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Forum Name: Cardiology Symptoms

Question: 2 months irregular heartbeat/fainting


 cat512 - Fri Mar 14, 2008 7:01 am

I am 37 yrs. old, female and have had an irregular heartbeat for a couple of months now, non stop. I have had an irregular beat here and there over the years. About 2 yrs. ago, I fainted 2 separate times under the exact same circumstances. Both times, it was 4:30 a.m., and was awakened by my sick child yelling for me to come to his room, about 3-4 minutes after being with them, got very nauseous, lightheaded, sweaty, and fainted. I did go to a cardiologist, had EKG, Ultrasound on heart, table tilt test, stress test, even had a test at a neurologists office to check for seizures, all came back negative or showing that nothing was wrong. I did let them know that I have irregular heartbeats from time to time. Last week, I was returning from Jamaica and took 100mg of dramamine, because the ride to the airport was 1 1/2 hrs. of curvy, bumpy roads and I get motion sickness. In the airport, as I was sitting down waiting in a restaurant for food to come, I felt a little dizzy and a little queasy, put my head down on the table, and next thing I know, my husband is holding me up after catching me from fainting while sitting. So, I have 2 questions, one is how normal is it to have an irregular heartbeat for 2 months, and the other is, should I have avoided the dramamine while having an irregular heartbeat? I read (after the fact) that dramamine can cause hypotension and also palpitations, dizziness...but have taken it before w/no problems. Could my already irregular heartbeat which has been ongoing, mixed w/the dramamine have caused the fainting episode? I do have an appt. scheduled at the cardiologists, but can't get in for another 2 1/2 weeks, should I get in there quicker?? Thank you.
 Dr. A. Madia - Fri Mar 14, 2008 11:49 am

User avatar Hi,

Dramamine containes Dimenhydrinate, a combination molecule of diphenehydramine and theophylline. Theophylline is a molecule known for its propensity to cause fast heart rate [tachycardia] and irregular heart rate [ premature atrial and ventricular beats]. If you are already sufferring from irregular heart beat, Dramamine can definitely worsen the situation.

The circumstances of your earlier two faintings like waking up in the night due to child's crying, which is naturally associated with anxiety,[sympathetic overactivation and arrhythmia] plus nausea, perspiration and passing out- prabably point to a serious ventricular arrhythmia leading to what is called Stokes Adams episode meaning fainting due to lack of blood supply to the brain resulting from ineffective heart pumping resulting from irregular and abnormal heart rhythm. In majority of instances such heart rhythm spontaneously recovers in a minute or two and one wakes up from the faint.

An extensive cardiological work up is called for in such cases. Your EKG, Echo, Tilt Table and stress have been normal as you say. Even then you must get in touch with your cardiologist as soon as possible. If she thinks fit, she might advise you to go for these tests again and in addition she may ask for some electrophysiologic testing too.

Meanwhile stay calm , don't panic, avoid all undue exertion, avoid situations that might provoke anxiety or severe stress.

All the best and I am sure you will be fine.


Apurva
 cat512 - Fri Mar 14, 2008 11:59 am

Thank you Dr. Madia, I appreciate it. I think I'll try and get my appt. moved up somehow. I have been exercising, I do the ellliptical machine 5 days a week, for 30 minutes at a time, should I stop that until I get evaluated? Also, I should have clarified what I meant by an irregular beat, my heart doesn't race...it is kind of like 2 regular beats, then 1 "heavy" or "hard" beat. And it was doing this when I last fainted in the airport, but not racing.
Thank you again.
 Dr. A. Madia - Sat Mar 15, 2008 12:39 am

User avatar Hi,

You may continue any exercise that you are habituated to!

Apurva
 cat512 - Thu Apr 24, 2008 8:15 am

Hi again,
I have another question- I returned to the cardiologist for my Holter results. It found that I have PAC's and PVC's and one instance of sinus tachycardia. My question is (I forgot to ask the cardiologist, and am changing doc's actually) when I was having the extra beats, is it normal to have them continuously for 3 months straight or not? They never stopped, it was a continuous thing, then one day, it ended. He tended to think I was anxious about fainting, but I'm not- if it happens, it happens, I'm not an anxious person. He said he wasn't concerned w/the PAC's/PVC's, but that the holter monitor showed my average heart beat per minute was 90 and he wanted to treat that w/a beta blocker. But 90 is not my resting heart bpm- that is around 70. I've checked it many many times at home, and if I'm up and cleaning, or doing things w/the kids it is 90ish, but lower when sitting and relaxing. I don't think I need to be on a beta blocker for that- he didn't ask me what I normally do at home during the day, he just wrote me a prescription for Sectral, and said to take it and see how it works. Well, I don't think it needs to be treated...and w/his seeming lack of interest in my 'case', I'm moving on to another cardiologist. But, my main question is- were my 3 months of irregular heart beats o.k. or should he have taken that more seriously?
Thank you so much for your help.
 John Kenyon, CNA - Sun May 18, 2008 1:23 pm

User avatar Hello cat512: While I have been away from the forum for a while, I'm back now, and getting back into the swing of things. I came upon your series of questions to doctor Madia, and while we wait for his next reply, I'd like to make a few observations, having read the whole thread.

First, the problem seems to have begun back with that (rather large) dose of Dramamine. While the ongoing problems may not be related to that anymore, they can often be triggered by something like that and then become self-perpetuating for a while. The dose of Dramamine (the original formula, apparently) was roughly twice the recommended maximum dose, so that, along with the stresses of traveling, could have triggered both your original heartbeat irregularities and even your syncopal episode. The fact that they continued on long after you'd taken that single large dose, however, suggests that was just a "gateway" experience and sometimes once the heart becomes irritable (for whatever reason) the premature beats can sometimes can trigger a startle reflex even in a person not generally considered to be an "anxious person."

It is "normal" for a given individula to experience a short or prolonged period of premature beats and if nothing else is found along with that, it is usually written off to anxiety, although it can occur without anxiety being predominate or even present. It is just a "crankiness" or irritablity of the heart muscle. Caffeine can certainly contribute, various non-anxiety-producing stresses, disrupted sleep cycle, etc. Many fairly innocent things can set this off.

It also usually goes away as abruptly as it begins, again often without any obvious reason.

Usually when a syncopal episode (simple faint) occurs it is due to a reflex action and is most often benign, but does warrant a workup. You've had one. The doctor found your resting pulse to be 90, and you state your normal pulse is 70. You know this because you check it frequently. This indicates a certain concern that the heart is operating in a "normal" fashion, and could betray a denied or unaware state of anxiety. Giving that the benefit of the doubt, our heart rates still do vary considerably during the course of the day, and running between 70 and 90 is hardly unusual. The addition of a beta blocker based on a one-time finding of resting rate of 90, especially if you are petite, seems to be a bit of overkill. Also, among the many beta blockers available, Sectral is less popular and less well tolerated by most people. It was originally marketed because it was thought to have a specific action against PVCs, which is now known to be less-than-unique to this drug. It also has instrinsic sympathomimetic action (ISA) which means it doesn't slow the heart rate as much as all the other, more popular beta blockers. While I am not a doctor, I do have a very deep experience in this area, and feel the prescription of Sectral to lean slightly toward "overkill." You, of course, as the patient, have the right to decline any medication, and I think this moderate change in resting rate wouldn't normally elicit this sort of response from a doctor. If your rate were consistently above 100 and caused you marked discomfort, one of the more common and less unusual beta blockers (such as long-acting metaprolol, starting with a low dose) would seem to be the most likely therapy. You don't, however, sound like you need to be on drug therapy for this "problem."

You might want to keep track of any future episodes of lightheadedness or frank syncope, though, and if this should occur you ought to report it to your doctor for further evaluation. It seems it was just an isolated incident, which is not uncommon.

I think it is opportune that you are changing cardiologists, and you might want to hold off on the Sectral til you've seen the new doctor. While the heart rate and irregularity issues sound very innocent, they may as well be mentioned to the new doctor in the context of the syncopal episode, and the fact that the "old" doctor wanted to prescribe Sectral even though he felt your problem was essentially anxiety-related. We'll assume, based on your own testimony, that that is an inaccurate finding as well, although we can sometimes fool ourselves pretty thoroughly where that is concerned.

At any rate, all you've described so far sounds pretty "normal" for an otherwise healthy young person.

Good luck to you, and do stay in touch.
 cat512 - Sun May 18, 2008 2:21 pm

Thank you so much for your help and information Mr. Kenyon. I appreciate the lengthy response.

I did go to my 2nd opinion/consultation w/a great cardiologist. He really took time to listen to everything, asked numerous questions, and spent at least 30 minutes reviewing everything and trying to figure out what is actually causing my heart to beat irregularly. He pretty much said what you were saying about the Sectral. He did not know why my previous cardiologist would prescribe that particular beta blocker...and also, he didn't think I needed to be on one at all. He did say that if and when my heart beats irregularly again, to come in and they'll hook me up to an "event" monitor, and I'll wear it for 30 days to try and see what triggers my heart to beat like it does. Throughout my entire life, for as long as I can remember, every once in a while, I've had an irregular beat, but lasting only a minute or less each time. It was just that this particular time, for 3 months continually, then the fainting episode...I felt it somehow had to be related..but like you were saying, my cardiologist said it very well could have been drug related, due to the dramamine. So, on top of the already irregular beating heart, and the effect of the dramamine (can cause palpitations and lower your blood pressure), it could have caused it to happen. I feel good w/that, because I haven't fainted often, and that would explain that episode. So... we left it at I have episodes of PAC's...due to something, trying to find that 'something' is where we are. He said it was more of an annoyance/nuisance for me to deal with it, but essentially harmless. As long as it's not life threatening, I'm o.k. with that.

I do have a question on caffeine though...I've tried to lessen what I drink (which I don't think was much in the first place- 2 cups of coffee in the morning, then maybe a glass of sweet tea, possibly 2 during the day). What is considered a lot of caffeine?? Or, does it affect people differently? Could that be a high amount for me, enough to make my heart beat higher throughout the day, or enough to cause a palpitation here and there?

Thank you again for all of your help!
Cat512
 John Kenyon, CNA - Thu May 29, 2008 11:07 am

User avatar Hi cat512 -

It's sounding like you've got a handle on this situation now, especially with the new cardiologist, who seems to be much more in touch with things. I think the Dramamine explanation works thus far, and of course if the problem starts up again on its own, a Holter monitor or event monitor (the latter is preferable for a number of reasons) would be a reasonable measure for sure.

There is one other possible cause which slipped my mind earlier, and which I haven't found mentioned elsewhere in this thread, which could have caused the sudden misbehavior: a low serum potassium level. This is not at all uncommon, especially among people who are traveling by air as you were. It can be due to simple dehydration, which is extremely common on airplanes in part due to the artificially controlled climate in the cabin and partly due to the failure to eat normally and regularly. Some people also, for various medical reasons (and quite often for no discernable reason), can lose potassium. Since Potassium is one of the electrolytes most essential to the proper function of muscles (and the heart is pretty much all muscle), a lower-than-normal level can often trigger premature beats and other random arrhythmias (sinus tachycardia, suprventricular tachycardia, etc.). Should the problem recur, if possible you ought to have blood drawn to see if this is a contributing factor. If it is, it's usually fairly easy to manage with proper diet and hydration or, in those occasional cases where there is a medical cause for it (or no discernable cause -- "idiopathic") there are long-acting supplements that can be taken to compensate. It can make a really big difference.

This latter is an often overlooked cause of some episodes of sporadic "crazy" heart behavior in otherwise healthy individuals. It's entirely possible this was covered during your workup, but at that time you weren't in the middle of an episode, so testing for potassium could come up perfectly normal. It's worth keeping in mind for sure.

As for the caffeine question, unfortunately the answer is "It depends." Everyone seems to be somewhat different where this is concerned, and although caffeine is a stimulant, it may sometimes get a bad rap. You don't seem to be overdoing, but it may be that you tolerate it a little less well than some. It's been my experience and observation that even within individuals tolerance for caffeine may depend upon a lot of things. For instance, if you've been sleep deprived and/or stressed over a day or two, you might be a lot less tolerant of it than if you were well rested and relaxed. There are some people who actually drink coffee or tea just before they go to bed, and sleep fine that way. It's not something I would recommend by any stretch, but if someone's been doing that for years and it works for them, it's certainly not wrong. If you have an uptick in perceived premature beats you might, at that time, try cutting your morning coffee from two cups to one or leaving out the tea in the evening (or,of course, both) just to see if it makes a difference. If not, by all means don't deprive yourself.

Hopefully this is all moot and whatever caused the first go-round will wind up just being "one of those things."

Best of luck to you and please do stay in touch.

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