it, and it's harder to exercise because the circulation (heart and lungs) are affected. There is a fine line between this "normal" condition and a light myocarditis.
You can get an inflammation of one spot in the heart. This can cause lots of PACs (if it happens to be in the upper chambers) or PVCs (if it happens to be in the lower chambers) but no signs of heart failure. There are a lot of variants. Some are benign. Some are not.
Some symptoms of myocarditis (that can also be caused by other things, incl. anxiety, poor exercise condition, etc):
- PVCs that increase with exercise. In theory, PACs too, but PACs are more normal during exercise and will happen anyway if adrenaline levels are too high.
- Sudden unexplained drop in exercise condition.
- Elevated heart rate for hours after exercise.
- Shortness of breath
- Signs of heart failure
- Chest pain, often similar to angina / MI
Medical tests:
- Dilated cardiomyopathy on echo
- Signs of inflammation on echo
- Elevated cardiac enzymes (NT-proBNP/ANP, troponine)
- Inverted T waves or ST segment changes on EKG.
- Elevated CRP, WBC and fever
I believe I answered the specific questions in the other post.
If you have myocarditis, you should definitely ask your doctor before you exercise!
Good luck!
On the pauses, PACs / PVCs will have different feelings depending on when they hit in the cardiac cycle. Some you won't feel at all. Others will be hard thumpers. These are known as early, middle, and late stage ectopics. These can be further divided into such categories as interpolated, or R on T, ...... It's impossible for anyone to tell what's going on without seeing it on an EKG. Soooo, don't dismiss the pauses as not being ectopics based on the feelings.
On the anxiety issue, it does not require any stress to have episodes of inappropriate anxiety or subsets of anxious responses. By definition anxiety attacks and panic attacks are labeled as "out of the blue". My personal feeling is that PAD and GAD are not cognitive mental issues at all, I think they are central nervous system issues. It's completely out of one's control.
1. Yes, inappropriate sinus tach (IST) and atrial tach are completely separate issues. IST can be ablated but doing so would require a permanent pacemaker. This is because the heart's pacemaker is the sinus node. If it's ablated the heart's natural pacemaker would be destroyed and you'd require a pacemaker 100% of the time.
Atrial tachycardia is premature atrial contractions happening in runs, all in a row. These are originating in cells that are not part of the SA node. They shouldn't be firing but they are for some reason. These can be ablated as-well if it's originating all in the same spot.
2. The pauses are probably PACs or PVCs, which I was talking about above. I doubt these are the type of pauses caused by the SA node not firing (or 3rd degree AV block) but it's impossible to tell without an EKG. If this were the case, and the SA node did fail to fire or the AV node didn't conduct it to the ventricles (3rd degree AV block), the heart's backup system would be something called a ventricular escape beat. If I recall correctly that can take upwards of 5 seconds to occur. Do these pauses last 5 seconds? I doubt this is what's happening to you. You aren't reporting any of the symptoms that usually occur when that happens. Again, need to catch it on an EKG to be sure.
3. Have you looked into asthma for the shortness of breath and difficulty breathing?
The myocarditis can take a while to get back to 100%. 6 months at a minimum I hear.
On the anxiety issue, it does not require any stress to have episodes of inappropriate anxiety or subsets of anxious responses. By definition anxiety attacks and panic attacks are labeled as "out of the blue". My personal feeling is that PAD and GAD are not cognitive mental issues at all, I think they are central nervous system issues. It's completely out of one's control.
1. Yes, inappropriate sinus tach (IST) and atrial tach are completely separate issues. IST can be ablated but doing so would require a permanent pacemaker. This is because the heart's pacemaker is the sinus node. If it's ablated the heart's natural pacemaker would be destroyed and you'd require a pacemaker 100% of the time.
Atrial tachycardia is premature atrial contractions happening in runs, all in a row. These are originating in cells that are not part of the SA node. They shouldn't be firing but they are for some reason. These can be ablated as-well if it's originating all in the same spot.
2. The pauses are probably PACs or PVCs, which I was talking about above. I doubt these are the type of pauses caused by the SA node not firing (or 3rd degree AV block) but it's impossible to tell without an EKG. If this were the case, and the SA node did fail to fire or the AV node didn't conduct it to the ventricles (3rd degree AV block), the heart's backup system would be something called a ventricular escape beat. If I recall correctly that can take upwards of 5 seconds to occur. Do these pauses last 5 seconds? I doubt this is what's happening to you. You aren't reporting any of the symptoms that usually occur when that happens. Again, need to catch it on an EKG to be sure.
3. Have you looked into asthma for the shortness of breath and difficulty breathing?
The myocarditis can take a while to get back to 100%. 6 months at a minimum I hear.
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