Innapropriate Tachycardia

[jen100480]

I am 30 years old, always been relatively healthy person. Had 3 kids and three years after the last one I didn't feel hormonally stable. I was very weepy and moody. Went to my doctor and even though I had a tubal ligation, she put me on birth control pills for the hormone. Tried two different ones before taking Yaz. It seemed to help with the mood swings and my skin cleared up. Took it for two years then decided it was time to get off, I'm not a big person for medication. I was hoping that my hormones had a chance to level out. My doctor told me to go ahead and stop taking it. About two weeks after this was my first bad episode. My hr was 150's and I felt almost fluish. Nausiated, chills, a rush sensation, maybe adrenaline,my legs feel weak after this rush,palpitations, random chest pains on both sides of my chest, I get this scared feeling too. This episode came on gradually over a week. I went to a doctor and they immediately said panic attack, then a few days later went again, then they said it was a virus. Finally wound up in the ER. They saw my hr but every test they did showed everything was normal. I have had a whole battery of tests done, EKGs, echo,stress test blood work, 24 hr urine analysis, hormone work up, cardiac enzymes. The only thing is I have a pain in my stomach with these IST episodes, which led to a hida scan and they found my gallbladder wasn't performing well so they took it out but the day of the surgery I had another episode at the hospital. They caught the IST on an EKG this time. I think it has something to do with hormones, it seems these IST episodes happen around my cycles, the week before of the week of. I cut out all caffeine and cut back on sugar and sweets. Nothing seems to help. Making sure to keep hydrated. I am hopeless, no one seems to know where this is coming from. I am a stay at home, homeschooling mom and I can't function like this. I am wearing a monitor for a month. The last talk of where to go next is a possible tumor on an adrenaline gland or in my intestines, which would require a CAT scan with contrast and maybe a EGD and colonoscopy. My cardiologist last spoke of sending me to a electrophysiologist. I am on Metoprolol 25mg a day. Are these appropriate next steps for me?

[is_something_wrong]

Hi, welcome to the heart rhythm community :)

There are no doctors here, but some of us can recognize your symptoms.

Let's just make some assumptions.

1) I assume you are in sinus tachycardia when your events occur
2) I assume this isn't a permanent condition (It appears now and then?)

You've done 24 hour urine analysis, I'm not sure what they were looking for, but they probably analyzed total catecholamines (adrenalin and similar substances). If this test was negative, and your blood pressure is normal/low, tumors on the adrenaline gland (pheocromocytoma) is really unlikely. It presents with blood pressure that can't be controlled with beta blockers alone, severely high. Anyway, do all the tests that your doctors tell you to do, but please don't worry about this.

There are some other neuroendocrine tumors that may cause problems, one is carcinoid and the other is insulinoma. The first one causes massive diarrhea after meals, along with flushing and heat waves. The other keeps your glucose levels more or less constantly low, giving symptoms like dizziness, tachycardia and anxiety. They are both extremely rare, but always good to rule out.

IST isn't an "on and off" condition. With IST, you have constantly elevated heart rate (above 100 most of the time, with mean heart rate (24 hours) above 95), and some stress will make it increase even more. The only time your heart rate dips when you have IST is during sleep. IST is not a heart disease, it's more an autonomic imbalance.

All other causes of sinus tachycardia are "appropriate", even if they don't have an explaination that's easy to understand, like exercise. We all get elevated heart rate during exercise (or at least we're supposed to get tachycardia with exercise). There are probably hundreds of conditions that causes sinus tachycardia, the most common ones are (except exercise) fever, anxiety, drugs, dehydration, blood loss, heart failure, coffee, hypoglycemia, smoking, hormone imbalances, ANS imbalances, changing body positions, etc. Like I said, there are lots of them.

If your echo and cardiac enzymes are OK, you can rule out causes like myocarditis (heart inflammation) and other cardiomyopathies (heart failure). What may be interesting, is your glucose levels during your events, and do they often occur an hour or so after eating? If they do, you may have reactive hypoglycemia (a benign condition) but this is just speculations.

I assume the events are caused by some sort of adrenaline rush, but it's not necessarily related to anxiety attacks, I believe most of us are "stamped" with that diagnosis a bit too early. Something may increase adrenaline levels. If Lorazepam helps, the anxiety diagnosis is somewhat strengthened, I think. It's completely possible that you have a minor hormone imbalance, hypoglycemia or low blood pressure, that causes some symptoms, and that you severely elevate the symptoms by being afraid of them. I do. And I really don't blame you. This is scary.

Sometimes exercise may help, if you can handle it. Ask your doctor. If you don't tolerate beta blockers, there are other medications that slow the sinus node without affecting heart contractility, that are often used with IST.

Good luck. Stay in touch with your doctors. I hope this was somewhat reassuring, at least :)

[jen100480]

Another thought, my blood pressure has always been good until taking the metoprolol it became very low. 94/56- 104/64. I was also prescribed Lorazepam but I only take it when necessary because I know it has a addictive factor. It seems to help when I have mild episodes so I can sleep at night.Otherwise I'm up for hours.