"So just be cautious, and just dont accept a diagnosis of anxiety. Drugs to treat anxiety come with their own nasty problems."
This my friends is good advice.. Some anxiety drugs, benzodiazepines in particular carry a risk of status epilepticus and death if stopped too quickly after long term use.
As for the limitations of a 24 hour monitor it is unfortunate.. They do offer alternatives though.
My favorite are the 2 week holters, cardiokey being the brand name,that sticks out to me, but im sure every company has its own variant of it.
My least favorite are 30 dsy event monitors because they require the patient to actually push a button when they have symptoms... If you fail to push the button within 10 seconds of feeling crappy you risk not capturing the arrhythmia.
"Normally they hook me into a monitor and it slowly starts to come back down."
I noticed,this was mentioned in the comment above. While supraventricular tachycardias "take off" suddenly, they subside just as quickly. When you drop out of svt, heartrates can elevated a bit above normal for a few minutes and gradually return to normal resting rate. You didnt mention how fast, and that is an extremely important item to note. If you're experiencing near daily symptoms, a Holter monitor might be an aid in diagnosing what you're feeling. But I've seen plenty of people on the forum who are prescribed a 24hr. monitor, have no recorded events that day, and who then have their possible legitimate cardiac issue passed off as anxiety, only because the physician saw nothing on the monitor except a normal heart rhythm and waveform. So just be cautious, and just dont accept a diagnosis of anxiety. Drugs to treat anxiety come with their own nasty problems. Once you start them, halting treatment is typically a long, difficult, process.
Got some more time to explain my logic here.. If we break down the history i think this is a simple one... At least compared to 7 ablations guy, or the dude with a typically compelling sick sinus argument in his 20's.. Theres some real interesting ones that pop up here... Fortunately for op i dont think this is one of such cases.
"When I get kind of tired, my heart beats really hard once or twice and then my HR takes off like a rocket."
With regards to this bit of the history. This fits the ectopic description like a glove, its basically textbook. You get tired, heart rate slows down, 'un-suppresses' the ectopy... You get a pvc.. Compensatory pause ensues.. Combination of normal tachycardic response and anxiety sustains atrial tachycardia.. Visit the ED, rate tapers down.
"Normally they hook me into a monitor and it slowly starts to come back down."
This is a key point, reentry terminates abruptly. Atrial tachycardia will terminate more gradually.
In any case the answer ultimately comes from an ambulatory monitor of some sort, such as a holter. Only way to definitively answer these types of questions is to witness the episode evolve.
How often does this occur? Daily, weekly, etc.
Do these events exhibit the same symptoms?
How does a typical event end?
Have you ever tried to palpate your pulse say in your neck or wrist and count the beats?
Probably pvc's, try asking for a referral for a holter.