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Transient episodes of tachycardia

Posted · Report post

Hey all,

So, twice during the last week I've had single instances of transient episodes of tachycardia that have awaked me during the night. They were about 5 days apart or so.

(Disclaimer. No opinions given here will be considered advice, nor will change the course I choose to follow regarding this issue. This is posted for educational and discussion purposes only.)

I awoke to feel my heart pounding, was a bit flushed. Though not diaphoretic, I had that prickly feeling in my face and arms that seems to precede it. Slight dispnea, no chest pain or pressure, slight dizziness, but I'm unsure if that was from physiology or from anxiety over the episode.

My pulse rate would run up to around 130, pulse bounding, I was very cardiac aware so unsure if there was anything unusual there or if my attention made it seem that my heart was beating harder than usual.

The first episode lasted (not timed, my 'feeling' only) maybe 4-5 mins with me kind of freaking, (breathing slowly, trying to stay calm) out before it occured to me to try and v/v (vasovagal) it down, which I was able to do by holding my breath and bearing down. Rate quickly (15-20 secs) dropped to around 80 (baseline is 60ish), stayed there for "a couple of minutes" and then over approximately a minute and a half to two minutes crawled back up to the 130's. I was again able to v/v back down. I v/v four or five times over, what Babs tells, me was a half hour or so before things seemed to settle down and stay put.

The second episode was more or less the same though the duration was approx. 15 minutes this time. Was able to mitigate several times with carotid massage. (It was interesting to try these techniques on myself. It finally occurred to me to have Babs get me a cold towel for my face to see how that compared, but the issue didn't repeat for me to try it. Though it will be on the top of my list for next time.)

No other s/s that I'm aware of surrounding these episodes or in daily life.

49 years old, 6'/220lbs, asymptomatic during regular exercise, lifetime smoker, no significant previous medical history, no n/v, chest pain/pressure, has regular physicals/ECGs due to work, no illegal drug use, no prescription meds, Melatonin periodically for sleep, but not on these occasions, OTCs periodically for head/backache, baseline vitals P 60ish, BP 126/74, RR 12ish with no history of respiratory issues, no recent illness, no unusual stresses.

It did kind of feel like times gone by when I'd have an anxiety attack, but there was no tachypnea and controlling my breathing didn't seem to mitigate the issues in any way.

So what do you think? I've googled it and visited my favorite med pages and can see where this is sometimes caused by meds, which don't apply here, and other times by cardiac blocks, though that usually causes more regular and persistent symptoms if it causes any....It's curious...

Dwayne
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Posted · Report post

Electrolyte imbalance (poor diet), stimulants (caffeine), smoking, stress

Those were the causes given to me by my doc for the frequent PVCs I was getting. I would suddenly feel like my heart was going to explode out of my chest. I sometimes find myself with a sudden spike in hr to around 120. Usually happens later in the day after a coffee and smoke diet though.
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Clearly it is the stress of not having come to New Zed and had a BBQ with us ... well its kinda rainy here this weekend, might want to come next week.
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Get back to the jungle, you're in withdrawl.
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Were you home in bed with your wife instead of a PNG sheep??? :-}

Just kidding

It sounds like time to see the doc and describe the S&S and possibly a holter monitor for a couple days to see if it can be captured.
49 is NOT too young to have cardiac issues. Not something to fool around with.
Make the appt NOW
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I echo island.. Good advice. Do it!
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So, bless you both for your concern, (cincerly) but you all suck at scenarios...

What is your treatment, advice, differential, diagnosis,? (I swear, if you claim that EMS doesn't diagnose I'll kick your balls/ovaries right up next to your tonsils)
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Posted · Report post

Could be paroxysmal SVT or afib, reflux, pheochromocytoma, cardiac ischemia. Have I scared you enough to get you to a doctor? Workup would include EKG, Holter, bmp, troponin, TSH, 24 hour urine to start. I think a little pt education is in order to discuss the seriousness of any chest symptoms in a middle aged, life long smoker who knows better.
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... and he calls me pigheaded. Get your fat ass to the doctor Dwayne, or I will storm down there and kick the farts out of you...
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[quote name='ERDoc' timestamp='1353162302' post='290450']Could be paroxysmal SVT or afib, reflux, pheochromocytoma, cardiac ischemia. Have I scared you enough to get you to a doctor? Workup would include EKG, Holter, bmp, troponin, TSH, 24 hour urine to start. I think a little pt education is in order to discuss the seriousness of any chest symptoms in a middle aged, life long smoker who knows better.[/quote]

Seriously, listen to what ERDoc is saying if you haven't already. I do however expect that you've had proper follow up and are now posting it as a case study. In my experience you can be stubborn but you're not a complete dumbass and would follow up appropriately.

In the interest of aiding the differential, any recent cough, cold, flu, or vaccinations (generally any potential exposure to an infective process be it viral, bacterial, parasitic, or even fungal)? Any relevant family history (CAD, diabetes, arrhythmias, etc.)? How about heart tones? Everything lubbing and dubbing the way it's supposed to? You didn't happen to have a monitor to throw yourself on while this was happening did you? :ph34r: How about vitals during the episode?


Sent from my SGH-T989D using Tapatalk 2
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Just because you are a pigheaded Pt: You would get a full workup to include 12 lead, dual 16 ga IV's just in case, Full rainbow blood draw for the lab. A full hx of events any meds taken including vigra,cialis etc due to your advanced age and the fact you have been away from your poor wife. Then you would go to the local cardiac center for more labs and monitoring over a 24 -48 hour period.
Would look for strange foreign diseases, parasites and bacteria's since you have been out of the country for extended periods.

Like Kaisu said : STOP being a dickhead and get to the DR.
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Do what I did one night. When we got our LP12s I took one home before putting it into service and strapped myself into every monitoring parameter it had before I went to sleep...then downloaded the data the next morning.

Worst sleep EVER!!!!

Got a spare LP12 laying around. :)

ERdoc has all the right answers, so the rest of us just get to poke fun at ya.
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You all or such dorks...

Before posting I'd made an appt with my PCP. But because of the posts I went to the urgent care at the local hospital. They weren't overly concerned, ran a 12 lead only...picture perfect...Doc said he was unconcerned given my recent/current/family history. My job doesn't really have insurance, (Kind of, you pay up front and then they consider it for payment later) so I think that he chose not to do more than he felt prudent. Doc diagnoses anxiety issues...that doesn't feel right to me, but neither does MI...And I can't really afford to persue a long course of action if it's only for peace of mind and not based on logical, realistic concerns...know what I mean?

The reason I didn't consider it emergent, right, wrong or indifferent, is that I'm completely asymptomatic at all other times, and no n/v, chest pain, headache, dizziness, sig diaphoresis during episodes. Zero family history of hypertension/stroke/cardiac issues, plus I workout 4 times per week minimum and maintain a HR of 140-160 for 60 to 90 mins without symptoms. Shouldn't a significant pathology show itself with exertion if they are going to present at rest?

Vitals today BP 126/76, P 56, SPO2 97% r/a, 12 lead of an unusually fit, horny 18 year old...

So, with those things being known, what might I be missing in the cardiac world that might cause such symptoms only three times (last time it started to ramp up, but then settled within 2-3 mins) in a couple of weeks and not at all during exertion?

So, though it would be nice to have all of the other things done...If for no other reason so as to avoid having any fart stomping done, not going to happen on my budget. Though, I certainly will persue it more aggressively should things seem to change at all..
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Posted · Report post

WPW? V-Tach?

Holtor Monitor.
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Posted (edited) · Report post

Did this happen while you were reclining? I'm inclined to think regurgitation.... edit... sorry - meant reflux. Stop eating all that fatty crap before bed.

edit PS Glad you are OK. Would really miss you..

PPS - about a third of cardiac patients have no symptoms of cardiac until the MI - when 50% of them die. thus our concern Edited by Kaisu
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[quote name='Kaisu' timestamp='1353201149' post='290473']
Did this happen while you were reclining? I'm inclined to think regurgitation
[/quote]

[quote name='DwayneEMTP' timestamp='1353092417' post='290426']
Hey all,

So, twice during the last week I've had single instances of transient episodes of tachycardia that have [b]awoke me during the night[/b]. They were about 5 days apart or so.
[/quote]

I dunno, but I tend to sleep in a prone position....I suppose Dwayne could hang upside down from the ceiling though. :) Edited by Arctickat
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Posted · Report post

Would WPW be new onset at my age? Present at such a low rate?

I was sleeping, flat, on a bed, the first two times, peeing the third...
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http://www.ncbi.nlm.nih.gov/pubmed/15575244
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Pubmed reference FTW!!
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Posted (edited) · Report post

[quote name='DwayneEMTP' timestamp='1353200763' post='290470']
Doc diagnoses anxiety issues...that doesn't feel right to me, but neither does MI...And I can't really afford to persue a long course of action if it's only for peace of mind and not based on logical, realistic concerns...know what I mean?

[color=#FF0000]Nope! I don't know what you mean...[/color]
[color=#FF0000]I would spare no expence on investigating a cardiac issue if you are concerned.[/color]

The reason I didn't consider it emergent, right, wrong or indifferent, is that I'm completely asymptomatic at all other times, and no n/v, chest pain, headache, dizziness, sig diaphoresis during episodes. Zero family history of hypertension/stroke/cardiac issues, plus I workout 4 times per week minimum and maintain a HR of 140-160 for 60 to 90 mins without symptoms. Shouldn't a significant pathology show itself with exertion if they are going to present at rest?

[color=#FF0000]If it is exertional in nature, then yes! [/color]
[color=#FF0000]If it is non-exertional in nature (accessory pathway, afib, valve issue etc) then no![/color]


So, with those things being known, what might I be missing in the cardiac world that might cause such symptoms only three times (last time it started to ramp up, but then settled within 2-3 mins) in a couple of weeks and not at all during exertion?

[color=#FF0000]To put it frankly (and a little smart-ass), Paraoxysmal Cardiac rythm disturbance of unknown etiology.[/color]

So, though it would be nice to have all of the other things done...If for no other reason so as to avoid having any fart stomping done, not going to happen on my budget. Though, I certainly will persue it more aggressively should things seem to change at all..

[color=#FF0000]I highly suspect these tachycardias are going to be runs of bigeminal PVC's or PAC's, probably linked to dehydration (Poor water intake, high dose caffeine), combined with stimulants both intrinsic (anxiety, occasional adreniline shots) and extrinsic (smoking, pop, coffee, betelnut) stimulants.[/color]
[color=#FF0000]But my 100% honest advice to you, is wear a frickin halter for 24hrs. I doubt the cost is too much considering these could be runs of v-tach![/color]

[/quote]

Oh BTW: don't take this wrong.... but you are getting old.
Things like valve problems, athrosclerosis, aneurism, are real. Yes it would be early.... but still a consideration. Edited by mobey
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Dwayne. I'm going to BEAT YOU. And I'm close enough to do it, too! If you don't get yourself in to get a cardiac workup and holter monitor, I will drive to where you are and kick your ass. You know how I said you're too hard on yourself sometimes? This ain't one of those times. You are, in fact, being an idiot.

You know something's wrong. Don't tell me you don't. Especially if it WOKE YOU UP. You know it's probably your heart. And you're willing to risk Dylan's future on a "well what if it ain't nothing and I spent all that money" moment?

I'm gonna turn this around and ask you, what if Babs or Dylan came up to you and described the exact same thing (and had it happen three times with no provocation)? Would you hesitate to spend the money? Of course not.

Take care of this, BEFORE YOU FLY BACK TO THE BOONIES.

Wendy
CO EMT-B
RN-ADN Student (21 days and counting)
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[quote name='Eydawn' timestamp='1353296507' post='290514']

You know something's wrong. Don't tell me you don't. Especially if it WOKE YOU UP.

[/quote]

Great point, and good catch in the history there!!
I dunno how I missed that. That is a significant finding.
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