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Date of last update: 10/20/2017.

Forum Name: Arrhythmias

Question: What can cause bradycardia, tachycardia, and PVC's?

 nurse26 - Fri Apr 17, 2009 2:59 pm

I have recently started having heart "flutters" and chest pain. I also have had anxiety attacks in the past, so I figured that it was probably stress-related. My echo was completely normal, but a holter monitor revealed PVC's, along with bradycardia at 40 bpm, and tachycardia at 119 bpm. I am a new nurse, so I know just enough that I'm scaring myself, but not enough to know what's really going on. I have woken up twice at night with my chest burning and my arms and legs tingling. I thought I was having an anxiety attack, but my pulse never increased. It actually got weaker and then normalized. I know that PVC's are normal, and I expected the tachycardia because of my stress level. But the bradycardia is throwing me off. All of my blood tests came back normal and my thyroid is normal. I do have an appointment with a cardiologist, but it takes some time to get in to see dr's as I'm sure you know, so all I'm doing now is worrying. Do you have any idea what is going on?
 John Kenyon, CNA - Fri Apr 24, 2009 12:07 pm

User avatar Hi there --

You know what they say about a little knowlege being a dangerous thing. It can also, however, be a useful thing. Sometimes it's difficult to be sure. Now, everything you've described would seem normal and stress-related except possibly the slow heart rate. What isn't clear is if this happens at specific times or just randomly. If it happens in the evening, when fatigued or sleepy or resting, or early in the AM, it could just be normal vagatonic response exaggerated slightly, especially if you are very physically fit.

There is, as you probably know, a condition, fariry rare, called sick sinus syndrome (SSS) in which heart rate alternates randomly between very slow and rather fast (and often in a-fib). While this is very unlikely and usually happens in much older people than you, since you'll be seeing a cardiolgist in a bit, it would be a good question to raise. Since you are a new nurse you are constantly learning new things and also experiencing things that are new. You might consider your cardio consult an edcuational opportunity as well as a way to likely ease your mind about what's been going on.

I very seriously doubt SSS, strongly suspect vasovagal stimulation, possibly dyasutonomia (not a serious issue but often an upsetting one), but the cardio doctor will be able to rule any of this in/out fairly easily. Meanwhile I would just take note of things, when they happen, and try to connect any dots, as much of this may be situational and not anything at all to be concerned about. Since I haven't seen an EKG of yours I wouldn't want to just cavalierly tell you "there's nothing wrong," but if I were a betting type I'd put my money on that.

I hope this is helpful. Please follow up here as needed and by all means update us after your cardiology visit. Good luck to you.

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