U.S. CitiesCity-Data Forum Index
Go Back   City-Data Forum > General Forums > Health and Wellness
 [Register]
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
View detailed profile (Advanced) or search
site with Google Custom Search

Search Forums  (Advanced)
 
 
Old 08-14-2019, 09:03 AM
 
587 posts, read 190,698 times
Reputation: 1251

Advertisements

Yesterday, I had a heart arrhythmia that came and went a couple of times, then came and persisted over the course of three hours. Sometimes it felt like I was having very frequent PVCs — one every 2 to 3 beats. But my heart rate would also change radically and abruptly. I have actually had episodes like this in the past but they usually resolve themselves within a matter of minutes (and of course have never shown up on a Holter monitor) and they are always asymptomatic.

This time it was also asymptomatic, but really annoying so I decided to get myself to urgent care. I figured either it would simply go away right before I saw the doctor or get it documented, either of which would be a good thing.

It did not go away before I saw the doctor, but actually got worse to the point where I became symptomatic for the first time. I started feeling faint, browning out, then coming back. While this was going on I was hooked up to an ekg or a heart monitor (I forget which) and the doctor could see that the brown out episodes coincided with pretty long sinus pauses. So, they called an ambulance, sent me to the ER and now I am admitted at a local hospital for a cardio workup.

So far we know it was not afib, but instead some kind of sinus arrhythmia.

My heart rate went back to normal on its own in the ER without medical intervention, but they admitted me and, like I said, are keeping me here for a cardio workup.

So, here I am in the hospital waiting for the cardiologist who will appear sometime today.

Care to play “guess that arrhythmia” in the meantime? I am thinking it might be bradycardia-tachycardia syndrome, but it is pretty rare in younger patients.

BTW, I am trying not too hate my body too much. It seems to have a true penchant for unusual or rare diseases and I sincerely wish it would get a different hobby.
Quick reply to this message

 
Old 08-14-2019, 10:21 AM
 
Location: SW Florida
10,258 posts, read 7,470,611 times
Reputation: 15585
Quote:
Originally Posted by Jill_Schramm View Post
Yesterday, I had a heart arrhythmia that came and went a couple of times, then came and persisted over the course of three hours. Sometimes it felt like I was having very frequent PVCs — one every 2 to 3 beats. But my heart rate would also change radically and abruptly. I have actually had episodes like this in the past but they usually resolve themselves within a matter of minutes (and of course have never shown up on a Holter monitor) and they are always asymptomatic.

This time it was also asymptomatic, but really annoying so I decided to get myself to urgent care. I figured either it would simply go away right before I saw the doctor or get it documented, either of which would be a good thing.

It did not go away before I saw the doctor, but actually got worse to the point where I became symptomatic for the first time. I started feeling faint, browning out, then coming back. While this was going on I was hooked up to an ekg or a heart monitor (I forget which) and the doctor could see that the brown out episodes coincided with pretty long sinus pauses. So, they called an ambulance, sent me to the ER and now I am admitted at a local hospital for a cardio workup.

So far we know it was not afib, but instead some kind of sinus arrhythmia.

My heart rate went back to normal on its own in the ER without medical intervention, but they admitted me and, like I said, are keeping me here for a cardio workup.

So, here I am in the hospital waiting for the cardiologist who will appear sometime today.

Care to play “guess that arrhythmia” in the meantime? I am thinking it might be bradycardia-tachycardia syndrome, but it is pretty rare in younger patients.

BTW, I am trying not too hate my body too much. It seems to have a true penchant for unusual or rare diseases and I sincerely wish it would get a different hobby.
Ahhh, Jill, another thing you don't need healthwise with everything else you have going on.

But in light of that happening, you're right where you need to be right now. And the fact that you were in a place where your arrhythmias (and associated symptoms) could be documented as they occurred, may well give you a definitive diagnosis without the delays necessitated by testing to catch the arrhythmias and correlation of symptoms.

And you're no doubt having your heart monitored as you wait there for the cardiologist, you're in a telemetry unit in the hospital, aren't you? So they can determine if you have had further episodes of the tachycardia, and sinus pauses, or just what is going on with your heart.

If you're experiencing sinus pauses, along with a tachycardia, that sure does sound like a typical description of"tachy-brady" syndrome, which is a manifestation of "sinus node dysfunction", also referred to as "sick sinus syndrome. It can be associated with atrial tachycardias such as a-fib or a-flutter, the pauses generally occur as the tachycardia slows down and the sinus node takes a few seconds or more to kick back in for a normal sinus rhythm heart rate. From what I've read, a pause of 3 seconds or greater is significant, and is associated with symptoms such as you experienced, or even passing out.

Don't know if your cardiologist will recommend further testing, he/she will review your medical history, and medication list to see if you're taking meds that might be at least partly responsible for your cardiac issues. Depending on what's going on, especially if you had numerous pauses (especially symptomatic) that lasted more than several seconds, the doc may recommend a pacemaker.

Just some thoughts, you might want to see a cardiac electrophysiologist to sort all this arrhythmia stuff out.

Best of luck, it'll be ok. Take it from the voice of experience here, tachy-brady is entirely manageble (mine's managed with a pacemaker and medication).
Quick reply to this message
 
Old 08-14-2019, 01:02 PM
 
587 posts, read 190,698 times
Reputation: 1251
Thanks travelassie!

I saw a cardiologist nurse practitioner already. She said that I had 4 ekgs. The first actually showed afib, the second and third showed sinus arrhythmia (not otherwise specified) and the fourth was normal. (This was over the course of 3.5 hours.) The good news was that I converted and eventually achieved normal sinus rhythm on my own without medication. So it looks like the afib triggered the other tady-brachy-like arrythmia. I am feeling kind of happy about this because it doesn’t feel like a totally new problem. (I already knew I had afib.)

She prescribed a beta blocker. So we will see how that works in the future.

What is it like having a pacemaker? Did you have some pretty scary episodes before you had any be installed?
Quick reply to this message
 
Old 08-14-2019, 02:20 PM
 
10,311 posts, read 6,786,961 times
Reputation: 19416
With everything that you have going on right now, could this be from nerves
Quick reply to this message
 
Old 08-14-2019, 02:25 PM
 
1,245 posts, read 467,321 times
Reputation: 3923
You're in the hospital surrounded by medical professionals and are seeking insight on CD?

Jill, Jill, Jill... *sigh*

FWIW, sounds like your afib is not well controlled.
Quick reply to this message
 
Old 08-14-2019, 02:46 PM
 
409 posts, read 251,109 times
Reputation: 513
Quote:
Originally Posted by Jill_Schramm View Post
Thanks travelassie!

I saw a cardiologist nurse practitioner already. She said that I had 4 ekgs. The first actually showed afib, the second and third showed sinus arrhythmia (not otherwise specified) and the fourth was normal. (This was over the course of 3.5 hours.) The good news was that I converted and eventually achieved normal sinus rhythm on my own without medication. So it looks like the afib triggered the other tady-brachy-like arrythmia. I am feeling kind of happy about this because it doesn’t feel like a totally new problem. (I already knew I had afib.)

She prescribed a beta blocker. So we will see how that works in the future.

What is it like having a pacemaker? Did you have some pretty scary episodes before you had any be installed?
Could be episodes of PAC....yes stress can bring this on....

Certainly glad you got it all documented in ER...often it is hard to Dx arrhythmia even with several days wearing a holster..

Wait and see if the beta suppresses them....before you start worrying about pacemaker...which btw is an easiest procedure these days..

I have been on a beta for over 30 years! I used to call them skippies...was never symptomatic like you were..nuclear stress tests always ok

Yes...next step likely a cardiac electrophysiology guy..

As if you needed more stress!
Quick reply to this message
 
Old 08-14-2019, 03:11 PM
 
Location: SW Florida
10,258 posts, read 7,470,611 times
Reputation: 15585
Quote:
Originally Posted by Jill_Schramm View Post
Thanks travelassie!

I saw a cardiologist nurse practitioner already. She said that I had 4 ekgs. The first actually showed afib, the second and third showed sinus arrhythmia (not otherwise specified) and the fourth was normal. (This was over the course of 3.5 hours.) The good news was that I converted and eventually achieved normal sinus rhythm on my own without medication. So it looks like the afib triggered the other tady-brachy-like arrythmia. I am feeling kind of happy about this because it doesn’t feel like a totally new problem. (I already knew I had afib.)

She prescribed a beta blocker. So we will see how that works in the future.

What is it like having a pacemaker? Did you have some pretty scary episodes before you had any be installed?
So it could be that your a-fib (even if it's not all that frequent right now) could be a player in the apparently tachy-brady episode( s) you had. With any luck the beta blocker will help keep the afib under control by keeping your heart rate within normal ranges, and that may help with keeping any bradycardia at bay.

I've had supraventricular tachycardia (SVT) for many years, and have taken metoprolol since 2001 when I had an episode that wouldn't stop (HR around 190's) till I got Adenosine in the ER. I had testing afterwords to rule out cardiovascular disease (I don't have it) but they told me I'd have to take metoprolol for he rest of my life unless I agreed to a cardiac ablation. I refused the ablation, and the metoprolol did a great job of keeping the tachy to a minimum for many years, and I had a normal heart rate at that point.

I started taking diltiazem for high blood pressure some years later, and took both these drugs for many years. I mention this because both beta blockers, and calcium channel blockers (metoprolol and diltiazem, respectively) tend to lower the heart rate (which is why they're used to control heart rates in tachyarrhythmias), in some people they lower the heart rate significantly, most people not so much. But for many years I had no issues with either of these drugs.

Fast forward about 14 yrs, another episode that turned out to be a-flutter took me to the ER again, but this stopped shortly after I got there (had gone on for about 4 hours at home). They kept me overnight and I saw a cardiologist the next day. He scheduled a followup event monitor and a followup visit, and changed the type of metoprolol I was taking from the extended to the immediate release. At that point, heart rates were still ok, and the SVT episodes were short and infrequent. And no problems I could see with the drugs.

But about two years after that (around early-mid 2017), my heart rates began taking a nosedive (sometimes into the low 40s at that point). This was intermittent, and not symptomatic at first, and the heart rate would go up appropriately with activity. The cardiologist was concerned that the diltiazem and metoprolol combination was having a cumulative effect on lowering the heart rate and his opinion is that diltiazem isn't that effective for either tachy or blood pressure control so he took me off the diltiazem, and we assumed the heart rate would go up. Well, for a couple months, even without an increase in the metoprolol, the intermittent low heart rates continued, at times they'd drop into the 30's and I'd be a little light-headed when that happened. But then the SVT started up again, again, intermittently over the next 4 months or so, and were increasing in frequency (picked up on a 2 week Zio monitor patch), and the cardiologist tripled the metoprolol dose from 50 to 150 mg/day.

Well, that amount of metoprolol did a great job on the SVT but over time the incidents of bradycardia became more frequent, and were becoming symptomatic (light-headedness, exercise intolerance, chronic tiredness mostly) but I carried on, mostly waiting and hoping I'd get used to get used to the stuff, and being in denial that anything serious was really happening. And if I cut back on fhe metoprolol, the SVT would break through, and the bradycardia still happened.

But when I finally admitted the symptoms were getting to me, the cardiologist ordered another Zio monitor in January 2019, and the results showed numerous incidents of heart rates in the low 40's correlating with my reported symptoms, as well as some episodes of SVT. Within a short time the cardiologist referred me to an electrophysiologist, I think we both assumed I'd have that SVT ablation, maybe relieving the need for the metoprolol which was likely at least contributing to he bradycardia, and we would see where it went from there.


Well, from January 2019 onwards till I saw the EP in early April, the bradycardia became more frequent and the symptoms worsened, not just the light-headedness and tiredness, but also a couple of times when I came close to passing out, but hung onto something till it got better-at this point the HR would go into the high 30's or so. The worst experience, though, was the feeling that I was disoriented and confused, feeling as though I didn't have the mental wherewithal to complete a task or even finish a sentence. I found this frightening, I wondered if I might be spiraling down the rabbit hole into dementia at times. This happened several times when I was out in public, at an event, volunteering activities, with friends, and always when my heart rate went down into the low 40's, high 30's.

So when I saw the EP, he informed me that he believed I had atrial tachycardia (from review of my records), and explained why this would likely not be amenable to a sucessful ablation, but better off controlled with medication. He called the sick sinus diagnosis, and on the possibility (as he said) it "might"be due to he metoprolol, he proposed I taper off the metoprolol and switch to diltiazem. He said I'd need a pacemaker if this didn't resolve the bradycardia and control the SVT, and it didn't.

So the scuttlebutt was that while it's likely both the metoprolol and diltiazem (even separately) might be associated with bradycardia in some people, in most cases (including mine), these drugs only unmask an underlying sinus node dysfunction process that will continue to progress with time anyway. I couldn't disagree , as from what I had seen that bradycardia reared its ugly head no matter how little of the metoprolol I took, or with a drug (diltiazem) that isn't suppose to cause significant bradycardia in normal people, and it occurred at times more random than one would expect if it were solely in response to a drug. And I can now take enough of the medication I need to control the tachycardia and high blood pressure without having to worry about my heart rate going too low.

So I had the pacemaker a dual chamber St. Jude model, put in on June 12. No problems, I was discharged late the same day it was put in. There was a little pain (more of an ache like a toothache) for several days but nothing that couldn't be well controlled with some Extra Strength acetominophen. The incision has healed well, and a couple of pacer checks and adjustments in the office have indicated I'm atrial pacing at 84%, the rate response allows the heart rate to increase as I need it to and all is well. I have a remote monitor on the nightstand that communicates with the pacemaker via bluetooth and sends this information to the patient monitoring website for access by the physician or clinic, so after a time this will significantly cut back on office visits if all is otherwise ok.

And I feel so very much better, with much more energy with the pacemaker. I even feel as though what passes for my mind is back. And I even sleep better! I didn't want a pacemaker, dragged my feet when I was informed I needed one, but even my Queen of Denial alter ego must admit it was a good thing. And while I still feel it in place sometimes, even a few little mild twinges when I stretch out that arm sometimes, I'm well on my way to forgetting it's there.

Last edited by Travelassie; 08-14-2019 at 03:23 PM..
Quick reply to this message
 
Old 08-14-2019, 05:17 PM
 
587 posts, read 190,698 times
Reputation: 1251
Quote:
Originally Posted by gus2 View Post
You're in the hospital surrounded by medical professionals and are seeking insight on CD?

Jill, Jill, Jill... *sigh*

FWIW, sounds like your afib is not well controlled.
Trying to pass the time that’s all. I had to wait 8 hours to see a cardiologist.

Actually it has been really well controlled. In four years, I have had about 5 afib episodes and they have usually occurred when I had a fever or was sick. I have also had palpitations that were much more mild and definitely not afib, just a few PVCs for example. Also, I have controlled the afib episodes up until this point by using metoprolol as a pill in the pocket.

My cardiologist wanted me to start taking extended release metoprolol every day. But then I didn’t have the non-extended release pill in the pocket. So, the cardiologist here has given me another prescription for the non-extended release metoprolol.


Yes, stress is definitely a factor. The last three weeks have been the most stressful I have lived through since grad school. And I am a lot older and less physically resilient now. I am having a lot more success controlling my mood than my stress level. In other words, it is not always doom and gloom, but when it’s not, it’s more like “fight! Fight! Fight! You can do this!!!” than meditative calm.
Quick reply to this message
 
Old 08-14-2019, 05:19 PM
 
4,979 posts, read 2,143,620 times
Reputation: 9834
"Care to play “guess that arrhythmia” in the meantime?"
Jeopardy: what happens when we want to post on C-D?
Quick reply to this message
 
Old 08-14-2019, 05:28 PM
 
587 posts, read 190,698 times
Reputation: 1251
Quote:
Originally Posted by Travelassie View Post
So it could be that your a-fib (even if it's not all that frequent right now) could be a player in the apparently tachy-brady episode( s) you had. With any luck the beta blocker will help keep the afib under control by keeping your heart rate within normal ranges, and that may help with keeping any bradycardia at bay.

I've had supraventricular tachycardia (SVT) for many years, and have taken metoprolol since 2001 when I had an episode that wouldn't stop (HR around 190's) till I got Adenosine in the ER. I had testing afterwords to rule out cardiovascular disease (I don't have it) but they told me I'd have to take metoprolol for he rest of my life unless I agreed to a cardiac ablation. I refused the ablation, and the metoprolol did a great job of keeping the tachy to a minimum for many years, and I had a normal heart rate at that point.

I started taking diltiazem for high blood pressure some years later, and took both these drugs for many years. I mention this because both beta blockers, and calcium channel blockers (metoprolol and diltiazem, respectively) tend to lower the heart rate (which is why they're used to control heart rates in tachyarrhythmias), in some people they lower the heart rate significantly, most people not so much. But for many years I had no issues with either of these drugs.

Fast forward about 14 yrs, another episode that turned out to be a-flutter took me to the ER again, but this stopped shortly after I got there (had gone on for about 4 hours at home). They kept me overnight and I saw a cardiologist the next day. He scheduled a followup event monitor and a followup visit, and changed the type of metoprolol I was taking from the extended to the immediate release. At that point, heart rates were still ok, and the SVT episodes were short and infrequent. And no problems I could see with the drugs.

But about two years after that (around early-mid 2017), my heart rates began taking a nosedive (sometimes into the low 40s at that point). This was intermittent, and not symptomatic at first, and the heart rate would go up appropriately with activity. The cardiologist was concerned that the diltiazem and metoprolol combination was having a cumulative effect on lowering the heart rate and his opinion is that diltiazem isn't that effective for either tachy or blood pressure control so he took me off the diltiazem, and we assumed the heart rate would go up. Well, for a couple months, even without an increase in the metoprolol, the intermittent low heart rates continued, at times they'd drop into the 30's and I'd be a little light-headed when that happened. But then the SVT started up again, again, intermittently over the next 4 months or so, and were increasing in frequency (picked up on a 2 week Zio monitor patch), and the cardiologist tripled the metoprolol dose from 50 to 150 mg/day.

Well, that amount of metoprolol did a great job on the SVT but over time the incidents of bradycardia became more frequent, and were becoming symptomatic (light-headedness, exercise intolerance, chronic tiredness mostly) but I carried on, mostly waiting and hoping I'd get used to get used to the stuff, and being in denial that anything serious was really happening. And if I cut back on fhe metoprolol, the SVT would break through, and the bradycardia still happened.

But when I finally admitted the symptoms were getting to me, the cardiologist ordered another Zio monitor in January 2019, and the results showed numerous incidents of heart rates in the low 40's correlating with my reported symptoms, as well as some episodes of SVT. Within a short time the cardiologist referred me to an electrophysiologist, I think we both assumed I'd have that SVT ablation, maybe relieving the need for the metoprolol which was likely at least contributing to he bradycardia, and we would see where it went from there.


Well, from January 2019 onwards till I saw the EP in early April, the bradycardia became more frequent and the symptoms worsened, not just the light-headedness and tiredness, but also a couple of times when I came close to passing out, but hung onto something till it got better-at this point the HR would go into the high 30's or so. The worst experience, though, was the feeling that I was disoriented and confused, feeling as though I didn't have the mental wherewithal to complete a task or even finish a sentence. I found this frightening, I wondered if I might be spiraling down the rabbit hole into dementia at times. This happened several times when I was out in public, at an event, volunteering activities, with friends, and always when my heart rate went down into the low 40's, high 30's.

So when I saw the EP, he informed me that he believed I had atrial tachycardia (from review of my records), and explained why this would likely not be amenable to a sucessful ablation, but better off controlled with medication. He called the sick sinus diagnosis, and on the possibility (as he said) it "might"be due to he metoprolol, he proposed I taper off the metoprolol and switch to diltiazem. He said I'd need a pacemaker if this didn't resolve the bradycardia and control the SVT, and it didn't.

So the scuttlebutt was that while it's likely both the metoprolol and diltiazem (even separately) might be associated with bradycardia in some people, in most cases (including mine), these drugs only unmask an underlying sinus node dysfunction process that will continue to progress with time anyway. I couldn't disagree , as from what I had seen that bradycardia reared its ugly head no matter how little of the metoprolol I took, or with a drug (diltiazem) that isn't suppose to cause significant bradycardia in normal people, and it occurred at times more random than one would expect if it were solely in response to a drug. And I can now take enough of the medication I need to control the tachycardia and high blood pressure without having to worry about my heart rate going too low.

So I had the pacemaker a dual chamber St. Jude model, put in on June 12. No problems, I was discharged late the same day it was put in. There was a little pain (more of an ache like a toothache) for several days but nothing that couldn't be well controlled with some Extra Strength acetominophen. The incision has healed well, and a couple of pacer checks and adjustments in the office have indicated I'm atrial pacing at 84%, the rate response allows the heart rate to increase as I need it to and all is well. I have a remote monitor on the nightstand that communicates with the pacemaker via bluetooth and sends this information to the patient monitoring website for access by the physician or clinic, so after a time this will significantly cut back on office visits if all is otherwise ok.

And I feel so very much better, with much more energy with the pacemaker. I even feel as though what passes for my mind is back. And I even sleep better! I didn't want a pacemaker, dragged my feet when I was informed I needed one, but even my Queen of Denial alter ego must admit it was a good thing. And while I still feel it in place sometimes, even a few little mild twinges when I stretch out that arm sometimes, I'm well on my way to forgetting it's there.
Thanks for sharing all that. It’s good to hear that the pacemaker has helped you feel so much better.

Reading through your account helps put my tiny tachy-brady episode in perspective!
Quick reply to this message
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.

Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.


 

Quick Reply
Message:
Over $104,000 in prizes was already given out to active posters on our forum and additional giveaways are planned!

Go Back   City-Data Forum > General Forums > Health and Wellness
Similar Threads
Follow City-Data.com founder on our Forum or

All times are GMT -6.

© 2005-2020, Advameg, Inc. · Please obey Forum Rules · Terms of Use and Privacy Policy · Bug Bounty

City-Data.com - Archive 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 - Top