Dealing with tachycardia
March 24, 2021 5:45 AM   Subscribe

How do you?

I've been experiencing episodes of tachycardia a few times a year in the last 10 years, only since a major medical trauma of a fall from height which resulted in spinal fractures that were fused, and broken foot. I'm 48 AFAB and mostly healthy otherwise.

These episodes only happen during moderate exercise. I exercise almost daily, so I can categorically say this is not due to overexertion, but rather happens during medium exertion periods. It has never happened outside of exercise.

An episode is: heartrate ~200 (as measured by strap monitor, or manually). I feel wobbly and unwell and weak but not faint. My chest feels like a bowl of worms. I'm usually not breathing hard, but can't -quite- get enough oxygen anyway.

I've learned to terminate the episodes with the valsalva, or creating pressure in my chest. That usually works. Yesterday it didn't, for a long time, like 20 min.

I also have exercise-induced asthma. Regular albuteral gives me regular and episodes of tachycardia, so I was given lev-albuterol, which usually doesn't. I think it may have for yesterday's episode.

I have two questions:

1. How long does it usually take you to recover?
Because these episodes happen during exercise, stopping for the day isn't always an option. Sometimes I have to get back to the car, for instance. The feeling-bad tends to last a while. I'm still aching in the chest today after yesterday's episode. Is this your experience?

Once, I called my doc's office the next day to ask to see them. I clearly wasn't dead. But their only answer was "go to the ER" which I didn't think I needed to, but ... ok. Then the ER held me for 36 hours, even when I insisted "only happens with exercise, not gonna happen sitting on a bed". I'm very, very hesitant to repeat that experience. I know the only answer to cardiac questions is "go to the ER" but ...

I have an appointment with cardiology in 2 weeks. I've been before, and they basically said I'm healthy.

2. How is yours treated? Any other advice for living and dealing with this? What should I ask the cardiologist? It makes me very hesitant to go work out again.
I know from previous experience that I have exercised again, but I'm feeling kind of bad today so could use some encouragement.
posted by anonymous to Health & Fitness (13 answers total) 1 user marked this as a favorite
The “bag of worms” is a classic descriptor for atrial fibrillation, which can be exercise induced and is the most common heart arrhythmia.
CDC page on A-Fib symptoms, risks and treatments
Whatever it is, a Holter Monitor may help diagnose whatever is going on — it’s a simplified EKG that you were non-stop and press a button to record when you feel symptoms.

Honestly, if it were me I would avoid vigorous exercise until the cardiologist gives the OK.
posted by shesdeadimalive at 6:26 AM on March 24 [1 favorite]

I can't answer most of the medical side of this because the details in my case were/are different, but I would second shedeadimalive's suggestion to ask about a wearable monitor. There are great wearable monitoring systems these days that they can stick to you for 14 days and get a much more complete picture of what's going on.

I have dealt with a different medical condition that had similar effects during exercise. (I had a firm diagnosis, and I did wait until getting the all clear from my doctor before doing heavy exercise again.) Mostly I was OK, but sometimes I'd end up feeling crap and need to get home with minimal exertion. The strategies I used, in order from feeling-worst to semi-functional:

-Treadmill, or other exercise equipment, and ideally something in your own home. I know being outside is way better but sometimes this is just a safer option.

-Running in circles or on tracks. I have a 1/3-mile loop that works well because there's a cut-through I can take, so if I run circles around it, I'm never further from 1/8 mile from my house.

-Similarly, when I've lived near transit, I've run along a transit line so I can hop the train/trolley/bus home if I hit a bad patch. This usually means further to travel to a stop but is still better than running the full way home. (I guess calling an Uber could also work, although I've never tried that!)

With respect to the asthma, can you also reach out to your pulmonologist and see if there are better options, like adding a maintenance inhaler (rather than only relying on a rescue inhaler)?

The other suggestion I'd make is to be really specific with your cardiologist about how this is impacting your life, and ask them specifically about how to deal with these symptoms. I find doctors often implicitly assume that your only question is "will this kill me" when what you're actually looking for is as much "how do I make living with this suck less." I think doctors often don't *get* the way things affect your life unless you make it really explicit. "This makes me scared to exercise, because [specific details]. I need strategies to deal with this." etc.

I hope they've got some good suggestions and take the effects on your life seriously!
posted by pie ninja at 6:34 AM on March 24 [3 favorites]

Has the cardiologist talked about a Holter test, which is a wearable device you use for a few days to get data from a variety of situations to work with? I did this after a brain bleed that ended up with follow-on palpitations, as a precaution, and it gave them some data. The test wasn't able to replicate my experiences of heart palpitations, so my doctor eventually gave me a prescription for beta blockers and suggested I take one if I experienced palpitations intermittently, since they were unable to replicate the palpitations. I took a few of them over a year, and eventually I stopped experiencing them.
posted by answergrape at 6:47 AM on March 24

I have chronic tachycardia. It is not related to exercising, but is a more constantly elevated heart rate.

My primary care doctor sent me to a cardiologist, where I got a echocardiogram followed by an office visit. The cardiologist concluded that this was related to another condition that I have and not dangerous, but still wanted to see me again in six months. After that next appointment we went down to annual visits. At each visit I get an echocardiogram and the consult. He is helpful and takes the condition seriously, even though he's comfortable with the fact that it's not dangerous.

There are medications for tachycardia. I take one daily, at a very low dose.

At some point a couple of years ago I had a couple of trips to the ER for things that I thought might possibly be heart attacks but were not. My cardiologist had me wear that heart monitor thing for a week or two just to see if anything was going on. That was an interesting experience and it felt good to be checking all the boxes. It turned out all was fine.

You didn't say anything about your first visit to the cardiologist and what that consisted of. Did they do an exercise stress test? An echocardiogram? An EKG? How did they conclude it was nothing to worry about? I agree with others above that the short-term wearable heart monitor could provide some info about what's happening.

Good luck with this.
posted by Winnie the Proust at 7:54 AM on March 24

Of course, check with your doctor, etc., etc.

I have SVT that my cardiologist was convinced would require ablation surgery. Tachycardia can be caused by caffeine, but most doctors say that relatively large amounts of caffeine are needed. My doctor insisted that my 1 cup of morning coffee couldn't be the cause because it wasn't enough caffeine and the episodes usually occurred in the evenings. I replaced the coffee with a cup of rooibos in the morning and the tachycardia has entirely stopped. Maybe it's unrelated, but I'll take it.

Also, I wore a heart monitor for a week to record the episodes and had other extensive testing. Please do the same to rule out any other problems.
posted by defreckled at 8:31 AM on March 24 [1 favorite]

Tachycardia is bread and butter cardiology so your cardiologist should be able to manage this without re-admitting you to a hospital. The big question will be, what kind of tachycardia are you experiencing? It can range from pretty much benign (such as inappropriate sinus tachycardia) to quite dangerous (like sustained ventricular tachycardia). A heart monitor (Holter, Zio patch, etc.) can show what type you are dealing with, and I bet that's what your cardiologist will suggest.

If you are impatient to know what's going on or want to have more data in hand to provide your cardiologist and have a little money/FSA funds to burn, you could consider ordering the AliveCor KardiaMobile EKG tester, which allows you to easily measure your heart's electrical output yourself when things seem to be going haywire. (Available through their website or Amazon for about $89/$150 depending on which model you get.) When I was experiencing tachycardia I found it reassuring and helpful to be able to share the EKG tracings from my incidents of tachycardia with my cardiologist. It's a neat gadget. Some exercise watches are also able to detect certain arrhythmias.

I hope your cardiologist is able to help you get to the bottom of this and that whatever is going on proves easy to manage.
posted by reren at 9:05 AM on March 24

Oh, and I realized I didn't answer your two direct questions:

1. How long does it usually take you to recover?
My tachycardia is pretty much constant, though mild. Lengths of bouts of tachycardia can last just seconds sometimes, too.

2. How is yours treated?
Medication. Initially, a beta blocker, now a calcium channel blocker.

I would recommend reading up on the different types of tachycardia. This will help inform your conversation with your cardiologist.
posted by reren at 9:11 AM on March 24

If you have SVT, it's not uncommon. I had it for years, and finally had a long episode, went to the ER, and they caught it on the monitor. I ended up getting a full cardiac workup. I was given a beta-blocker prescription, but have not taken it, generally, as it it mildly sedating. I was offered ablation, but I dislike then idea, and heave learned to manage things.

Stay hydrated; if you are a bit dehydrated, it can affect your body's electrical system.
Ease up on caffeine. Do not take stimulants, like most ADHD meds, some asthma meds, some recreational drugs.
Manage stress as well as you can. When I wore a Holter monitor, it showed how stressful meeting with my boss was, and I got out of there, though it wasn't pretty.
A very cold cold, very wet washcloth on the face stimulates the Diving Reflex, and the physiological effects can revert your heart rhythm.
There are a number of heart rate apps for phones; mine uses the flash/light to measure my pulse, and I can use it to breathe calmly, kind of like biofeedback.
If it happens while driving, pull over.
posted by theora55 at 10:10 AM on March 24

My husband had a weird episode of tachycardia which turned out to be atrial fibrillation. No identifiable trigger - it just happened. He and I were pretty unsettled about it and went to an ER where they tried to convert his rhythm to sinus (normal electrical heart conduction) with medication. 10 hours later he was still in afib and they decided to cardiovert him, basically shock with paddles. The electrical dose used is lower than when shocking an unresponsive person but still not fun. They did give him some sedation first. Cardioversion worked, and he hasn't experienced another episode in over a decade.

The cardiologist told him that being in afib for more than 24 hours is grounds to begin anticoagulation with warfarin, as clots can form in the heart if the rhythm isn't regular and blood remains in the chambers. It's not just the rate, it's also that the heart muscle needs enough time to fill the chambers and the electrical coordination to squeeze out the contents. This is the lub-dub of a heartbeat as the heart's chambers fill and empty in coordination. I'm glad you're pursuing information on what is really going on. Also important is that going forward you will have answers to what the rhythm is and effective ways to deal with it.

If your tachycardia is reliably caused by exercise, I think an exercise stress test on a monitor is something a cardiologist might order. Holter continuous monitoring is also likely. There are a variety of tachycardia rhythms (sinus tach, afib, atrial flutter, etc.) and each has a preferred treatment. Capturing this on a monitor will give critical information to the cardiologist. Best of luck to you and please update us on your progress!
posted by citygirl at 10:11 AM on March 24 [1 favorite]

I get near-tachycardia sometimes when I eat carbs. Usually I avoid carbs, so if I eat dried banana chips or something sweet, my heart pounds even at rest and much more with exercise. To your question, I’d consider diet - could diet, specifically carbs, be a factor?

For me, it lasts three or four hours for my heart to settle down.

To the worry - it is scary. You are doing well to take care of yourself. If you exercise before you see your cardiologist, please go with a friend, in cell range and not too far from a road - just in case. Prepare your notes about patterns about what you do before it happens.

A stress test is maybe warranted. Maybe do the pattern activity before you have one so you can get it to recur in the lab. Even if it doesn’t, they can probably find something.

Unfortunately, it’s well documented that doctors pay less attention to and don’t listen well to middle-aged women. Be your own advocate and speak up. If they can’t find something at rest, make sure they measure your heart under stress.

Bring a friend for moral support, if you can. Confederates can sometimes advocate with the nursing staff in ways that can help. And they can help you remember what happened and what was said.

You got this!
posted by rw at 10:34 AM on March 24

You may have Postural Orthostatic Tachycardia Syndrome (POTS). It’s usually evaluated by a cardiologist. Though not all cardios are familiar with it.
posted by Crystalinne at 12:20 PM on March 24

I have a form of tachycardia and asthma. My form of tachycardia isn't necessarily dangerous, but becomes dangerous with asthma medication in that my heart rate becomes to fast for my body to get oxygen to where it needs to go. It presents similarly to asthma in that I feel like I can't breathe, but it's medication induced so obviously this was a big problem.

Any time your heartrate is getting high enough that you feel wobby and can't get enough oxygen that is definately a reason to get checked out, even at an ER. I'd hold off on triggering events if at all possible until that appointment.

I think repeating what you said here in the way you said it would be good for any cardiologist. It ticks lots of boxes for the things that are heart arrhythmias is very clear and concise ways. If it's reliably and easily triggered make sure you tell them that, and ask if they could give to the chance to do so.

Because asthma medications are contraindicated with beta blockers I ended up on Ivabradine to help control my heart rate instead of the normal stuff they percribe which slows down my overall heart rate. But before I was just always tachycardic. Your arrhythmia is not my arrhythmia. Anyway, because my heart rate was high without any stressors, and they wanted to get my baseline down so when I added asthma medicines I wasn't getting into danger.

I bought a kardia two lead ekg from like best buy, and while it wasn't helpful because my tachycardia is just a fast heart rate the data it provided was useful to me. It was less than $100 and gave me something to look at and data points for my physician. If you can afford to do so and don't want to wait, just grab one.
posted by AlexiaSky at 8:52 PM on March 24 [1 favorite]

My spouse has SVT, and has used the REVERT variation of the Valsalva manuever to get back to a regular pulse. Having a second person to help with legs makes it easier, and it shifts quickly. It can be tiring, so they take it easy for the next day. If it doesn’t resolve we seek medical attention, though that hasn’t happened much at all since we figured out how to do it. It’s random, though, not predictable.
posted by childofTethys at 1:26 PM on March 25

« Older Dealing with other people’s children   |   Running a Python Script every week on a remote... Newer »

You are not logged in, either login or create an account to post comments