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- Wed Aug 20, 2003 5:43 pm
19 y/o male, overweight but active. Non-smoker, no alcohol. Total cholesterol 130. No family history of heart problems. About 10 months ago I started to have bursts of tachycardia. These occured while I was resting or doing some non-strenuous walking (shopping, for example). I would notice my heartrate pick up quickly, peaking at 130 - 150 bpm for 20-45 seconds. I had a stress test, blood workup, EKG, and holter. I also cut back on caffeine. Stress, blood labs, and EKGs came back normal. My doc did mention that she suspected WPW at first due to something she saw on the EKG - I can't remember if it was the QT interval or the ?RS interval being borderline long. The holter captured several episodes and they were all normal, 1:1 sinus tach. For the first 2 1/2 mos I had frequent episodes - in December they were just about every day - sometimes two in one day. No shortness of breath, chest pain, etc. though I did sometimes feel mildly lightheaded. I think that may have simply been from the anxiety. The episodes severely decreased in frequency and I have been down to one every 2-3 mos. for several mos. now. I do get the occasional palpitation, probably 2 or 3 per week. I saw a second cardiologist and he did an echo and a tilt. The echo was normal but I failed the tilt. He diagnosed vasovagal pre-syncope as I never had any fainting spells. I can and do exercise and have never had any associated discomfort or problems.
My questions are:
1. Could the vasovagal pre-syncope explain the tachycardia? I
saw the second doctor about the tachycardia and I felt like he never really adressed the issue beyond the echo.
2. Given the normal baseline EKGs and stress test, does this sound like it is probably a benign and rather boring arrythmia, or is there something you know of that may present these symptoms and is difficult to diagnose?
3. Should I seek a third opinion as I was not very satisfied with
the second? Should I inquire about an EP study?
4. I have read about SVT and PSVT. Would those be apparent in the episodes captured by the holter? Could the holter results distinguish between atrial tachyarrhythmias and AV tachyarrhythmias?
5. Could a history of tachycardia 'episodes' indicate a predisposition to future problems like afib etc. and does it increase my risk of other health problems IE sudden arrest, blood clots etc...
| Dr. Yasser Mokhtar
- Thu Aug 21, 2003 9:14 pm
Thank you very much for using our website.
You sound like you read a lot of cardiology in the last few months.
Palpitations are sometimes difficult to deal with because they may be caused by either normal rhythms that you just feel (and normally you should not feel your heart beating) or by abnormal rhythms that are sometimes difficult to catch especially if they are paroxysmal (come in attacks) as in your case.
i assume from what you told me that the blood work that was done for you contained all the things that are usually ordered in these circumstances such as electrolytes, calcium level, phosphorus level, magnesium level and thyroid function tests.
If any of these were not done, please, ask your doctor to order them for you. In addition please check a complete blood count.
In addition, i am not sure about your blood pressure during these episodes and whether it is normal or not. Because if it was higher than normal, you should be investigated for a condition called pheochromocytoma which causes bouts of hypertension and tachycardia.
You did well by cutting down on your caffeine and i hope that by saying cutting down you mean completely stopping.
If the holter showed sinus tachycardia, this is normal rhythm but at a faster than normal rate which is not easy to deal with because usually it can not be given anti-arrhythmic medications like the other rhythms.
Regarding svt/psvt, the holter should be able to pick it up but sometimes it is not that easy. A regular ecg would be better if possible because it shows more leads and the recording is usually of better quality although of very short duration in comparison to the holter.
About the vasovagal presyncope, it is not related to the tachycardia because this type of syncope is a cardioinhibitory, vasodepressor syncope which means that the person who suffers from this type of syncope will pass out because his/her heart rate will be low and the person will develop hypotension (low blood pressure). And it sounds from what you said that the cardiologist did not give any medication to take for it.
Regarding the future probability that you might develop atrial fibrillation or not or have an increased chance of sudden death, i can not answer that question because i really do not know what type of arrhythmia you have and whether it is related to other cardiac disease or it is just an idiopathic arrhythmia. Although the echo being normal ruled out lots of organic cardiac causes of arrhythmias such valvular diseases.
If you are really worried about this arrhythmias, like you said you can be asked to see a specialist in eps and seek his opinion regarding whether or not it would be valuable and worth your while to go through an ep study.
Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped and please keep me posted and if you still need any clarification or more questions answered, do not hesitate to post them immediately.
Yasser Mokhtar, M.D.