So I am a 23 year old medical student. For the past 4 months ive been experiencing random episodes of sinus tach as well as several panic attacks. Now the reason i differentiate between the 2 is because the latter seems to be preceded by cognitions (fear), sensations, and what you might call "cues" that trigger anxiety attacks. The former seems to come out of the blue, sometimes waking me up. Ive checked my pulse during these episodes on a pulse oximeter and it can get as high as 190bpm for very short periods of time, then gradually slowing back to NSR (does respond to valsalva and like maneauvers).
Ive had several resting ECGs following these incidents which are unremarkable. Ive had an unremarkable stress echocardiogram (54% EF incr. to 68% upon exertion) with no exercise-induced dysrhythmia, dyspnea or chest pain. Ive had a normal 24-hr Holter study with 0 PVCs and PACs. My TSH level is normal, as are my basic electrolytes + magnesium (immediately following episodes). 24-hour urinary metanephrine study unremarkable. Chest x-ray normal.
My blood pressure is normal in/around 120/70 at rest. During episodes it can be as high as 160/100 for very brief periods, usually normalizing within an hour after acute on-set. My resting heart rate varies wildly im guessing because i am 23, but usually 60s-80s depending on time of day. Like i stated during the episodes, my HR can push 180 for very short period esp. If im paying attention to my pulse. Also, i am constantly aware of my heart beat following these episodes and during high anxiety days (bounding carotid pulse, can also see in the mirror) though BP seems normal. I am currently seeing Dr. Mohammed Khan, a CC-trained EP at Alexian Brothers Medical Center.
My event monitor captured one of these episodes. Sinus tachycardia btw. 170-110. This was just one episode, though.
My major fear is that there is something other than anxiety, as i didnt think your own catecholamines could cause such a high HR, brief as it may be. Also wondering if prior to event monitoring i could be experiencing some SVT runs, although ive been told SVT wouldnt gradually dissipate back to NSR, but would come on very quickly and terminate very quickly. The in and out sensation of being aware of my heart beat has also caused me to become neurotic about sudden cardiac death. Should i be concerned about this? I am adopted so I have no family history.
Am i missing something? Anything? Or could this really be just harmless panic attacks?