Practical types of tachycardia

Officially, there are several ways to classify tachycardia. None of them seem to have implications for what I can do about it. Some months ago someone here suggested I write something, so here goes.

I am currently AF symptom free, with only Warfarin as a daily medication. I have been prescribed the full Pill in the Pocket, consisting of Flecainide (to control the rhythm) + Bisoprolol (to control the rate). I have taken both these meds in the past, even before I had AF.

To me, there are three kinds of tachycardia that I can experience.

1. Classical. It starts suddenly, and finishes suddenly. It can last 2-40 minutes. It can happen any time especially ie both after exercise, or when relaxing. If I act fast enough I can sometimes stop it by using the holding my breath and pressing down of the diaphragm. The beat is totally regular, and often has a distinctive sound like two tin lids banging together (I have a metallic mitral valve). It is usually around 140bpm.

2. Overworked. There are usually warning signs – spells of high irregularity. The heartbeat starts demanding to be noticed, like a diesel engine being pushed in high gear going uphill. Often comes when I have been thinking about something that makes me nervous. Often comes when relaxing. The rate is usually lower than the Classical form. It is thuddyer, around 120 and does not have the metallic sound. The end is usually gradual, as the irregularities kick in and fight back: it is like the pleasant feeling of the lightness felt when sailing when hitting a bump. Near the end these bumps increase, building up anticipation, and the relief when lower rate is achieved.

3. Relaxing after exercise. After a time of work, brisk walking, maybe getting too tired, I get home, shower and eat, and notice that the heart rate has simply not returned to the resting 80, and persists at 90-100 even an hour or more after it should have gone down.

In the pre-AF days, I was aware of types 1 and 3, and would have usually ignored them. My cardiologist told me to see him only if I had three events of type 1 in a week. For that he prescribed Flecainide for a few months at a time, and told me I could come off it in the holidays. Nowadays I try to be proactive, because it was an unstoppable tachycardia that started my AF.

So. What do I do?

Type 1. Stop. Try breathing manoeuvres. Take a rest if possible. If no joy in 20-30 minutes, crunch and swallow some flecainide.

Type 2. Ditto. Consider taking Flecainide before the tachycardia starts.

Type 3. Take action fast: some bisoprolol. If I am wrong, I have done no harm. The heart is needing some help to get back to resting state.

Some of this may be counter-intuitive. I reason this way. Some amount of irregularity is helpful and normal. When it gets too much, the heart rate increases, since this has the effect of dampening/eliminating irregularity. Therefore, the treatment is an antiarrhythmic, which tackles the cause.

So now you have my personal practical classification, with clear treatment of the probable cause.

2 Replies

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  • I can identify with your three types of tachycardia, but also have two further types than you have mentioned when my heart goes really fast. Will give some thought to posting here again later.

    Its interesting that you crunch your Flecainide tablets. Were you advised to do this and does it mean the Flec gets into your system quicker?

    Jean

  • Please do reply. I am interested. There is a need to talk about the tachycardias from the point of view of the patient + what we can do.

    Crunching. I generally find swallowing tablets difficult. So I often work out if the tablet is crunchable. Usually if you can break it in half it is crunchable. My reasoning is that powdered tablet is more likely to get into the system quickly. The down side is that some of the powder might get stuck in the throat, and so cause irritation, and not be absorbed. So a drink helps. This probably needs a separate thread. Anyway, I await your next post with interest.

    Ivan

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