Evening Tachycardia

[whisperwolf]

Hi.  I am a 37 y/o female not overweight, I don't smoke. Not diabetic. My cholesterol and blood sugar were just checked and are good.  I have hypothyroidism, but I am on medication and that was recently checked and is within normal limits.  I do have asthma and am taking medication for that.  

Over the past two months I have had the following symptoms.  I wake up in the night not quite feeling well.  I usually feel a bit weak in my arms and nauseated.  Usually I have heart palpitations and chest pain. Then my heart will start pounding and I will usually get up to head for the bathroom because I think I am going to vomit.  I feel very weak and am shaking. I then notice my heart is racing.  When I take my pulse, it is usually between 160-180.  I don't really notice feeling anxious, I am usually half asleep and after the episode passes, I just want to go back to bed. My pulse usually comes back down within 5 minutes. Then I start to get the chills. By the time I am thinking I should call 911, the episode passes I feel dumb about calling 911.  I also notice my skin looks funny, kind of a reddish color on my face and arms and my hands and feet are a strange grey color?  

I have had these symptoms approx. 8 times over the past 2 months and always at night. I do take medication for anxiety.  The only symptoms I notice during the day is that I sometimes have shortness of breath and palpitations and sometimes my blood pressure is high.  But I figured it was because of my asthma.  

[whisperwolf]

Just wanted to give you a follow up.  All my lab work came back normal, EKG normal. Heart echo normal.  But I went to the ER on Monday evening after having episodes of fainting, severe weakness and chest pain, palpitations and SOB.  The paramedics came and took me to the ER since I was home by myself.  The ER didn't find anything abnormal.  When I saw my primary doctor, he told me it was all anxiety and depression and my heart was fine.  He says I have no symptoms of PVST or any other heart problems.  The only test he was willing to order was a urine and blood cortisol levels.

I am trying to find a new primary doctor.  

[whisperwolf]

Thank you.  
Last night my blood pressure and pulse was going up and down for about a half an hour.  I was having chills and felt ill.  My BP monitor kept telling me it was detecting an Arrythmia.  

The readings went something like this;
127/92 p 80       8:22 pm
136/93 p 82       8:40 pm

103/62  p 63 arr 9:31 pm
93/40   p 45 arr 9: 34 pm
129/81 p 75 arr 9:38 pm
129/88 p 88 arr 9:41 pm
119/44 p 87 arr 9:43 pm

I thought, this is crazy.  It can't be right. I'm going to bed.  

[caregiver222]

You have symptoms that could indicate a problem with the right heart. The term is cor pulmonale.  It commonly takes place at night, and the co-factor is a compromised ability to transfer oxygen in the lung. I am reluctant to suggest this because it may not be the case and I don't want to cause you to worry unnecessarily. The momentary spike in blood pressure is compensatory, and I would think twice about taking meds to restrict my heart rate. I don't think you need a psychiatrist. You need a cardiologist to provide a definitive diagnosis.

[sick and tired 47]

Anxiety can trigger PSVT as hormones can too. It is SO nice your psychiatrist does not think its anxiety, For me the drs kept blaming it all on anxiety and gave me antidepressants with increasing doseage which did not help.
  Good luck to you , let us know how you make out!

[whisperwolf]

HI. I saw my psychiatrist today and told her about my symptoms.  She does not think it is anxiety.  She came up with the suggestion of PVST as well.  But to be sure, she is changing my anxiety medications.  

She suggested I go to the ER next time I have an episode.  

I am having another interesting symptom;  

Sometimes if I lay on my left side, my left hand will start to get very cold.  If I compare the left hand with the right, it will be white.  When I stop lying on that side, the left hand will slowly start to regain warmth and color and I notice the shoulder will hurt for a few days afterward.  My fingers will also tingle but not go totally numb.  

[whisperwolf]

Yeah, he knew it was high and was only "keeping an eye on it."

Last night was really frightening....I had a headache, palpitations and chest pain, checked my BP, it was 169/104. I checked it in both arms twice and it was about the same.  I went to bed and woke up 2 hours later nauseated, chills.  Had a BM instead of vomiting. Took my BP and it was 120/94 pulse was 142. BP 4 mins later was 155/78, pulse 103. 6 mins later it was 111/79 pulse 81.

This morning I went back to the doctor and he seems to think it is all anxiety now, but is putting my on meds for hypertension.  I am already on anxiety meds(since 2005) and these symptoms started about 3 months ago. I know when I am anxious; I usually can't sleep, am restless and my mind won't shut down.  But this wakes my up from a deep sleep with the feeling like I ate something bad and afterward I am sleepy.  

I think this doctor has a horrible bedside manner and now I regret changing doctors, but at least he is listening to me.

I have never had any kidney pain, but have had abdominal pain.  

There is a family history of hypertension on both sides (mom and dad).   My mom has a recent diagnosis of angina. My grandma(carotid artery blockages), uncle(2 cardiac stents), and great grandpa(2 triple bypasses) have all had heart attacks and my grandma has had 2 strokes.  

Thanks for the advice, I will definately get a copy of the labs when I get them back.

[NTB]

hi, do you mean that your old doctor knew your BP was that high and wasn't concerned?

It's funny you mention about the infection. My own problem started with a virus, not bacteria - and I discovered I was low on magnesium, too.

Did you ever have kidney pain?

Also, if it were me, the first thing I'd look at in the CMP would be potassium (for aldosteronism), and then creatinine and BUN for kidney function. If you get copies of your test results, you can have clues as to what's going in before you visit this new (and thorough) doc,

(I assume you would have mentioned if you had a family history of bad hypertension.)

[sick and tired 47]

Great news for you- a Dr. that really cares!! Good luck to you, keep us posted on your news!

[whisperwolf]

My new doctor was concerned about my BP being so high for my age; 132/100.  I routinely see it in the 150's/100's for over a year.  I told him about my other symptoms and he is ordering CBC, TSH, B-12, CMP, Lipid, and EKG/Echo.  He said "Don't come back until you have these tests done."  

[whisperwolf]

Interesting.  Thanks so much for the information!
I will try those maneuvers next time it happens.
I will mention these symptoms when I see my doctor this week.
I have a BP monitor on order.  
I was told I have PVC's 5 years ago.
This all started after a C. Diff infection.  I was hospitalized and my electrolyte level was very low.  Do you think this could be related somehow?

[NTB]

well, it's possible that your heart isn't pumping adequately because your thyroid hormone levels dip too low overnight, and the lack of oxygen wakes you up - nausea, malaise, weakness

then your body compensates for the hypoxia with a flood of adrenalin to kick your circulatory system into high gear, including high heart rate... and then the shaking.

Maybe the adrenalin even creates a PAC which kicks off a run of PSVT, as Irish and S&T refer to. You could try maneuvers such as at:
http://www.merck.com/mmhe/sec03/ch027/ch027d.html
to break the tachycardia. If they work, that helps with diagnosis.

Greyish hands and legs might be from your body diverting blood from extremities to the brain and heart where it is needed most.

Reduced daytime heart function might explain the shortness of breath.


Or maybe it's something completely different, where asthma leads to sleep apnea which creates PSVT.


Btw, very simply stated: PSVT means the Tachycardia starts and stops suddenly (Paroxysmal), and that Supra Ventricular refers to where the electrical pulses originate (not within but above the ventricles).

One thing to note: PSVT can cause weakness, etc because of inadequate blood flow, but you get what might be hypoxia before the PSVT starts.

Those are just some ideas. Good luck and let us know how you make out :)

[whisperwolf]

No, I don't have a BP monitor, but I am getting one this week.  My Endocrinologist did a wide range of Thyroid testing to test for all sorts of thyroid diseases such as Hashimoto's, etc and they were negative.  

Thanks for the advice!

[sick and tired 47]

I agree with above post. I had exact same symptoms, which kept increasing til almost every night.  After many tests  I was diagnosed with PSVT. I too suggest seeing a cardiologist, but see a electrophysicist cardiologist who speciallizes in this area. My regular cardio did complete workup and found nothing.  
The EP cardio did event monitoring for a month and it was found. Good luck to you.. it is quite scarey feeling but with meds it will be fairly well controlled.
I am on atenolol and now am not afraid to go to sleep at night again.

[NTB]

hi, do you take your BP immediately when these episodes begin? that might give a useful clue

hopefully you're also aware of the whole controversy about hypothyroidism and what blood tests might or might not mean - e.g. how testing TSH alone might not be sufficient

[IrishMama31]

It sounds to me like you may have SVT.  I too suffer from this and have the same symptoms.  It can be quite scarey and annoying at the same time.  I have never woken up from sleep with an episode, but many people do from what I have been told.  I suggest you tell your doctor what has been happening for sure and have him/her send you to a cardiologist.  You may need meds to keep this thing under check.  I am on toprol 25mg 2x a day.  The toprol worked pretty good for me as long as I took it on time daily UNTIL I reached about 5 mths prego 6 weeks ago.  Apparently pregnancy makes whatever medical conditions you have worse =(  I get to go to a new cardiologist in the morning and boy am I scared to hear how labor and delivery could go.  Good luck, makes that appointment, and let me know what they say!!