Tacky Cardigans are Spooky!

October 31, 2005 7:01 PM

Anyone ever had a tachycardia? I'm in a brunch line, not stressed, not active, just standing there talking. My heart rate shoots up. My dad, a doc, is with me. Says my pulse is 150 bpm. It gradually decreases over the next 15 minutes. The doc today says it's weird for a tachycardia to lead to a pulse shooting up so high. I'm scheduled to wear a halter monitor for a day, but outside that, he says there's not much that can be done. Why do these occur, and how do I keep them from occurring again? Also, if I have lots of stress in my life (just finished a PhD, new very high stress job), can it cause my pulse to race at a time when I am not stressed? Any stories, experiences, information is appreciated. (About me: 35, female, in good health, not overweight, yet not athletic).
posted by abbyladybug to health & fitness (25 comments total)

I was diagnosed with tachycardia. Docs don't know why. Echocardiogram didn't show anything. My heart would race during the day and make me feel anxious. Sometimes at night I'd wake up in bed suddenly with my heart racing.

The cardiologist put me on 25 mg of Atenolol morning and evening, and it took care of it. I'm now down to 12.5 mg morning and evening (which is a dose so small that they don't make a pill that size), and it is keeping it under control. When I went off it came back. Again, no real diagnosis of cause, but the meds are generic and very cheap, so I just stay on them. No harm, they're not psychoactive in any way, no bad side effects, etc.
posted by alms at 7:07 PM on October 31, 2005

I have precisely the same symptoms alms described. Suddenly my heart rate will be just through the roof. Unlike yours, abbyladybug, mine does not gradually decrease - it goes back to normal just as suddenly as it started.

My doctor sent me in for an echo, and nothing came of it - they said my heart was quite healthy. The doctor also said it happens to him and isn't too uncommon.

His advice was to cut out the caffeine and stress as best I can, but said that other than the tenseness one feels while it's happening there are no real consequences to the rapid heart rate and it's not a warning sign for some particularly bad condition or anything.
posted by mragreeable at 7:13 PM on October 31, 2005

Did they do a thyroid test? Thyroid problems (Graves disease) were the explanation for my rapid heart rate. And they can be brought on by stress, too.
posted by GaelFC at 7:18 PM on October 31, 2005

Maybe Social Anxiety Disorder? For some people, even dealing with unfamiliar waitstaff will send the heart rate right up. For some days, this is my norm. If unfamiliar situations do this to you, off to the doc for you... (It's treatable).
posted by kamikazegopher at 7:23 PM on October 31, 2005

I was diagnosed with Wolf Parkinson White Syndrome in 1989. I was 19 at the time. For about two years I had been having the same symptoms as you - standing around doing nothing when suddenly my heart would race, pulse would be up around 200, I would feel faint, then it would stop. By 1989 it wasn't stopping too easily anymore and finally one got so bad I went to the ER where my pulse was about 210. It felt like there was a person in my chest trying to kick his way out - you could literally see my shirt moving with each heart beat. That's when I got the diagnosis.

I would advise that you keep pushing your doctor and see a cardiologist, and a good one. The idea that caffeine and stress should cause this in a normal heart is suspect, based on my experience. My EKGs showed an entirely healthy heart until I was EKG'd within 10 to 30 minutes of an episode, and then it was obvious that something was wrong. Untreated, conditions such as this in the short term can cause accidents and injury due to loss of consciousness or light headedness at unfortunate times and in the long run can shorten your life span due to added stress to the heart. Additionally, the duration and intensity of attacks will get worse with age. It is not good for you and stopping caffeine or relaxing will not make it stop if you have a condition such as mine.

I ended up being a test patient for a procedure in which part of my heart was cauterized to eliminate the loop problem - a small piece of dead tissue makes the infinite circuit impossible now. This procedure is called cardiac ablation and is now relatively common and easy. I have never had a recurrence since I had the operation in 1990. Doctors tell me to consider myself cured.

I would absolutely take it seriously and as I said find a good cardiologist. It can't hurt to be looked at and then told that you don't have a condition, but if you do it is best to find out and know what to do about it and how to get it treated.

Best of luck.
posted by spicynuts at 7:46 PM on October 31, 2005

Oh and I wanted to address the 'doctor says it is common and happens to him from time to time'. I had several general practitioners pull this malarky on me. If this happens to you once, twice, a couple times over a year, ok..I'll buy that, depending upon the circumstances and the realities of your life at the time. But it was happening to me with increasing frequency and was becoming absolutely terrifying and also detrimental to my ability to work, study, hang out, whatever. There is no way I would allow any doctor to tell me that that is normal and my persistence got me a good diagnosis and a cure. I'm just saying pay attention and make your doctor pay attention as well.
posted by spicynuts at 7:51 PM on October 31, 2005

I had the exact same condition as spicynuts, from the age of 5 until 16 when they finally invented the procedure he describes. After that, no problems whatsoever. My mother was diagnosed with the same when she was 40. It is relatively common but the severity varies a lot. A good introduction is for example on this page.

I do not understand what your doc says about it being uncommon for your pulse to rise to 150bpm, mine was regularly over 200bpm and the doctors did not find that uncommon. But I second the advise of seeing a good cardiologist to determine the cause and possible treatment. It may be that beta blockers is all you need. Sometimes during the episodes, if they persist, holding your breath or downing your head in an ice bucket are handy tricks. There is quite a lot of information about this online if WPW syndrome is what you end up being diagnosed with. Good luck!
posted by keijo at 8:02 PM on October 31, 2005

Definitely get the thyroid checked ASAP. My heart would race up to 200 as well. Same thing as spicynuts - you could see my shirt shaking with each heartbeat. It would happen for no reason at all or with stress. This could have nothing to do with your issue at all, but it's such a simple test that when you get checked out, get your thyroid levels tested just to be sure.
posted by barnone at 8:02 PM on October 31, 2005

If you don't feel confident about your doctor's advice, see a 2nd doctor. I've had episodes of SVT, Supraventricular Tachycardia. It can be stress related, but for me it's mostly caused by an asthma inhaler. Changed the inhaler and rarely have SVTs since, certainly not a severe epiosde. My doctor recommended the Emergency Room when I had an attack that lasted over an hour. They did not think a heart rate in excess of 200 was okay.

For SVT, there are techniques you can learn to flip back to normal heart rhythm. One is cold water on the face, not just a splash, but a cold, wet cloth for several minutes(effective for panic attacks as well). I still carry beta blocker meds just in case. My Mom had the ablation and it was quite successful. If it became persistent, I'd have the procedure.
posted by theora55 at 8:56 PM on October 31, 2005

All the above sounds excellent, but it's also a fairly common symptom of perimenopause. Talk to your gynecologist. I have it - scared the shit out of me when it started at about age 38, but then I did a stress test & an EKG and learned that my heart was fine; it was my hormones that were being obnoxious. Unfortunately, I don't think there's anything they can do about it if that's what it is - just wait it out and know that it's okay.
posted by mygothlaundry at 8:59 PM on October 31, 2005

Throw me on the pile of people who have experienced this. In my case, sudden onset, lasting about 3-5 minutes, sudden end, maybe 2-3 times a year, for 11-12 years.

Cardiologist told me to stand on my head to get it to stop. I'll try the cold towel thing next time.

It hasn't been getting worse, so I haven't seen the need to ask about it again.
posted by trevyn at 9:42 PM on October 31, 2005

trevyn, head immersed in a bucket of ice water is much better, I've had this done to me in ER.
posted by keijo at 10:29 PM on October 31, 2005

Yup, tachycardia here. My case resulted in an Implanted Cardiac Defibrillator and I have been disabled ever since. The least stress causes my heart rate and blood pressure to go through the roof. That includes driving; in fact, a car that pulled out from a driveway in front of me led to the instance that resulted my getting the ICD.

Further, the least stress causes me chest pains severe enough that I cannot concentrate on anything else.

Unless you have low cholesterol numbers, "good health" means nothing during a debillitating episode, except that you MAY recover from the side effects quicker. As for the heart itself, well, there I could only speculate, so ask a doc. However, level of athleticism will increase collateral blood vessels into your heart, so it MAY decrease your risks, but many other factors could also be present.
posted by mischief at 10:31 PM on October 31, 2005

I'm an CVICU RN, and I urge you to see a cardiologist. Family practice docs sometimes will pooh-pooh this, but if you have WPW or underlying cardiac problems you need to know.

It's likely just paroxysmal supraventricular tachycardia (PSVT), which is usually - usually - pretty benign, but you need a cardiology workup to be on the safe side. Sustained SVT makes your heart work harder to pump blood through the body because the upper chambers (the atria) aren't filling enough before the heart contracts, and that means not enough blood to the ventricles to be pumped out to your body. If a pump, like your heart, doesn't get enough fluid in it, it doesn't pump as much out, so your body compensates accordingly and starts prioritizing the blood flow automatically to the vital organs - and as an instructor of mine used to say, the brain isn't considered a vital organ, which is why people collapse from something like this.

The other problem with tachycardias like PSVT is the concern about conversion to more serious dysrhythmias like atrial fibrillation or flutter, which can cause blood clots and stroke.

Be careful when using things like ice cold water, headstands, or a Valsalva maneuver (bearing down like you're trying to move your bowels) to lower your heart rate. Those things do work because they cause a vagal nerve response that lowers the heart rate and blood pressure, but they can also (rarely) cause them to drop precipitously low, so low you could lose consciousness for a few minutes.

On preview: mischief, your tachycardia is ventricular. The original poster's tachycardia, and others before your post, are almost certainly atrial in nature and are treated by cardioversion, an office/outpatient supervised procedure, instead of defibrillation.
posted by lambchop1 at 10:47 PM on October 31, 2005 [1 favorite has favorites]

lambchop1, mine was treatedwith defibrillation about 20 times, and I was given the ice-bucket treatment almost as many. But I'm not a doctor or nurse so sorry for suggesting anything else than seeing a cardiologist. It is just interesting to hear other people tell their experiences.
posted by keijo at 10:59 PM on October 31, 2005

"mischief: your tachycardia is ventricular"

Yup! Good catch. That's why I love you cardio nurses!
posted by mischief at 11:26 PM on October 31, 2005

Also, lambchop, you just identified and corrected a major discrepancy in my disability appeal with Social Security.

(This really is a job for a lawyer, but after this appeal my private insurer takes over the process; I get paid the same amount either way.)
posted by mischief at 11:48 PM on October 31, 2005

What does a heart workup run these days? Pretty screwed without insurance, eh?

I have had this all of my 45 years. I wouldn't call it painful. It is uncomfortable and feels like my heart is pounding out of my chest and my whole body is literally moving with my pulse. You can see my chest beating. It is alarming, but I have become accustomed to it. It is more than anything a major inconvenience when it happens.

It completely saps me of my energy and I must lay down. I feel exhausted while it is happening, but within moments of my heart returning to a normal rate I feel 100%. I usually rest a few minutes anyway for good measure. It doesn't gradually slow down. It just shifts gears completely down to a much lower rate, like from 160 down to 80 in a second. It can last a few minutes or it can go on for an hour occasionally.

When I was a kid (11 or 12) a cardiologist called this "palpitations." They got an EKG on me during one where I was clocked at 190 bpm. My EKG on paper looks a little bit different from most folks'. The doc told me at the time that this condition is not uncommon and that I have a normal life expectancy.

I still experience them a few times a year, the last time being last Monday morning when I was leaning against a tree minding my own business and my heart kicked into high gear. I wasn't doing anything strenuous at that moment, but had been staying up late for a few nights on a camping trip,which prolly was a contributing factor. It lasted about a half hour.

I can see where the head-in-the-bucket-of-water trick would work, as I have found immersing my whole body in a tub of cool water will usually return the heart rate to normal fairly quickly. Another exercise the doc told me so long ago was the trick mentioned briefly earlier in this thread about holding one's breath. I was told to take a deep breath, hold it and bear down at the same time. This has worked for me many times, but not every time.
posted by wsg at 12:28 AM on November 1, 2005

Cannabis can contribute to an increased heart rate. Not that anyone here would use that stuff. But I find this rather contrary to expectations, so thought I'd mention it.
posted by Goofyy at 4:46 AM on November 1, 2005

he original poster's tachycardia, and others before your post, are almost certainly atrial

This is a perfect example of why you NEED to see a cardiologist. Several GPs diagnosed me with SVPT...supra ventricular tachycardia. Incorrect diagnosis. It's your heart. Take the time to figure it out and insist on careful diagnosis.
posted by spicynuts at 6:03 AM on November 1, 2005

Have you looked into any alternative therapies, specifically acupuncture and chinese herbs? Acupuncture can be beneficial with few, if any, side effects. I've had personal experience with decreasing palpitations (they were much less severe than yours) using acupuncture and drinking chinese herbal formulas. It also sounds like the tachycardia is related to your high stress. Acupuncture works very well in alleviating stress. Trust me, I'm a grad student and it's helped me stay focused and calm. Anyway, it's worth giving it a shot. You've got tons of advice here and good luck!
posted by icetaco at 6:55 AM on November 1, 2005

The doc today says it's weird for a tachycardia to lead to a pulse shooting up so high.

Ri-i-i-ight. Tachy = fast, cardia = heart. Tachycardia simply means an elevated heart rate; the convention is that a rate over 100 is tachycardia. It's a physical finding, not a diagnosis. 150 is a perfectly run-of-the-mill tachycardia; above rates of about 180, the ventricle begins to start contracting before it's filled, and the stroke volume (cardiac output per beat) begins to drop. The heart can sustain electrical tachycardias of around 300 or so, but these don't move blood, rendering them quite dangerous.

And, as lambchop points out, the key here is diagnosis. Most tachycardias are benign and easily treated. A few are different and threaten your life. Any family practitioner can dismiss a tachycardia, even if it's a dangerous one; only a skilled cardiologist can properly diagnose one (and then dismiss it, if warranted.)

By the way, the idea that atrial/ventricular is synonymous for benign/dangerous is a decent first approximation, but it's not entirely correct. Either kind can kill you.
posted by ikkyu2 at 8:46 AM on November 1, 2005

Very interesting. I left this question here this morning, and I love all the answers waiting for me tonight. The one thing I can definitely rule out is social anxiety. I'm extremely social, used to perform, no stage fright, and I can talk to a wall if noone else is around. That said, I do have a very demanding job right now. It's my first real job since finishing my doctorate. I'm in a new city with crazy friving (Boston) and LOTS of responsibility. Still, at the time of the event, no stress to speak of. I've decided to decrease some of the meds I take which affect heartrate (Concerta for ADHD and Zyrtec for allergies). Hopefully less stimulants in my blood combined with more exercise and more relaxation will help. Man, it was scary though. I don't want that to happen again for sure.
posted by abbyladybug at 8:04 PM on November 1, 2005

Concerta's notorious for provoking these. Still worth getting it checked out - if it happened to me I'd want a 12-lead EKG with rhythm strip, and a 24 hour Holter monitor, interpreted by a cardiologist, as a minimum starting point.
posted by ikkyu2 at 9:18 PM on November 1, 2005

I pick up the halter monitor on Thursday, and I'm switching to the 27mg of Concerta rather than the 36mg. I think with the stress of the new job, the added adreneline seems to mean that the 36mg is a bit much. I actually felt less anxious yesterday and today without the Concerta. No way I'm going off, but I'm very happy to decrease the dosage.
posted by abbyladybug at 5:39 AM on November 2, 2005