Slow Tachycardia?

[Samkel7y]

Hello there. This is my first venture on to this forum so please be patient with me!

I am male and 60 years old, and I must say that compared with what some people out there have to put up with my symtoms are pretty mild, but they are getting worse and beginning to get me down and I would be most grateful if anyone has any words of wisdom. Can you have Tachycardia without your heart beating too fast?!

I started with what I call my wobbly ticker about 10 years ago. The rhythm either becomes completely random or goes one, two, three... miss one... one, two, three... miss one... etc. An episode would last perhaps 30 mins and leaves me feeling pretty drained, but after an hour or two it would all be over and I'd forget about it until next time, which might be a couple of months later. There seems to be no pattern in what brings it on (activity, time of day or whatever). After a year or two of the G.P. trying different beta-blockers a cardiologist diagnosed (I think) Atrial Premature Beat and prescribed Atenolol, which seemed to be of some benefit but by no means "cured" it. I've been on them ever since, until recently.

About six months ago the episodes started to happen a lot more frequently, and the fluttering sensation which always precedes them happened more frequently still. (I'm reluctant to use the word flutter because I understand that Atrial Flutter is a separate condition, but a flutter, or "heart in the mouth", is what it feels like). I had a 24 hour (Holter?) monitor (during which, needless to say, things were better than usual!). There was one very brief "wobble", which showed up on the monitor, but the dozen or more times I pressed the button when the fluttering feeling came did not show anything unusual. That feeling is now with me almost 24/7.

The same cardiologist has now diagnosed Atrial Tachycardia and prescribed Bisoprolol, starting at 5mg and increasing by 2.5mg per month until "symptom control" is achieved. I'm now in the second month, so I'm on 7.5mg.

The thing is (and thank you for reading this far, if you have), that the syptoms are no better - worse if anything. I'm trying not to be a hypochondriac but I know that Tachycardia means rapid, and as far as I know my pulse has never been unusually fast. Irregular yes, but not what I would call palpitations. Beta blockers slow down the pulse; are mine doing more harm than good?

Thank you and best wishes,

Sam

[Kaiser78]

Tachycardia is when your heart beats over 100 beats per min, when average resting heart rates are around 70bpm, some meds can make you worse it's all trial and error!

[BobD Volunteer]

Hi Sam, Tachycardia is any rate over 80 and Bradycardia (slow heart ) is less than 60 according to my EP (Electrophysiologist.) What you describe as missed beats are what doctors know as ECTOPIC beats. Ectopic means out of place. What happens is that the ventricle contracts to pump blood before the atria has filled it so you feel the missed beat as no blood is pumped..

If you feel your pulse. Atrial Fibrillation will be an irregular erratic pulse with no pattern to it. On and ECG it is easy to see. Atrial Tachycardia is a quite different thing and you would normally have a higher heart rate well up over 100 from my own experience.

Many cardiologists mean well but they are usually only plumbers and I always say you wouldn't ask a plumber to re-wire your house so try to get to see an EP (see above). The other thing to understand is that if you do have Atrial Fibrillation then you have a five times greater chance of stroke than otherwise so need to consider anticoagulation to reduce your risk. Don't be fobbed off with aspirin as it has no place in stroke prevention as per latest guidelines.

Bob

[Samkel7y in reply to BobD]

Hello Bob and many thanks for your reply. Your analogy with plumbers and electricians has made things a lot clearer!

I see that you're a volunteer so may I ask, will the general reply I've just sent get to all the people who responded to my original post or should I reply to each one individually as I'm doing now to you?

Best wishes,

Sam

[BobD Volunteer in reply to Samkel7y]

Sam, they will all see it alongside your original post.

Bob

[fallingtopieces]

Sam, I get 'tachycardia' at 80-87 beats per minute. I know officially tachy is over 100bpm but my resting heart is is only around 59-64bpm so over 80 is fast for me. Tachycardia is a regular but fast beat.

If you find it difficult to take your own pulse (or even if you don't) and you have a smart phone, I recommend downloading a pulse reading app such as 'instant heart rate' by Azumio.

Your description of feeling flutters but nothing showing on an ecg sounds similar to the week or so after my 90 min AF episode in 2012 where I felt all 'jittery'. I knew my heart rate was regular (using that app at the time), but it did feel as though my body was quivering.

Beta blockers didn't agree with me. They gave me nightmares(a known side effect) and stopped me from doing certain things as I couldn't exert myself. I felt as though I was driving with the hand brake on.

Pat.

[Offcut]

I have many problems heart and lungs and Without my rhythm pills I stay at about 120 but with I am about 60 with the occasional burst.

The last Holter was a little weird it showed AF and a low of 39 BPM and a high of 169 BPM?

[porridgequeen]

Hi Sam.

I experience exactly what you are describing as fluttering and Fallingtopieces describes as jittery. Mine did show up on a 24 hr ECG and the EP said it was the heart slowly speeding up and just as slowly slowing down and was quite normal and happens to everyone, even those who do not have AF. He said we AFers just become more sensitive to changes in heart activity. I get it fairly regularly especially if I am tired.

Hope that helps

Angela

[Hidden]

I'd ask for a referral to an EP. I have been put on the wrong drugs by both a GP and a cardio. Clearly, your drugs aren't working, so I guess you need to find one that does. My EP put me through 4 drugs to get the one that works on me.

If you want to jump the queue, like I did because I felt rubbish, you can get a private consultation for about £150-250. Got mine in a few weeks instead of months. Same guy, then procedure done on NHS by him as well.

Koll

[Rellim296]

Hi Sam and welcome. What you are saying about your symptoms sounds vaguely familiar if I cast my mind back quite a long way. You don't mention whether you have had an echocardiogram. This might be helpful.

It sounds as if it might be time to get past the cardiologist and get referred to an EP, as Bob says, and get some treatment that improves your symptoms although you may find that medication will start to creep into your life in a slightly intrusive way. But if you've a dicky ticker you want to be in control of it and stop it doing all sorts of unwelcome things. There are hypochondriacs and then again there are ostriches ....

[jennydog]

Sam, I could have written your post about 2 years ago. I went the Atenolol to Bisoprolol route. I denied "palpitations" but found it hard to describe the onset of feeling rotten. My heart beat wasn't much faster than 80 even when I was in AF.

As AF is so intermittent a 24 hr monitor would not stand a cat in Hell's chance of picking up my AF. I was refered to an ElectroCardiologist who had me fitted with a 7 day loop monitor, essentially an ECG working all the time. This confirmed his suspicion that I was having more episodes than I realised

To cut a long story short, I had an ablation 31 days ago and I've not felt my heart since.It's the best thing I ever did. They said they were surprised at what they found, given my history. I had their report yesterday. I knew that the left atria was enlarged but the report states "seriously dilated."

Get a referal to an EP and make sure that you are on warfarin.

Good luck.

[Hidden]

Hi Sam, push for an EP visit - I booked one contrary to my cardio's advice. You're not a hypochondriac and bear in mind your partner may thinks so. I had this and when I felt better with 3 pillows in bed she thought I had lost it. I maintain unfortunately in most cases you have to push 'the white coats' very hard including making your own suggestions to get them to accept you are just not one on the production line.

Good Luck!

[Samkel7y]

Many, many thanks for all your replies. I feel I've had more understanding from you lovely people in the past 24 hours than from all the medicos I've seen over the years.

Rellim296, thanks I've had an echocardiogram and that was fine.

I've also had a few ecg's and a stress/treadmill test but, needless to say, they happened to be when my heart wasn't misbehaving.

I'll be seeing my GP next week and will be pushing for an appointment with a cardiophysiologist, and thanks for the advice.

One more question though. Who or what is anEP?

[Rellim296 in reply to Samkel7y]

Glad your electrocardiogram was OK - a lot of us have developed a slightly or moderately enlarged left atrium (or worse) as a result of heart arrhythmia and that would show up.

An EP is an electrophysiologist - the electrician of the world of cardiology. They deal with rhythm disorders. AF can strike anyone and quite a few of us have normal hearts that function OK but the timing just gets askew, either all the time or just every now and then. Actually some of us have abnormal hearts that function OK apart from mild (or indeed wild) irregularities. Hearts that have some mechanical peculiarity are the sort of challenge that cardiologists like.