Random Tachycardia

[NotAllWhoWonder]

Hi Hearties!

I had 4 MIs in 2018 at the age of 38. My LAD was stented (99% blockage), I was given a boatload of meds, and sent on my way. In the years that followed, I have had countless trips back to the A&E, with the primary symptom being tachycardia, dizziness/light-headedness, and occasionally chest discomfort (never angina). More concerning would be the complete opposite, where bradycardia would kick in and my HR would drop to 40 - while I was driving, etc.

A switched on GP saw that something clearly wasn’t right last year, so referred me to the chest pain clinic - I waited months for my appointment letter, only to find out that they had decided I didn’t need to the appointment so had cancelled it. My GP kicked-off and got me a referral to a wonderful cardiologist in Epsom. He immediately took me off the Bisoprolol, and put me onto Isoder. Also referred me for another angiogram, which found that OM-1 was > 50% blocked. Stented again, and sent on my way last September.

The tachycardia has returned, however, and I’ve had another 3 episodes that had me back in A&E (2 where I had to get an ambulance out), and another 2 without since my second stent. This past week I had 3 of those 5: Monday was an ambulance trip, Friday I managed to get through it after doing vagal exercises (coughing hard, bearing down, dunking my head in cold water) and taking the Bisoprolol the hospital gave me on Monday when I was discharged, and then I possibly had another yesterday but I popped a Bisoprolol as soon as I started feeling “weird” again. Symptoms subsided quite soon after.

So, what happens? I’ll be sat at home working, or watching telly - basically anything that isn’t very exciting, and I’ll suddenly feel a bit strange. Almost like a cold sensation in my head that goes down the back of my neck like a tingling. Without warning, my heart rate will shoot up from around 70bpm to 150bpm - and only drop slightly to 140bpm at times. I’ll check my BP and it will be spiked. I’ll start feeling a bit unsteady, and feel a bit light-headed. My mouth will go a bit dry, and breathing will be a bit laboured. The palpitations will be insane by this point, my heart pounding like crazy. This will last for around 1.5 to 2 hours in extreme cases - I’m usually already at the A&E by this point. I only ever ring the ambulance if I’ve started panicking and feeling really unwell. I usually get quite scared because I’m home alone if it happens during the week (I’m a remote worker in IT) but try and hold off calling 999 for as long as possible in case it passes, but mainly because I feel like I’m wasting everyone’s time - they could be saving someone else’s life. I’m between a rock and a hard place because of my cardiac history, though, and paramedics and A&E staff always reassure me that I’m doing the right thing by getting help .

The outcome is always the same, though: ECG doesn’t show anything untoward, troponin is low (except for Monday where it was slightly higher from the first reading to the next, so they kept me overnight in case). Apple Watch ECG which I take as soon as it starts up shows a sinus rhythm. So, I’m discharged again, without any answers.

TL;DR: I have random tachycardia episodes but no idea why. Has anyone else experienced this and how did you resolve it permanently?

[Tos92]

Hi NotAllWhoWonder

I’m sorry to hear about your 4 heart attacks, and then your 2 stents on top of that. I can’t imagine it’s been an easy journey for you.

In terms of the tachycardia, I went through similar episodes of this during Summer 2022. I always knew when an episode was coming which always took me over 160bpm on resting or whilst sleeping. Unlike yourself, my symptoms were cold sweats, especially in the night, and an almost constriction/squeezing pain in the middle of my chest. After a while, these symptoms eased on their own and a cause was never found.

Upon attending A&E, due to the episode being so quick and isolated whilst at home, by the time I reached the hospital, the episodes resolved themselves and I always produce a normal ECG like yourself.

I do have a congenital heart defect which causes coronary spasms. I usually put my symptoms down to this when the cardiologists say they can’t find anything.

I hope someone can come along with a more thorough insight into your symptoms and tachycardia.

All the best.

Tos

[NotAllWhoWonder in reply to Tos92]

Thank you! Sonor showed that my heart was fine, with no scarring or lasting damage from the MIs, and no heart disease. My aorta is in a weird position apparently, and I have a slight bit of leakage in one of the valves, but apparently both are quite “normal”.

[Deejay62]

I’m sorry to hear what you’ve been through and what you’re going through. I’ve had tachycardia with dizziness and feeling lightheaded, and after I’ve had a headache when it’s reverted to sinus rhythm, maybe it’s because the blood pressure drops. Maybe you should ask your Gp to refer you back to see the cardiologist.

[Ewloe]

I’ve had two 5 day ECG monitors as my Arrhythmias are totally random. And I’ve seen an electrophysiologist as for these arrhythmias. I’ve got muscle damage since my heart attack but you can get arrhythmias without having had a heart attack. Have you had a good prolonged holter monitor or ask about a loop recorder as a diagnosis is obviously needed before treatment can be made. Good luck.

[Sarrobs]

Could it be Paroxysmal Supra Ventricular Tachycardia?You stated you wait before seeking emergency help but unless you are able to slow your heart rate within half hour by medication or valsalva maneuvers then you should seek help. If it isn't brought under control reasonably quickly, then it could lead to damage of the heart muscle.

I have SVT's, these increased so now taking Bisoprolol which has reduced heart rate in general and the SVT severity and awaiting consultation for a permanent fix of an ablation

I hope you get some answers soon and sorry to hear of all the issues you have had to face.

Very best wishes to you

[NotAllWhoWonder in reply to Sarrobs]

Thank you.

I did some Googling in my free time between tests at the A&E, and actually stumbled across SVT on the NHS site. All the symptoms were spot on. Mentioned it to the cardiologist who saw me and he said it’s possible. Wouldn’t make a diagnosis, obviously, and said I just need to speak to my GP.

[Sarrobs in reply to NotAllWhoWonder]

I've had SVT's since I was at least 11 but these weren't diagnosed for over 30 years, until I bought myself a heart monitor (like a hand held ECG - think it's a HCG 801, new technology at the time but now used by lots of Drs so I understand) and captured them to show my GP and then cardiologist for diagnosis. SVT's aren't just a fast heart rate i.e. I have the re-entrant loop type so a monitor will show my ventricular pulse to be 150+ to 200 BPM but the upper chambers of my heart will be double that speed. The tell tale sign of SVT's is how quickly it starts and stops, it is not a steady increase and decrease in heart rate - from 200 to 70 in one beat.

You can also buy an ECG sensor/app for your smart phone which is a lot cheaper, I think it is about £100 it helped diagnose my friend who had Paroxysmal atrial fibrillation for many years and was also struggling to gain a diagnosis. You put 2 fingers on the sensors that plug in to your phone I believe and it provides you with an ECG reading and 'diagnosis' to show your cardiologist.

[Sarrobs in reply to Sarrobs]

amhcare.co.uk/shop/equipmen...

Is the monitor I bought about 15 years ago

Not sure which monitor my friend bought but this is one I just found

ebay.co.uk/itm/204318625403...

[Dollywow1999 in reply to NotAllWhoWonder]

How aggravating you told the Dr what you suspect is wrong

[EllenMcC]

I don’t have a heart condition but do have anxiety and panic attacks. My heart rate can stay high for awhile and I get that tingly sensation that starts in my chest and radiates out a bit. Very scary. An anti depressant has “fixed” me. Like others suggested try and get the holter monitor you need to know what is going on and then you can work with doc to control it. Good luck

[NotAllWhoWonder in reply to EllenMcC]

I’ve had a one of those monitors on before. The problem is that if I don’t have an episode while I’m wearing it, it’s basically futile.

I saw my cardiologist’s reg for the follow up for my stent about a month ago, and explained what had happened. His recommendation was an implant in my chest that basically recorded everything 24hrs a day for 2 years. It seems invasive for what is effectively guesswork at this point, though.

[Drummerstu]

Hi The_Voice,

I am going to approach this in a slightly different way. You have had a very stressful time by the sound of things and I am wondering have you ruled out Panic attacks/Anxiety? Is there a thought process that triggers your heart rate? One of the issues that can arise after a heart event is PTSD. I have had to work hard on my mind just as much as my physical health since my LAD event. Take care and I wish you well.

Thanks

Stu

[NotAllWhoWonder in reply to Drummerstu]

Hi Stu.

I had considered it, yes. I actually went for CBT about a year or so after my MIs because my solution for handling trauma is to bury it. Didn’t work out too well because I had significant PTSD which just became too much. The sessions really helped me confront and overcome most of it, because I would start drowning in my own thoughts of my mortality, death, etc, something I had never even considered before it all happened.

I can’t say for sure that this is what causes these episodes, because I’ve had them ever since my MIs. They’ve even happened when I was on Bisoprolol, which I took to regulate my HR. But, I won’t outright deny that it could be panic attacks - I’m just not aware of any specific triggers such as stress, etc.

It could very well be that these have occurred before my MIs, too - I also have become super aware of my health and body, but especially my heart since my MIs, so anything even slightly different is instantly elevated. Prior, I probably wouldn’t have even have noticed it. May just have felt a bit tired or something and not even noticed the heart rate as anything weird.

[Drummerstu]

Hi The_Voice, I can resonate with a lot of what you have said, and its very common! The heart manual which I was given after my event is something I use a lot for the relaxation audio. I would recommend it heartmanual.scot.nhs.uk/

Also mindfulness is excellent to allow you to be aware of your thoughts as they arise. Have a go at this as a starter youtube.com/watch?v=Yi79fR4...(Not working as expected?)

Let me know how you get on.

Cheers

Stu

[NotAllWhoWonder in reply to Drummerstu]

Cheers, will do. I have tried to narrow it down, but there’s never anything specific. I’ll be sitting down to have dinner, be reading a work email, just getting back from a walk during lunch, etc - they have nothing in common.

[Bezzum in reply to NotAllWhoWonder]

Hi, I've had random episodes of tachycardia, when my heart justs beats fast and I , feel breathless. I did look up SVT's and it mentioned that just changing your position can cause them, like bending forward. I also had a fairly tight bra, it sounds strange but since I've stopped wearing my bra they seem to happen less😊. I've been to GP but they cant do much for me as the episodes are too far apart for a monitor at home. Sometimes SVT's stop eventually on their own. However, I think that the internal monitor that was suggested for you may be the only way for sure that the medics can get to the bottom of whats happening with you.

Take care x

[EllenMcC]

my panic attacks often happened when I first woke up or later in the day when I finally sit down to relax. Now that I have been thoroughly checked out when I feel one starting I get up and get moving. Luckily for me once I found the right med they are well controlled

[NotAllWhoWonder]

So, no surprises where I was again last night or for what reason.

At home, chilled, and then suddenly feel my heart pounding, HR shoots up to 150 and BP is 171/85 (sys is normally around 120). Pop a Bisoprolol as instructed, do vagal exercises, and wait. HR and palpitations don’t subside after 30mins, so I ring for help as previously instructed. Won’t send an ambulance because there’s a 4hr wait time, and I’m not an emergency. Because I have a cardiac history, advise me to ring 111 or find my own way to the A&E.

Can’t drive because of my sciatica, so trying to figure out what I should do when the intercom rings downstairs 30 minutes later. An ambulance arrived: absolutely amazing guys, as always - you can tell they really love their jobs and care about their patients! They check me over, and by this time all my symptoms are normal again. I don’t particularly want to go to A&E at this point because I’m stable - but mainly because of my sciatica; I had to stand for around 24 of the 26 hours I was there last Monday because they couldn’t offer me a bed, and I can’t sit because of the pain down my leg. No, with their combined experience they can’t in good conscience leave without me. They know best, so off we go!

Get booked in at Majors. They don’t have a bed (no surprises) but want me in there for monitoring because of history. They just need me to go to gen pop to get my ECG and bloods done. This was at 17:56 (according to my admission form). I had my first round of bloods and ECG done at 23:05. Few minutes later I chat to an amazing doctor who explains the why’s and how’s. I explain that I simply can’t stand anymore cause the pain is too much, so if first round is OK, I need to be discharged if they can’t offer me a bed. He agrees, and I go back to waiting in gen pop. Around 12:30, the doctor calls me over again in a side passage (I get nervous when that happens… like what’s so bad you can’t tell me in front of other patients lol?). ECG and bloods were fine. BUT, my one thyroid marker was elevated - as in double what it should be (should be 5, it was 10). I’m stunned. No-one has actually ever bothered to look at anything apart from troponin before and we may finally have figured out what is causing this?!

He says that because this is my 4th episode in 2 weeks I’m being referred to cardiology (winning!) and that he’s also going to ask my GP to do more thyroid tests (still winning!). Oh, and because I’m fine he’s not going to bother with the 2nd bloods, and I can go home (I just can’t stop winning!).

Got home quite late, but ultimately quite pleased that I went to A&E and had my bloods done. Like it was meant to happen. Did some quick research and symptoms of hyperthyroidism are palpitations and tachycardia! I don’t think I have it all the time because previous blood tests at the GP have shown it as slightly under active, but I guess it spiking at random times could cause it? Anyway, I feel this may be a massive step for me.

TL;DR: I was in A&E again, but thanks to some awesome paramedics and a switched-on doctor, I discovered that my symptoms may be cause by hyperthyroidism.