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Forum Name: Miscellaneous Cardiology Topics

Question: fluctuating tachycardia


 greenwood - Sun Nov 02, 2008 8:47 am

Hello,
Background: I'm 31 year old female who suffers from neuropathic pain (vulvar vestibulitis) and had been taking nortriptyine (10 mg 3x daily or 30 mg once daily) for this pain. I stopped abruptly on my doctors advice, having taken my last dose on monday morning (Oct. 27).

I recently went to Urgent Care for an unrelated issue while my doctor was on holiday a couple of weeks ago. The triage nurse raised concern about my high heart rate, which was quite high on arrival, but slowed to 127 by the time they did an ECG. I was told it was still high-ish and to see about getting my thyroid tested. My blood pressure was 137/? which is VERY high for me (I am always low normal at about 102, 106ish. My highest known was 116) so it was also thought I could be nervous being at the hospital.

When my doctor got back from holiday Monday, I went in to ask about the test and he found my heart rate was 200 BPM, variable. He was very concerned. I told him I had been having bursts of palpitations and sleeplessness for months...since I started the tricyclic. He sent me across the street to an internal medicine doctor who did an ECG, which was then 137 BPM. He said my blood pressure was 50/75. I thought I mis-heard him (he has an accent) so I asked again and he repeated it again. I commented with shock on how extremely low that seems and he said it was because my heart was racing so fast. I still think I must have heard something wrong because that seems like coma state to me??? I did nearly faint on standing at the other doctors but I didn't feel particularly unwell. This doctor told me to stop taking the medicine immediately and ordered blood tests, a chest x ray and thyroid ultrasound. I have not heard any results after one work week and I assume this means all was normal. My family doctor said no news was good news.

Since stopping the medication on monday, I have been feeling very unwell...headache, body aches, nausea. I assume it is some sort of withdrawal even though my dose was so low. I'm starting to feel a bit better today. I assumed that my heart issues would stop but so far they have not. I definitely don't feel as though I'm on as much of a "high speed" as I was before and, in fact, I'm so exhausted that I can hardly function. My dishes have piled up and even running out to the store requires a long rest afterwards. I do not feel anxious or depressed, just utterly exhausted. I have noticed, also, that my heart rate changes for no particular reason. I can be watching TV and feel fine and then suddenly my heart will speed up while I'm just sitting there and then slow back down. It is not as extreme as before I stopped the medication, though. Last night I was sitting down and tested my heart rate. It was 76 bpm. Then I tried standing up just beside my chair with no extra movement and it was 110 bpm. I'm not sure if that is normal or not but it fits with the changes I feel when I bend to scratch my leg or something.

Is this something I should be concerned about? It was assumed by both doctors that, if it was not thyroid, then it would be medication related. the heart speed definitely did improve after stopping the Nortriptyline but I just feel as though something is still wrong. Is it possible that having such a fast heart rate for months could have stressed my adrenal glands or something and this is causing the exhaustion and fluctuations? Is that something that would just go away on it's own? Is it something that could/should be tested in some way?

Thanks for your time!
 John Kenyon, CNA - Thu Nov 06, 2008 10:13 pm

User avatar Hello -

First of all, you probably did misunderstand the accented doctor, since it is impossible to have a blood pressure of 50/75, since the systolic (top number) is, by definition, greater than the lower one. More likely he was saying "150/75," which would be more consistent with what you'd gotten earlier.

Now then, as to what's going on. You would seem to have had some inapproriate tachycardia (I don't believe it was supraventricular tachycardia or any other more exotic rapid tachycardia, because the EKG would have shown this), which could have been caused by the nortriptyline, which can have a variety of cardiac side-effects. Also, since you stopped the medication you've experienced a slowing to normal (and 75 at rest followed by 110 after standing is not abnormal).

Pain blocking drugs such as nortriptyline and others even of other classes can have this side effect (inappropriate tachycardia), and since it seems to have improved, maybe even normalized, since you stopped, this seems the likely culprit. You may have to try some other medications for this same purpose til you find one which doesn't disagree with you. Just because this happens with one doesn't mean it will happen with them all.

Your feeling unwell after having stopped the nortrityline is not unheard of either, especially when one's been on it for some time. It's usually best to taper off these things, but there's no harm in stopping cold (when used as a pain blocker) other than the syndrome you've described, which isn't so much dangerous as just plain annoying. You should begin to start feeling more like yourself shortly, but the original complaint will no doubt return and require some other sort of drug to manage it.

This occasional inappropriate tachycardia can also, of course, be caused by thyroid disease and/or the medications used to treat that. This also should be checked to be certain everything is in line in that respect. It is also possible, though less likely, that you're suffering a certain degree of adrenal exhaustion, which would be related to one of the other two problems (thyroid or the discontinued med), and so that, too, should soon begin to resolve.

While you should begin to feel more and more normal, please follow up with us and keep us updated. I think there is adquate reason to suspect the medication -- and its discontinuance --as the primary causes of both the inappropriate heart rate and the feelings of general unwellness.

Best of luck to you. Please stay in touch.
 greenwood - Mon Nov 10, 2008 3:48 pm

Thank you for the response. You were right, after surviving the annoying effects of withdrawal I began to feel much better. I went back to the specialist today and my blood pressure was good (I checked about the 50/75 thing from before and he told me it had been 50/40 which was exceptionally low and he was surprised I was standing at the time). I'm at a healthy 110/67 now with a slightly fast pulse but I was nervous. He told me my lingering tired feelings are from an iron deficiency and that if I take a one a day tablet I should begin to feel completely myself again.

The vestibulitis is unfortunately more of a problem than I expected. I didn't realize the Nortriptyline had actually been working but clearly it was. I won't be seeing my gyn until December 19th so I plan on doing a little research on alternatives up until that time. I have heard that topical Gabapentin has given some women relief without the side effects of the oral medication. I hope that if I go in to my appointment with some informed options to present I won't be told that I'm just going to have to live with the vestibulitis which was the thought if the tricyclics didn't work.

Anyway, thank you again for your time. It was very reassuring, when I felt so unwell, to read that the way I was feeling were not unheard of and would pass. This service is appreciated.
 John Kenyon, CNA - Mon Nov 10, 2008 11:36 pm

User avatar Hello -

I'm glad to learn the effects of withdrawal of the offending medication are starting to abate and you're feeling better already. That's very good news. I believe the (corrected) 50/40 BP was either a momentary finding or perhaps an erroneous reading. It sometimes happens. The bottom line with low blood pressure is that if it works for the subject, then it's OK, and when it's as off-base as that reading was, it's either been transient or erroneous. At any rate you're doing well in that department and that's excellent.

The potential for topical gabapentin (and quite possibly even the same or a related medication taken by mouth) is great. If topical works, all to the good. There's not necessarily ever a uniform set of side effects with these meds, and some people tolerate them internally very well, while others do experience side-effects such as you did with the nortriptyline. I'll be interested to hear how the topical application works for you.

Please do stay in touch. Wishing you the very best.
 greenwood - Fri Jul 24, 2009 11:32 am

I just wanted to follow up and let you know that I have had some great success with 4% topical Gabapentin in a lipoderm base for treatment of the V. vestibulitis. It doesn't eliminate the problem but it does greatly reduce it without side effects. I would like as many doctors to know of this as possible because it really is worth a try for those female patients suffering with Vulvodynia. My only problem that could be related to the med (but I doubt it) is that I have felt like I have a chronic UTI for the last few months but tests come out negative. I actually had a "leak" of sorts where I went to the washroom and discovered that I was completely wet with a putrid smelling urine-ish fluid. I did not feel it happen and I don't know if it came from my bladder or vagina. I don't know if this would have happened to me anyway or if it is a result of the medication getting on my urethra and irritating it somehow. I'm inclined to believe it is not related to the medication. I see my gyn in 4 months and will mention it then it if continues.
Anyway, thanks again for all your help!
 John Kenyon, CNA - Mon Jul 27, 2009 9:05 pm

User avatar Great to hear from you and really happy to have you drop us a positive update, which really could be useful to a lot of doctors (and patients, too). The apparent UTI or whatever it is could well be due to the medication, but that's just speculation on my part, considering the fact the medication does block certain nerve transmissions, mainly those of pain. It will be very interesting to find out what, if anything, that turns out to be.

Thanks for touching base with us and for sharing a potentially very valuable bit of information!
 greenwood - Mon Aug 17, 2009 6:52 pm

Sorry to carry this topic on again but it seems the inappropriate tachycardia is back or didn't actually leave. I began to feel much better after stopping the Tricyclics and so when my heart rate was deemed acceptable at a followup appointment, we assumed everything was fine.

Recently I went to Urgent Care again for an unrelated issue while my doctor was on holiday and AGAIN I was told at triage (and I was tested a second time after a couple of hours of sitting in the waiting room) that I had a high heart rate at 131 and that I should follow up with my doctor. My BP was 116/?. I hadn't noticed the speeding heart rate as I had when it was 200 bpm last time, and I didn't feel particularly ill. If they hadn't told me I would have had no idea, although it was obvious once pointed out to me. I did follow up with my doctor a couple of weeks later and on that day my heart rate was 144 bpm and my blood pressure was 110/? (I can never remember diastolic numbers!). I was sent for an ecg the next day and, although I don't know the results yet, I honestly don't feel that my heart rate was racing at all for the test. So this appears to be fluctuating. I have been on summer holidays for a month and a half and have had absolutely no stress or anxiety, so I think it is safe to rule that out.

One thing that did come back on my blood tests is low iron, although I am told that I am not anemic. I wasn't told the test result number but when I asked if I could correct it through diet she said no, they wanted me to take a multivitiman with Iron in it.\
I wonder if it is possible that low iron is causing the tachycardia even though I am not anemic? I must admit that I am losing large quantities of hair (which I've been complaining about for ages) and I get dizzy when I stand up and occasionally need to sit down again because I can't see for a few seconds. These seem to fit with anemia but I am not anemic. These symptoms are not new to me, either. All but the hair loss happen on occasion.
I was wondering what you think? Is low iron without anemia enough to cause fluctuating tachycardia? If it is not iron causing it, what else may be causing the high heart rate and can it be dangerous if it is often high (up to 200bpm resting) but is sinus tachy only?

Once again, thanks for your time!

(ps. I spent a couple of days off of Gabapentin and still had the fast heart rate so I'm hoping it isn't that).
 greenwood - Wed Aug 26, 2009 12:14 pm

If it helps, I just found out my Ferritin (sp?) level. Lab normal starts at 80 and I am at 14, so quite low. My heloglobin, however, ok.

Does this mean that the low Iron is not the likely culprit?
 John Kenyon, CNA - Fri Aug 28, 2009 8:06 pm

User avatar Ferritin levels that low could possibly be causing your problem, since ferritin is essential to good blood oxygenation; at 14 you're probably anemic, and that can in turn cause increased heart rate. It's usually a slow-onset and not as rapid a rate as you've been having, but this is as the very least worth a look, and should be treated anyway. Let us know how this plays out.
 greenwood - Tue Sep 22, 2009 6:31 pm

I have an update for you and a lot of history and questions. I hope I can make it make sense. First of all, I was put on a 48 hour holter monitor a few weeks ago and had a stress test done yesterday. I didn't get much detail about the holter readings originally but yesterday he said that my heart rate was normal during sleep (50-70) and that I had a number of episodes of tachycardia during the daytime with a maximum heart rate of 183. Most of the episodes were on the first day with the monitor. This was interesting to me but made sense because the first day was my day off. Although I had very little stress to deal with that day, I did do a lot of moving around- getting groceries, cleaning and I took a walk in the conservation area that night. The next day I was at work and was sitting down literally ALL day for a conference.
Yesterday for the stress test they did my baseline EKG and my heart rate was 120bpm at base line. I thought this was quite high for a base line considering I had not had any caffeine or even anything but water that day. The test was on a stationary bike and my heart rate got up to the target of 180-something relatively quickly. I asked him if that meant I was out of shape and he said normally it would but I wasn't even slightly short of breath or tired and my blood pressure didn't increase. That, combined with the fact that I am not a sedentary person leads him to think that maybe my size is the culprit (I am 5 feet tall and very slender). After the test he did two more EKG's. My blood pressure didn't ever go up very high to begin with but it returned to the pre-test level of 97/? very quickly. My heart rate never did go back down to 120bpm. The lowest it went was 140 before he decided to detach me from the leads. He said that most people would have returned to normal by then. I'm not sure what that is supposed to mean for me but he didn't seem overly concerned. He left it that I am going to do a 24 hour urine test to check a hormone and if it is alright than we will assume it is just because of my size. He says it fits a pattern but that the pattern is simply much higher than normal. I was fine with this thought until I realized later that any time I had my pulse taken in the past (prior to about 2 years ago) it was always in the high 70's or 80's. I had a couple of procedures in the hospital and my heart rate was taken a number of times and it was never documented above 90 (in the records I have, anyway). If it were due to my size, would it not be the case that I always had a high heart rate? Can this fast rate just develop as a new normal in my 30's?
My mom is more concerned than I am that something isn't quite right and there are two reasons for this.
1. Her father died of a sudden heart attack in his 40's while curling and it was a shock to the family because he was always so fit and active. No one in the family knows what caused the heart attack because it was in the 70's and no one asked for details on his death. He was known to have a cigarette though.
2. She says that she has seen a distinct change in me over the last year and a half to 2 years that she recognizes from when she was diagnosed with Graves Disease (she also has two siblings with thyroid disorders). She says I have only two speeds these days, high speed and off and she would swear up and down that I had a hyperactive thyroid if my test hadn't come back fine. She also had tachycardia when her thyroid was overactive and says that I have an edge of irritability that has never been in my personality before. I have always been very laid back and easy going and now I seem to be more tense and hyper, even when I was off work for summer holidays and had no stress at all. I don't notice this so much, although I can see that she may be right. When I HoHummed her about it she made it quite clear that I live with it every day and don't see the change over time but that it is there and she feels very strongly that something has slowly changed over the last two years. In terms of life changes, nothing too dramatic has happened. Two years ago is approximately when I started trying the medications for my long time enemy vestibulitis (Amitryptiline/Nortryptiline) that we thought was causing this but when I went off them and thought I returned to normal, mom says I actually didn't.

It's interesting to get another person's perspective on me. I'm not usually one for anxiety and have always been pretty easy going until now. I wouldn't rule out stress as a factor because I know it can do some crazy things but it does seem strange that the heart rate was so high when I was on holidays for two months with my biggest worry being whether or not I would go shopping that day.

Any thoughts? Should I just leave it alone if the urine test comes back fine and assume it is my size and move on? Also, if my heart rate gets up to 180 after a bit of exercise, would it still be safe for me to do more vigorous exercise? I like to hike, ride horses and snowboard. Is there an upper limit to a safe heart rate if there is no real problem? THANK YOU for all your time!

PS. I have been taking Ferritin and b12 since the blood tests so hopefully my Iron is now back up.
 greenwood - Tue Sep 22, 2009 9:37 pm

I know my post from earlier tonight is long enough but I thought I'd add my EKG results from right after the stress test. He crossed a couple of things off it so I think that not everything from the machine should be taken at face value. I didn't have a heart attack but he seemed to imply that the reading looks like I did. I don't know how to read this so I will just write down everything as I see it.

Rate 183 Supraventricular tachychycarda, rate=183.....V-rate>(220-age) or 150

PR 77 Review rhythm analysis..........significant artifact detected

QRSD 76 Leftward axis (he crossed this out).....QRS axis -15 to-30

QT 274 Q's in II, III, aVF-possibly normal for age...Male under31 or Female under 40

QTc 478 Anterior infarct (he crossed this out)..........Q waves in V2 and V3
QT interval long for rate..............QTc > 470 mS


--Axis--
P 102
QRS -18
T 74
-Abnormal ECG-

Would you be able to briefly explain what these results mean? I'm assuming it is a normal, but fast, reading and that is why it looks abnormal. Am I right?
 John Kenyon, CNA - Fri Sep 25, 2009 11:09 am

User avatar Hello again. Your newest information and results all are interesting, although they don't seem to directly answer any questions concretely, although your doctor's suspicion this could be due to your size is one of the more reasonable possible contributors.

Your mother's observations are interesting and it is useful to get an objective view of how we appear, since subjective perceptions are often extremely skewed or blunted, or as your mother points out, can sneak up on us. This includes chronic anxiety, which could not only cause your symptoms but could be caused by your symptoms. This is an infuriating feature of this sort of complaint, as anxiety affects heart rate and rhythm and vice versa, and anxiety is also frequently (and innocently) denied by the sufferer because of that subjectivity and the fact that sometimes generalized anxiety doesn't have an external cause but is more or less spontaneous -- idiopathic. So that's something to consider, even though I suspect there has been some physical, perhaps metabolic change as well. Your mother is right, again, about the appearance of Graves' disease, except for the fact there is no clinical substantiation. Nevertheless when there is a family history of thyroid disease,sometimes symptoms will show up in advance of diagnosable thyroid problems,so this is something else to file away for future reference.

As for the Holter and EKG findings, these are interesting but again don't tell us too much. The Holter tracing interpreted some episodes of SVT, but given that your resting rate has become rather accelerated anyway, it's difficult to be certain this is SVT and at least probably isn't paroxysmal, but would seem to just creep into a range rapid enough to qualify. True SVT usually comes on suddenly and goes away abruptly, and may last for very brief spells or for hours or days. You would seem to have simply shifted into a lower gear (higher, numerically -- your "engine" is running faster to achieve the same rate of work). This would definitely be suggestive of hyperthyroid, and that should be rechecked periodically.

The EKG findings that are slightly suspect are mostly centered around those errant Q waves, which many think of only in terms of old myocardial infarction (heart attack) but actually may occur as a "normal abnormality" in some people. Since yours seem to be small and not associated with other telltale changes, they probably are normal for you, and may have little or nothing to do with the tachycardia. This is why the EKG computerized notes were scratched through. A human eye reading these things is far more accurate than what possibilities the maching has programmed into it. Makes for a useful guide, but often is incorrect as in this case.

You did very well on your stress test, just took less time than some to reach your peak. Again, petite size often goes with this, as the smaller the person the more rapid the heart rate as a rule. However, since you used to have a more average rate, it would seem something changed or is changing, and since it's not reflected in heart disease findings, it is probably either emotional or metabolic, perhaps both.

Please do keep us updated regarding all this, even though you appear to have nothing serious going on. It's got to be bothersome at least, and could eventually be explained by something unrelated to the heart, something that hasn't yet fully formed, such as thyroid disease.
 greenwood - Wed Oct 28, 2009 9:48 am

Just thought I'd post to say that he's decided that it is due to my size. Just to be confident I asked why my heart rate was always normal rate when taken prior to two years ago and it has been elevated every time it has been taken since then. He said that it just coincidence of timing and that I had never had a 24 hour holter done to prove I was normal before so I was probably just caught at "normal moments before". I'm not confident about that...a lot of coincidence there to always be in the 70's and 80's and then suddenly always be in the 120's to 150's. He was in a big rush and was grumpy with grumpy people waiting in the waiting room so I didn't ask about this further. Although I don't buy that it has always been that way I do trust him that it isn't a problem.

There are just two things that I wondered and wasn't able to ask due to his mood/busy office. I wonder if you could answer them for me.

1. My heart rate takes a long time to return to normal after exercise. My stress test base line was 120 bpm and after the test I had only returned to somewhere in the 140's when he disconnected me at 5 minutes of rest. Is this common? I know I must return to "normal" eventually so I'm not particularly worried, I just wonder if it is common and why it happens.

2. Is there such thing as an unsafe upper limit? If my heart rate starts high and gets higher easily but it isn't a heart defect causing this, it is always still safe? Is 200 bpm and higher safe if you have no symptoms? When my heart was caught at 200 bpm resting by my family doctor about a year ago I had no idea it was happening. I felt fine apart from being light headed when I stood up which happens to me all the time anyway. I didn't feel ill. Does this mean that 200 bpm isn't dangerous for me because I start high anyway?

Thanks again for all your help. It's a great service you provide and we all appreciate your time on here.
 John Kenyon, CNA - Fri Oct 30, 2009 10:18 am

User avatar Hi there -- Well, it sounds as though you've gotten about as much of an answer from the current doctor as you're likely to get, and he may be right (about your size being to blame). At least partly right. It probably contributes. Also, some people are naturally sympathomimetic (the sympathetic side of the autonomic nervous system is dominant, so they run a little faster at idle) and some are naturally vagatonic (the parasympathetic system -- the vagus nerve -- rules and keeps things slower) and most of the former group are more slight of build. So this may be a big part of it. I can't help but think there may be some endocrine thing contributing as well, but that's been pretty well searched out for now.

To answer your two questions:
1) For someone who is sympathomimetic the slower cooldown/slowdown is more typical, yes. Your numbers run a bit above the norm for that, which is why I still wonder about some perhaps evolving endocrine problem (hyperthyroid, adrenal tumor, etc.) but for now we're stuck with "you just run kind of fast."

2) The higher rates, in and of themselves, are not, in an otherwise healthy person, unsafe. They don't as many people reasonably assume, cause early or additional wear and tear. Much of this is actually relative to size as well as "wiring", and many people live very long lives with oddly fast heart rates. When the rate is consistently or even frequently up in the SVT range, though, one has to wonder if there isn't something adding a little boost and, again, so far that's been a blind alley. I have known one or two people who've run rates about as fast as yours and were perfectly healthy and remain so.

The speculation about the Holter monitor results is just that, and since it can't be proven one way or the other, we have to accept the doctor's view as, well, his evidence-based view, but also your skepticism is warranted because you just don't know what you don't know. This is one of the flaws in the monitoring technique, and why I often prefer an event monitor to a Holter. However, since you don't seem to experience well defined "events" but rather just tend to run fast then faster without any significant symptoms, the event monitor probably wouldn't reveal anything new.

The two possibilties I see are either this just stays this way or resolves mysteriously as it appeared, or eventually some problem in another (probably endocrine) system finally makes itself seen and is corrected. You'd still likely run faster that a bigger, taller person, but maybe more within the range we're used to seeing. Meanwhile, whchever way it goes, it seems you're doing fine, and again, the higher rate, in itself, poses no real threat to well-being. It's just kind of odd.

Thanks for staying in touch and please continue to let us know how you're doing, especially if anything new surfaces.
 greenwood - Sat Dec 05, 2009 1:07 pm

Hi again, I hope you don't mind that I'm popping by yet again. I appreciate everything you've done to help me and others on this board. I planned on just leaving things unless another symptom came up in the future that shed some light on things but having received a copy of my records after being discharged from the internal medicine doctor I wonder about an off the wall possibility. I thought I'd get your opinion.

Every EKG I've had when my pulse was fast always says QT interval long for rate but the doctor has never commented on it, so I've been assuming it is one of those abnormal-normal instances. It is on multiple EKG's but only on the ones when my heart rate is high. On the day of my stress test my baseline heart rate was 122 bpm and my QTc was 591 with the reference range of <470. The comment says QT long for rate. The QTc immediately after the stress test, though, was only 478 which is barely over normal. It still says long for rate and my heart rate was 183 bpm. The QTc rates vary depending on my tachycardia. One time they caught my heart rate at a normal 88bpm and my QTc was 403, which shows as well within normal.

I noticed that LQTS causes and increase in heart rate and one of the listed triggors is antidepressants. All of my issues started when I began taking the Amitriptyline and then Nortriptyline for my vestibulitis. Things improved but did not go away when the medication was stopped. Is this something you consider a possibility and if so, is it worth looking into when I've already been discharged and told that it is because I am small?

Thanks again for your time,

Greenwood

PS I have seen the summary from my holter and my tachycardia was for less time then I anticipated. Of the 48 hours I only had 12 hours of tachycardia with the highest rate being 179 for 21 minutes and 30 seconds The longest run of svt was 257 beats at 158bpm. Not sure if this means anything? I also had 6 hours of Bradycardia but it was only as low as 46 and was during sleep.
 norwegian - Sun Dec 06, 2009 2:18 pm

I apologize for jumping in on a thread that is not mine, and I'm no MD.

I just wanted to comment your QTc, because I have a similar experience.
My QTc is at normal HR 400 +/- 5, but one time I was put on ECG with sinus tachycardia (due to anxiety), my QTc was almost 440. And that with a HR of 110-120.

I believe QTc is highly unreliable on high heart rates. In my opinion, you should't worry about this, as long as your QT time is normal at normal heart rates. And, LQTS will only cause problems if the QT time is actually long (due to the combination of long QT-time and bradycardia). If your QT time is normal at low heart rates, this is (again, in my opinion) completely fine.

In LQTS the T-waves will also have an abnormal size, fairly easy for a MD to recognize. If he didn't mention this, don't think about it :)

It seems most of your episodes with tachycardia is sinus tachy and not SVT. The longest SVT run was approx. 2 minutes. Your bradycardia at night is also completely normal. Mine was as low as 38 at night and my cardiologist didn't even mention it. (Of course, it caused me a great deal of anxiety, and I have a question about that pending here).

It is actually a good sign that your HR tends to drop during sleep. Your heart is strong and is actually able to keep you up and going on a low heart rate.

PS: When I have times with strong anxiety, I notice my HR increases to 120-130 by just going out of my chair, or climbing some stairs. This is not the case when I'm relaxed. I believe many of your problems are caused by high adrenaline levels (from my own experience)

Good luck, I hope you will be OK :)
 John Kenyon, CNA - Tue Dec 08, 2009 12:05 am

User avatar Hi. Don't mind at all, and especially when there is something important needs addressing. This does. And yes, any of the tricyclic antidepressants (you mentioned two you've been taking) can prolong the QT interval, and especially in people already predisposed to this. Since yours seems to be variable instead of always prolonged I suspect it to be acquired, and so probably a result of the use of the drugs for vestibulitis. I would strongly suggest use of a different class of pain blocking drug to manage this and to then have the EKG checked again, as this is not something you want going on (prolonged Q-T) whether it is genetic or acquired.

Hope this helps. Please keep us updated.

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