Aa
My fast sinus rhythm baffles everyone... any ideas?
I have been experiencing an occasional fast sinus rhythm for over a decade, if not for my entire life (I am 36). I have always been kind of hyper and excitable, so I don't know which is causing which (or if they're even related). I have seen countless cardiologists who acknowledge that my heart rate does increase at times, but they all say my heart rhythm is "normal."
So one of two things happen to me: 1) It starts racing out of the blue. (Although I'm pretty sure it's not SVT, as it's more of a gradual increase and decrease). Oddly this happens most often during sleep, and always wakes me up. It can beat anywhere from 100-160 bpm. 2) It gets "stuck" at a higher resting rate in the 80s/90s for hours. (And lately the only thing that helps me to bring this down is drinking ice water). My normal resting rate on 37.5mg of metoprolol is in the 50s/60s so I'm not sure what it is off of the drug as I've been taking it for 3 years. Triggers that bring this on are alcohol, heat/humidity, high altitude, eating a rich filling meal, over-exerting myself, rushing around, blow-drying my hair (as odd as that seems), getting over-excited, cooking/baking, being on my phone...
My latest cardiologist offered: anxiety (which of course I don't completely buy, because what do any of those triggers have to do with anxiety?). But he has also suggested a mild form of dysautonomia or an extra wonky sinus node as possibilities, but he's reluctant to do an electrophysiology exam for now.
Does anyone else experience these symptoms along with these triggers? Have you ever been diagnosed with anything? What do you take to help you?
So one of two things happen to me: 1) It starts racing out of the blue. (Although I'm pretty sure it's not SVT, as it's more of a gradual increase and decrease). Oddly this happens most often during sleep, and always wakes me up. It can beat anywhere from 100-160 bpm. 2) It gets "stuck" at a higher resting rate in the 80s/90s for hours. (And lately the only thing that helps me to bring this down is drinking ice water). My normal resting rate on 37.5mg of metoprolol is in the 50s/60s so I'm not sure what it is off of the drug as I've been taking it for 3 years. Triggers that bring this on are alcohol, heat/humidity, high altitude, eating a rich filling meal, over-exerting myself, rushing around, blow-drying my hair (as odd as that seems), getting over-excited, cooking/baking, being on my phone...
My latest cardiologist offered: anxiety (which of course I don't completely buy, because what do any of those triggers have to do with anxiety?). But he has also suggested a mild form of dysautonomia or an extra wonky sinus node as possibilities, but he's reluctant to do an electrophysiology exam for now.
Does anyone else experience these symptoms along with these triggers? Have you ever been diagnosed with anything? What do you take to help you?
Yes, I have had episodes of this on and off over the decades. I also know that my father has it. When my father first had it, he was hospitalized and then later diagnosed with allergies, as the tachycardia seemed to have been triggered by food.
When these episodes started happening to me, it was quite terrifying. At first it was put down to 'panic attacks.' The episodes seem to happen once every five years, where I become to susceptible to having them for a couple of months, then they subside. Over time I came to realize that indeed the tachycardia is related to digestive trouble. I have had situations where the tachycardia wakes me up, suddenly starts to race into the 170+ rate, causing great distress, and then if I manage to use the toilet 'successfully,' the entire thing suddenly disappears, within a few seconds of a bowel movement.
I recently discovered that in German literature, this is called Roemheld syndrome. https://en.wikipedia.org/wiki/Roemheld_syndrome
Apparently there is quite a bit of German medical literature (I am told), but somehow has not made into mainstream Western knowledge. One could speculate that a Central European heritage might be something to do with it, I suppose.
Simply understanding that the problem is gastric has helped considerably. When the attacks happen, I just walk around and try to settle my stomach, without worrying that I am about to die. Sometimes there is no abdominal pain at all, no obvious signs of digestive disorder, but then I will discover that I had been harbouring some kind of blockage, eaten too much onion and beer, or something like that.
When these episodes started happening to me, it was quite terrifying. At first it was put down to 'panic attacks.' The episodes seem to happen once every five years, where I become to susceptible to having them for a couple of months, then they subside. Over time I came to realize that indeed the tachycardia is related to digestive trouble. I have had situations where the tachycardia wakes me up, suddenly starts to race into the 170+ rate, causing great distress, and then if I manage to use the toilet 'successfully,' the entire thing suddenly disappears, within a few seconds of a bowel movement.
I recently discovered that in German literature, this is called Roemheld syndrome. https://en.wikipedia.org/wiki/Roemheld_syndrome
Apparently there is quite a bit of German medical literature (I am told), but somehow has not made into mainstream Western knowledge. One could speculate that a Central European heritage might be something to do with it, I suppose.
Simply understanding that the problem is gastric has helped considerably. When the attacks happen, I just walk around and try to settle my stomach, without worrying that I am about to die. Sometimes there is no abdominal pain at all, no obvious signs of digestive disorder, but then I will discover that I had been harbouring some kind of blockage, eaten too much onion and beer, or something like that.
6 Comments
Wow. This is really fascinating. Thanks for sharing.
I don't know if this explains all of my symptoms, but it certainly sheds light on a few things: For one, I also often find relief of symptoms after using the bathroom, which I've always thought was odd. And certainly eating is a trigger for me, no doubt. If I eat a large meal, forget it. Alcohol is a HUGE precipitator for me. I pretty much can't really drink anymore.
I have been suspecting my vagus nerve as a potential culprit for a little while now, that it's being stimulated in some way. I can see digestion being one way. In certain situations, I also have a vasovagal reaction, although I experienced that more as a child than I do as an adult.
Yeah, no doctor I have ever been to, and I've been to plenty, has ever offered something interesting like this to me. It's almost always "it's probably anxiety, see a therapist" (which I've been doing, by the way, for 10 years, and it has not done anything for my tachycardia). Only since I've been in my mid-thirties have I been more assertive with doctors, and am finally starting to get them to offer some deeper suggestions, like dysautonomia or allergies.
It's great you've gotten to a point where you can manage the reaction without feeling like you're going to die. That's huge. No matter what causes my palpitations, if I could just get to that point myself, I'd feel like I was 75% of the way to feeling better.
I don't know if this explains all of my symptoms, but it certainly sheds light on a few things: For one, I also often find relief of symptoms after using the bathroom, which I've always thought was odd. And certainly eating is a trigger for me, no doubt. If I eat a large meal, forget it. Alcohol is a HUGE precipitator for me. I pretty much can't really drink anymore.
I have been suspecting my vagus nerve as a potential culprit for a little while now, that it's being stimulated in some way. I can see digestion being one way. In certain situations, I also have a vasovagal reaction, although I experienced that more as a child than I do as an adult.
Yeah, no doctor I have ever been to, and I've been to plenty, has ever offered something interesting like this to me. It's almost always "it's probably anxiety, see a therapist" (which I've been doing, by the way, for 10 years, and it has not done anything for my tachycardia). Only since I've been in my mid-thirties have I been more assertive with doctors, and am finally starting to get them to offer some deeper suggestions, like dysautonomia or allergies.
It's great you've gotten to a point where you can manage the reaction without feeling like you're going to die. That's huge. No matter what causes my palpitations, if I could just get to that point myself, I'd feel like I was 75% of the way to feeling better.
@rainbowbrite9
I do like a drink and I do know that alcohol exacerbates the problem (actually alcohol withdrawal of any kind, eg: hangover, causes elevated pulse), but not nearly as much as certain alcoholic drinks like beer, which cause gas and bloating. The underlying problem is certainly nervous, in my opinion. Some signaling mechanism is off.
Diet, illness, excess eating/drinking, time of eating, lack of movement, bad posture (too much sitting) all seem to play an accumulative role. I was getting tachycardia on an off in relation to food frequently for a few weeks just recently. Terrifying experiences nonetheless but as you know, the fear is manageable for me now. I managed to stop it dead in its tracks. How? I packed some luggage on my MTB and went cycling for 4 days through reasonable terrain across the country for about 400km. Today? 15bpm lower pulse, lost 2kg, no tachycardia at all. Plus, posture improved a bit, eating more like an athlete would eat, more regularly, smaller portions.
I do like a drink and I do know that alcohol exacerbates the problem (actually alcohol withdrawal of any kind, eg: hangover, causes elevated pulse), but not nearly as much as certain alcoholic drinks like beer, which cause gas and bloating. The underlying problem is certainly nervous, in my opinion. Some signaling mechanism is off.
Diet, illness, excess eating/drinking, time of eating, lack of movement, bad posture (too much sitting) all seem to play an accumulative role. I was getting tachycardia on an off in relation to food frequently for a few weeks just recently. Terrifying experiences nonetheless but as you know, the fear is manageable for me now. I managed to stop it dead in its tracks. How? I packed some luggage on my MTB and went cycling for 4 days through reasonable terrain across the country for about 400km. Today? 15bpm lower pulse, lost 2kg, no tachycardia at all. Plus, posture improved a bit, eating more like an athlete would eat, more regularly, smaller portions.
@rainbowbrite9
I forgot to mention, this once happened to me when I turned my neck too sharply suddenly. I was in tachycardia for quite a while. Doctor did some tests and said I have very sensitive nerves (did EKG while pressing carotid artery and other pressure points) and advised against anything that might overstimulate them. He even told me never to wear a tie, and if so, loosely.
I forgot to mention, this once happened to me when I turned my neck too sharply suddenly. I was in tachycardia for quite a while. Doctor did some tests and said I have very sensitive nerves (did EKG while pressing carotid artery and other pressure points) and advised against anything that might overstimulate them. He even told me never to wear a tie, and if so, loosely.
Wow, bodies are something, aren't they? I was just talking to my partner about this last night. You look around, you watch TV, and you just assume everyone is normal and you're the only one with these weird issues. So much of this is probably so "normal" but we don't perceive it to be that way. I think exercise is probably the best "medicine" for some of this stuff. I've been too afraid to do serious exercise because of my heart issues, but I had a stress test yesterday and the cardiologist pushed my heart to 188 and said I had excellent exercise intolerance. lol. I've also had symptoms like you said when turning my body quickly. I guess some of us are just more "sensitive" than others.
@rainbowbrite9 Yes, agreed on all points. I think that, unfortunately, many of the 'normal' people we around us are victims of a medical system that tends towards pharmaceuticals too often. Many are regular consumers of beta-blockers and whatnot. I would say that if the doctors can rule out any actual deficiencies in the heart or circulation, then this nervous reaction to position and food is probably largely harmless and the real issue is self-management when it does happen. My personal feeling is that when these episodes occur, it is a sign that something is causing my 'system' to get more sensitive, and it might be an indication that it is time to pause, look at oneself holistically and decide if some stressor needs to be mitigated. In my recent case a nasty seasonal flu played a role, for example. Another observation I just spotted is that your HR when doing intense exercise was 188, and I am sure if an army commander was pushing you to the limits, it would have been higher. I have a wristwatch HR monitor, and when I exercise I track my HR. I compare my HR with my friends, and I can safely say that at least within my community an HR of circa 190 is considered very high. Now the interesting thing is that I also can get up to HR circa 200 when really maxing things out on my MTB. And the Garmin Connect database says I have VOMax in top 5% globally. My last bout of gas-related tachycardia was giving me an HR of about 130 while just sitting around (though it did not elevate under exercise). It feels scary sitting with my heart racing, but is 130 all that high for people like us? Isn't this really about managing the fear, and staying fit enough that 130-150 HR doesn't really matter, especially knowing its temporary?
I do however wish that this issue was more widely recognized, so that there was enough of a corporate interest to investigate which anatomical or biological defect was causing some nerve to signal so strongly. On the other hand having a serious cause behind having to manage diet, having to manage posture, and having to stay fit could be a blessing in disguise. Food for thought I suppose.
I do however wish that this issue was more widely recognized, so that there was enough of a corporate interest to investigate which anatomical or biological defect was causing some nerve to signal so strongly. On the other hand having a serious cause behind having to manage diet, having to manage posture, and having to stay fit could be a blessing in disguise. Food for thought I suppose.
This is such a healthy way to look at it. I really appreciate you sharing all of this with me! And I agree that I wish it was more widely recognized. I am sure some day it will be...
I was recently diagnosed with POTS in February. I also used to wake up with tachycardia. I've had heart rates in the upper 170s when it's at it's absolute worst. I used to take metoprolol but it stopped working after I started having POTS symptoms in December of last year. I've started taking Coreg, and it has helped some - I still get tachycardia, however, but not as much. I also have many of the same triggers you have: eating, heat, and exercise.
I'm not a medical professional - but your heart rate could go up while blow drying your hair if you have POTS because your arms are raised above your head. The heat from the dryer could also be a trigger.
Try to find a doctor knowledgeable about POTS/dysautonomia (at the very least do your own research) because I was also told it was anxiety in the past (before my official diagnosis). I have my good days and bad days, but as of now, I use Coreg and Osteopathic Manipulative Therapy for treatment. I have high blood pressure instead of the usual low blood pressure associated with POTS.
P.S. We are also looking into whether I have Mast Cell Activation Syndrome (a known cause of POTS)
Hope this helps!
I'm not a medical professional - but your heart rate could go up while blow drying your hair if you have POTS because your arms are raised above your head. The heat from the dryer could also be a trigger.
Try to find a doctor knowledgeable about POTS/dysautonomia (at the very least do your own research) because I was also told it was anxiety in the past (before my official diagnosis). I have my good days and bad days, but as of now, I use Coreg and Osteopathic Manipulative Therapy for treatment. I have high blood pressure instead of the usual low blood pressure associated with POTS.
P.S. We are also looking into whether I have Mast Cell Activation Syndrome (a known cause of POTS)
Hope this helps!
5 Comments
Wow. Thank you so much for taking the time to comment. This is extremely helpful and kind of wild... I actually *just* learned about Mast Cell Activation Syndrome a few days ago and want to get tested for that as I've had chronic urticaria (hives) since around the time I started having heart symptoms (17-ish years ago). I've taken Zyrtec every day for the hives since then, and not surprisingly doctors aren't generally interested in it since it's well managed by the Zyrtec. I also always thought POTS was associated with a low BP, but after realizing how high my BP gets after standing, I just today, before reading your response, found that some people can have POTS the way you describe it - I believe it's called hyperadrenergic POTS. Have you by any chance heard of a drug called Ivabradine (brand name Corlanor)? Also, what kind of doctor are you seeing? A cardiologist? Neurologist? GP?
Hi, I'm happy my comment helped! I have heard of Ivabradine, but I don't know much about it, unfortunately. As far as current doctors, I see almost everyone in the book: cardiologist, rheumatologist, gastroenterologist, dermatologist, neurologist, and an allergist. I guess the main doctors that I deal with in my case are the allergist and cardiologist, however, I have a few new patient appointments coming up so that may change soon.
I have a question for you... Do you notice you have a lot of muscle spasms? That is a newer symptom that I am dealing with, that's why I'm going to the neurologist.
I have a question for you... Do you notice you have a lot of muscle spasms? That is a newer symptom that I am dealing with, that's why I'm going to the neurologist.
I've actually been having a twitch in my ear for about a week now. Ha. But otherwise, I do sometimes experience shakiness or tremors or muscle spasms (I think these terms are so subjective, so I'm not sure what to call it), during or especially after an episode. I usually just ascribe it to extra adrenaline in my system, but I have no clue. About ten years ago I had two really bizarre episodes of complete body shaking, and I did go to a neurologist to get tested for seizures. I actually forgot about that. Apparently everything was ok and they haven't happened since, thank god.
As for the Ivabradine, maybe you want to check that out. My doc gave it to me but I'm afraid to try it before I rule a few other things out. I just don't want to be on a drug unless I absolutely have to be. But I have read a lot of articles that it helps people with dysautonomia with cardiac symptoms, but I'm trying to remember if it was more for Inappropriate Sinus Tachycardia or if it was also being used for POTS.
As for the Ivabradine, maybe you want to check that out. My doc gave it to me but I'm afraid to try it before I rule a few other things out. I just don't want to be on a drug unless I absolutely have to be. But I have read a lot of articles that it helps people with dysautonomia with cardiac symptoms, but I'm trying to remember if it was more for Inappropriate Sinus Tachycardia or if it was also being used for POTS.
Yeah, I just started seeing a new cardiologist. He didn't want to touch my current regiment of Coreg yet, but he said next time we meet we could discuss tweaking it... I'll ask him about Ivabradine and see what he thinks.
I've been taking the Ivabradine for 5 days now, and it's definitely lowered my heart rate a little!
Have an Answer?
You are reading content posted in the Heart Rhythm Community
Are there grounds to recommend coffee consumption? Recent studies perk interest.
Salt in food can hurt your heart.
Get answers to your top questions about this common — but scary — symptom
How to know when chest pain may be a sign of something else
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
