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Help for Tachycardia

I have a history of high blood pressure, have been on Atenolol 25 mg split 12.5mg AM/12.5mg PM for @ 12 years.  

Last year went to ER in hypertensive crisis - BP was 226/127, and was "off" (high off and on) for about 6 mos, then finally got that stabilized.

August of 2015 I had an episode of tachycardia that scared me as I hadn't had it before, and my heart rate soared quickly.  Went to ER and they monitored me for about an hour and told me was normal sinus rhythm.  

Doc put me on a 24Hr holter, which picked up 3 short-run SVTs, sinus bradycardia (44 lowest), Bi-focal PVCs with VE trigeminy, Infrequent PACs, and 1st Degree AV Block.

I don't know what any of that means, but I was told that I was in sinus rhythm the whole time and "not to worry" about it.

My heart rate tends to be very erratic - up and down with the slightest movement, told that's "just me".  I was also on a 30-Day Event Monitor, and unfortunately, never had an episode of tachy during the 30 days,

Then this week, had another incident of tachy out of the blue - went to ER again, to try and capture the rhythm - normal sinus rhythm.  They gave me Ativan 1mg by IV (told them I didn't want it, they told me it would "help my heart".  Sent me home after an hour.  BP was high but came down within the hour.

No tachy the day after, then a worse episode the following day.  Again went to ER as I couldn't get it to stop, same deal, but no Ativan.

My cardiologist sent me to an electrophysiologist yesterday.  Mixed feelings about the visit.  I told him I wanted to know what kind of tachy I have, and he told me there really wasn't a good way to diagnose it (?) and that I had been in sinus rhythm on all my tests, and have had a stress test, so he's reassured that I don't have afib or ventricular tach.  

Originally told to take another 12.5 Atenolol when it happens,, but then saw how low my BP and heart rate is - 80s over 60s and heart rate often in the 40s (even during the day), so told me the "only solution" and it may not help is to go on an SSRI (Wellbutrin).

I read about this drug.  Do not want to be on it.  Lots of side effects.  He told me that even if they were able to find out what this is, since I am already on a BB, this is what the next thing would be they prescribe, that they would not prescribe an anti-arrhythmic or do ablation.

I don't know enough about this stuff to know if I am making a big deal out of this.  Should I just forget about it and deal with the tachy events as they happen, hoping my HR comes down?

The other thing he told me was to "not go to ER" as "they can't do anything for you" which I found odd.  Is there not a certain HR or a certain duration where it makes sense to go to ER?  Even my cardiologist told me if my HR was 120 for over 20 min to go to ER.  And the paperwork they gave me at ER said if the tachy lasts for more than 20 min and is 120+ to come back.

Really confused....  I have read that although SVTs (if that's all this is) are not "dangerous" per se like afib or ventricular tach, they cause "wear and tear" on the heart.

Is this just what life is going to be like from now on - dealing with these tachy events as they come, hoping my HR comes down on it's own?
1 Responses
1807132 tn?1318743597
I think a lot depends on the doctor.  A rate of 120 isn't super high.  A person will go that high or even higher just walking around.  If you know you were in the er when you felt yourself with the tachycardia then that means the type of tachycardia you are having is likely normal sinus tachycardia and not the concerning type like afib or vt.  But sinus tachycardia is harder to treat and most often caused by something outside the heart.  Can I ask  if you are on a water pill?  If you are on a water pill that could be dehydrating you causing you to get a bit of sinus tachycardia.  If you do not think your worst tachycardia has been captured on a monitor, this happens often, then you just need to keep an eye on things and try again when it gets more active but it can be hard to catch.  

How old are you?  What sort of heart tests have you had?  Have you had an echo or mri?  Has your carotid artery in your neck ever been checked?  My mother can have dangerous spikes in her blood pressure like you and she just found out she has a 70% blockage in her right neck artery so you might want to ask that it be checked.  She had hers initially checked in the cardiologists office it was a simple noninvasive test but it did leave her a bit dizzy.
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1807132 tn?1318743597
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