Puzzling Tachycardia

[Ruza2020]

Hi Everybody,

I hope someone in this lovely community will be able to help me understand my puzzling tachycardia. Just to give you some background.

I have been diagnosed with paroxysmal AFIB little over five years ago. I have been on Amiodarone (100 mg) for the past four years. Amiodarone helps, but I still get Afib episodes at least two times a month. My current question is as follows:

About four to five months ago I developed a new heart condition (this is in addition to my Afib).

My heart rate is around 57 beats per minute when I am resting. During sleep it goes as low as 48 b/m. However, as soon as I start to walk (within 5 to 10 Seconds) the heart rate jumps immediately to between 105 and 120 beats per minutes. This surge of immediate high heart beat causes dizziness, headache, major pressure in my head (it feels as if my had will explode). I feel weak and my brain shots down (unable to think). However, if I stop walking (still standing though) the heart rate drops within seconds.

If I ignore the tachycardia and push myself to do what I started (let's say making a meal that takes 5 to 10 minutes) at that point the only thing will help if I lie down. But, in this case lying down will not help my other symptoms (such as headache and a horrible pressure in my head) for about an hour or so.

I discussed this problem with my Cardiologist and my Electrophysiologist. Neither of them were able to figure out the cause of this new heart condition.

Does anyone have any idea what is going on?

Thank you kindly.

[mjames1]

Sorry what's going on. Have they considered POTS? If you google "self test for POTS" you can get a start, but your doctors should at least be considering the diagnosis based on the symptoms you describe.

I would also think they would want to do a HOLTER to capture these episodes as well as full bloodwork, including electrolytes. From those results, an updated echo might be in order and/or an exercise stress test. Medications should always be looked at, especially the Amiodarone in your case.

I just wouldn't sit back here. It sounds like this is significantly affecting the quality of your life. Keep at your doctors to find a cause and if feasible seek more professional opinions. Needless to say, we're not doctors, nor can we run tests, or know your full history, so can only make educated guesses here. Hope you get to the bottom of this and feel better soon.

Jim

[Ruza2020 in reply to mjames1]

Thank you mjames1. I did look into POTS. In some aspects it does resemble POTS, but it does not make sense that the heart rate goes to normal even though I am standing as long I am not moving. And yes, I wore HOLTER for two weeks. I sent it back three weeks ago - I have not heard from my cardeologist yet regarding the results.

[CDreamer in reply to Ruza2020]

POTS is only one disorder of the Autonomic Nervous System (ANS). Unfortunately there are very, very few specialists in this area but there are a few in cardiology. Not sure where in the world you live but suggest you research Dysautonomia and maybe in particular

“Afferent baroreflex failure which is characterized by unpredictable hypertensive crises, extremely labile hypertension, symptomatic hypotensive episodes, and orthostatic hypotension. This constellation of abnormalities makes baroreflex failure arguably the most challenging hypertensive or autonomic disorder to manage.”

Dysautonmia Center

Just a suggestion for you to explore, one of the symptoms is headaches.

In the UK Dr Boon Lin is considered by the Arrythmia Alliance to be one of the leading researchers in the field and there is some info on the AA - STARS website but it doesn’t have anything on Afferent baroreflex hypertension.

I had problems with ANS dysfunction some years ago so did a lot of research. I coudn’t get any help from cardiology or EP. Thankfully most of my difficulties were addressed by default with medication for an anutoimmune condition I didn’t associate with my ANS reacation so was quite co-incidental + pacemaker for AF.

PS - Has anyone suggested you have a head MRI? That was the first thing my neurologist suggested to rule out other serious possibilities.

[Ruza2020 in reply to CDreamer]

Thank you CDreamer. I will definitely look into Dysautonomia. I live in Canada - It might be challenging to find a right doctor for this condition here. My EP is sending me for a stress test to see if anything abnormal will show up. I am also having another Echocardiogram in few weeks.

[Bowcat]

Hi, I too am having the same problem. I've been having these dizzy pre fainting spells for over a year now and I've been to see my GP a number of times over that period but they don't seem to know what's causing it. I have since seen a Therapist in Pulmonary Rehab clinic and I had 3 episodes whilst I was there, it was nice the fact that it happened whilst someone could witness it. She said that she would write to my Dr to tell them that it needs investigating. I've just had a blood test at Dr's and all has come back normal so yet to find out what happens next but it is effecting my quality of life! 🤔

[Ruza2020 in reply to Bowcat]

So frustrating, right? Good luck, and all the best in finding a cause and proper treatments for your condition.

[Bowcat in reply to Ruza2020]

Thank you, yes it sure is. Wish you all the best too x

[Alphakiwi]

Similar problem to me. I had an echocardiogram done 3 years ago and it revealed i have a very enlarged Left Atrium 73mm/ m2.This I believe is part of the reason my woes so maybe check this out. I have a pacemaker to keep my hr from going to low at night etc but also in preparation for AV node ablation ( ablation not done just yet. All the best Colin

[Ruza2020 in reply to Alphakiwi]

Oh my goodness. AV ablation - why? Apparently removing AV Node should not be taken lightly - unless it is absolutely necessary.

[Alphakiwi in reply to Ruza2020]

Thankyou Ruza for your reply and concern. Yes i do understand the implifications. At 82 years of age how long do i want to live a life of misery is what it comes down to. This drug alternative is terrible to which you might day i am totally dependent on and they dont so far give a lot of relief and oh the side affects!. Im being tried on another one just this week but i think im scraping the bottom of the barrell. If node ablation will let me go on reasonable group walks and get back to riding my bike just a little and no side effects and no thumps and palpitations and fatigue etc etc then i will go for it. Its 5 plus years it started gradually worsening. Sorry to be such a misery today its been a rough night and thanks to all on here who have had this journey also and understand. Colin in NZ

[Ppiman]

The key thing your cardiologist would surely have determined is that these are all atrial in origin, which means they arise from mis-conduction in the part of the heart from which AF also arises. These atrial arrhythmias are said to be mostly benign, with mostly only AF needing anticoagulant treatment.

The problem with them is that they feel anything but benign, as we both find. I have them increasingly, with last night being perhaps the worst yet. I do also get AF but much less often (maybe monthly or a bit more often this year - again, much than least year). The bisoprolol I am taking (2.5mg / day, recently upped from 1.25mg) doesn't seem to be doing much at all except slowing my heart and dropping my BP.

I have been told that flecainide is the next step after an MRI which I await (anti-arrhythmic drugs like that need to be given on an otherwise "healthy" heart as they can bring on worse arrhythmias occasionally, I gather). I wonder why this hasn;t been suggested to you? I have also been told I will need an ablation for the AF as well as the ectopic beats. Again, I wonder why this hasn't been suggested?

In my own case, I find the anxiety this all brings in its wake (such as the feeling that this just can't be right and even that you might keel over at some point...) is a hard thing to deal with and quantify and separating the physical from the psychological is nigh on impossible for me to do.

Steve