Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Recurrent Episodes Of Supraventricular Arrhythmia And RBBB
Question: Hi, I am 54 year old male. I have RBBB I think since birth. I experience rapid heart beat twice. Once in high school playing soccer. Another time when I was ~24 or so. It was fast and erratic which lasted few hours. Except for these 2 occasions, I have not had any issues. Over the years, I did experience heart skips and heart flutters (a few seconds), but no major issues until May 2017 ~2pm. I felt three consecutive thuds in my heart and then it started to beat very fast. I felt dizziness & shortness of breath as well. I went to ER after work ~6pm. They did blood test which was OK. Was at ER for a few hours and Dr recommended overnight stay for observation, but I decided to go home and sleep it off. For next week or so, I was slightly dizzy and higher than normal HR but eventually I returned to normal. Then in morning of Feb 2018 , I felt a single thud and heart started to beat very fast. My smartphone HR app indicated 238 beats/sec for a couple of minutes and settled down to ~115 or so and then to ~105 or so. Felt weak for a week or so, but returned to normal. Then in Apr 2018, I had another episode. Since then I am experiencing rapid HR issue every couple of days. A week ago, I asked my doctor about heart medication and he prescribed Propranolol. He said to take it as necessary. I have been taking 10mg twice a day and I have not had fast heart rate issue, but I am experiencing slight dizziness and short of breath. Dr says my heart seems mechanically OK and fine. But I am concerned about the increased frequency and extended amount of time of fast HR episodes. I would really appreciate your advice. Thanks very much.
Some additional info please. I am 5'4", 124lbs. I have lost ~7lbs last 12 months. My BP is good - ~105-110/65-70. I noticed my BP shoots up (~140/90) for a minute or so when fast HR starts, but BP returns to normal quickly. I started noticing a couple of years ago that I get easily out of breath. I don't drink/smoke, drink coffee. No medication except Propranolol (started <1week ago). Thanks.
Some additional info please. I am 5'4", 124lbs. I have lost ~7lbs last 12 months. My BP is good - ~105-110/65-70. I noticed my BP shoots up (~140/90) for a minute or so when fast HR starts, but BP returns to normal quickly. I started noticing a couple of years ago that I get easily out of breath. I don't drink/smoke, drink coffee. No medication except Propranolol (started <1week ago). Thanks.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello,
I understand your concern and would explain that it seems very likely your clinical symptomatology to be related to recurrent episodes of supraventricular arrhythmias.
In order to properly concluding the right strategy to address these issues it is necessary to define the exact nature of these arrhythmic episodes.
Coming to this point, atrial fibrillation, atrial flutter, atrial tachycardia or paroxysmal supraventricular tachycardia should be considered in the differential diagnosis.
In the presence of a long lasting RBBB and these fast heart rate episodes, sometimes erratic in nature, it is necessary to investigate primarily for a concomitant cardiac or pulmonary structural disorders.
Although, your doctor has concluded a normal cardiac structure (heart seems mechanically OK), sometimes tiny structural disorders like an atrial septal defect (ASD),enlarged sinus venosus with associated anomalies may be missed during a routine cardiac ultrasound exam.
Hence it is necessary when any suspicions is raised to perform additional imagine tests like transesophageal cardiac ultrasound, cardiac MRI or CT to exclude such structural disorders that may rely behind your recent complaints.
I would like to review your cardiac ultrasound report if it is available. Could you upload it here on HCM for a second professional opinion?
Other issues should be sought as well:
A pulmonary disorder like a chronic bronchial-pulmonary disorder, pulmonary thromboembolic disorder, etc. should be excluded too.
In addition, a possible presence of a primary cardiac conductance disorder should be investigated also. Sometimes, sick sinus syndrome may be expressed with recurrent supraventricular tachycardia alternated with normal or slow basal heart rate.
An ambulatory 24-48 hours ambulatory ECG monitoring test (Holter) would be helpful in this regard.
I would like to directly your ECG report too.
Besides the above mentioned tests, it is also important performing some blood lab tests to investigate for other possible metabolic causes that may trigger this clinical scenario:
- complete blood count for anemia
- thyroid hormone levels for thyroid gland dysfunction
- blood electrolytes for possible electrolyte imbalance.
Hope you will find this answer helpful!
I remain at your disposal for any further questions whenever you need!
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello,
I understand your concern and would explain that it seems very likely your clinical symptomatology to be related to recurrent episodes of supraventricular arrhythmias.
In order to properly concluding the right strategy to address these issues it is necessary to define the exact nature of these arrhythmic episodes.
Coming to this point, atrial fibrillation, atrial flutter, atrial tachycardia or paroxysmal supraventricular tachycardia should be considered in the differential diagnosis.
In the presence of a long lasting RBBB and these fast heart rate episodes, sometimes erratic in nature, it is necessary to investigate primarily for a concomitant cardiac or pulmonary structural disorders.
Although, your doctor has concluded a normal cardiac structure (heart seems mechanically OK), sometimes tiny structural disorders like an atrial septal defect (ASD),enlarged sinus venosus with associated anomalies may be missed during a routine cardiac ultrasound exam.
Hence it is necessary when any suspicions is raised to perform additional imagine tests like transesophageal cardiac ultrasound, cardiac MRI or CT to exclude such structural disorders that may rely behind your recent complaints.
I would like to review your cardiac ultrasound report if it is available. Could you upload it here on HCM for a second professional opinion?
Other issues should be sought as well:
A pulmonary disorder like a chronic bronchial-pulmonary disorder, pulmonary thromboembolic disorder, etc. should be excluded too.
In addition, a possible presence of a primary cardiac conductance disorder should be investigated also. Sometimes, sick sinus syndrome may be expressed with recurrent supraventricular tachycardia alternated with normal or slow basal heart rate.
An ambulatory 24-48 hours ambulatory ECG monitoring test (Holter) would be helpful in this regard.
I would like to directly your ECG report too.
Besides the above mentioned tests, it is also important performing some blood lab tests to investigate for other possible metabolic causes that may trigger this clinical scenario:
- complete blood count for anemia
- thyroid hormone levels for thyroid gland dysfunction
- blood electrolytes for possible electrolyte imbalance.
Hope you will find this answer helpful!
I remain at your disposal for any further questions whenever you need!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Sharka. Thanks so much for your response. I will try to get the info you request when I return home. I am currently out of town to attend my daughter's graduation. BTW, I feel I have a bit of respiratory issue as well. Whenever I get cold/flu which is once a year, despite flu shots, I end up with bronchial issue which lasts over a month. Last year, it lasted a couple of months. This year April (1st week), I caught a cold/flu, I think I recovered but I still have constant phlegm in my throat. Finally, do you think catheter ablation may help with my condition? Thanks again.
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again!
It is necessary to clarify those respiratory issues and assure that no infection sequela are actually present.
A review of your respiratory system is recommended at this point, including pulmonary function tests and inflammatory markers.
Regarding catheter ablation procedure, I would explain that its application area is expanding and seems to be a trend for arrhythmia treatment in several cardiac conditions.
Nevertheless, before concluding to such medical indications, it is necessary to properly define the exact nature of arrhythmia.
From the other hand, as far as medication therapy is shown to be effective, catheter ablation could come to scene only when after a convenient discussion with a professional expert on this field keeping always in mind the required safety profile and after a precise medical indication is confirmed.
I remain open for any further discussions.
Kind regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again!
It is necessary to clarify those respiratory issues and assure that no infection sequela are actually present.
A review of your respiratory system is recommended at this point, including pulmonary function tests and inflammatory markers.
Regarding catheter ablation procedure, I would explain that its application area is expanding and seems to be a trend for arrhythmia treatment in several cardiac conditions.
Nevertheless, before concluding to such medical indications, it is necessary to properly define the exact nature of arrhythmia.
From the other hand, as far as medication therapy is shown to be effective, catheter ablation could come to scene only when after a convenient discussion with a professional expert on this field keeping always in mind the required safety profile and after a precise medical indication is confirmed.
I remain open for any further discussions.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. lliri,
I have another follow up question please.
I have been taking Propranolol for about a week now (10mg twice per day) and it is very effective.
But I read on internet that beta blockers have adverse effect on RBBB and therefore should not take beta blockers if one has RBBB. I would appreciate your feedback on whether this is true or not. Thanks very much in advance.
I have another follow up question please.
I have been taking Propranolol for about a week now (10mg twice per day) and it is very effective.
But I read on internet that beta blockers have adverse effect on RBBB and therefore should not take beta blockers if one has RBBB. I would appreciate your feedback on whether this is true or not. Thanks very much in advance.
Brief Answer:
Betablocker is not conterindicated in RBBB.
Detailed Answer:
Hello again!
Regarding your concern about beta blockers issue, I would like to explain that there are no contraindications to beta blocker use when there is presence of RBBB, unless other associated conductance abnormalities are present.
Betablockers use would raise concern only if RBBB would be an expression of other serious pulmonary or cardiac conditions (such as bronchial asthma, severely decompensated heart failure due to a congenital disorder, pulmonary hypertension, dilated cardiomyopathy, etc..
As far as you have shown improvement on betablocker, you shouldn't worry about it.
Hope you will find this answer helpful!
Wishing all the best,
Dr. Iliri
Betablocker is not conterindicated in RBBB.
Detailed Answer:
Hello again!
Regarding your concern about beta blockers issue, I would like to explain that there are no contraindications to beta blocker use when there is presence of RBBB, unless other associated conductance abnormalities are present.
Betablockers use would raise concern only if RBBB would be an expression of other serious pulmonary or cardiac conditions (such as bronchial asthma, severely decompensated heart failure due to a congenital disorder, pulmonary hypertension, dilated cardiomyopathy, etc..
As far as you have shown improvement on betablocker, you shouldn't worry about it.
Hope you will find this answer helpful!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr.
When I first got Propranolol, I was envisioning using it as needed but I am needing it every day. In fact, I feel I may need to increase from 10mg 2X per day to 10mg 3X per day. When drug wears off, I can start to feel chest discomfort, shortness of breath, and dull headache in the lower back of my head. After ~1hr of taking it, I feel much better. So I decided I will take it every day as long as it helps. But I noticed it worsens my breathing. Before taking it, I had a minor lingering breathing issue. Inhaling was not a problem, but upon exhaling I had an urge for dry cough. But after taking propranolol, breathing is not smooth for both inhaling & exhaling. I think this is because of Beta-1 & Beta-2 impact of propranolol. Do you think switching to beta-1 blocker like bisoprolol or metoprolol would be recommended? Thanks again very much for your very helpful responoses so far.
When I first got Propranolol, I was envisioning using it as needed but I am needing it every day. In fact, I feel I may need to increase from 10mg 2X per day to 10mg 3X per day. When drug wears off, I can start to feel chest discomfort, shortness of breath, and dull headache in the lower back of my head. After ~1hr of taking it, I feel much better. So I decided I will take it every day as long as it helps. But I noticed it worsens my breathing. Before taking it, I had a minor lingering breathing issue. Inhaling was not a problem, but upon exhaling I had an urge for dry cough. But after taking propranolol, breathing is not smooth for both inhaling & exhaling. I think this is because of Beta-1 & Beta-2 impact of propranolol. Do you think switching to beta-1 blocker like bisoprolol or metoprolol would be recommended? Thanks again very much for your very helpful responoses so far.
Brief Answer:
I would explain:
Detailed Answer:
Hello!
You are right about a potential connection between Propranolol and breathing issues.
Beta-blockers are well-known at producing some adverse effects like respiratory distress, bronchospasm and even wheezing, etc. in certain predisposed individuals.
And this is true especially when using non-selective beta-blockers (like Propranolol, etc.).
Switching to selective beta-1 blockers (like Nebivolol, Bisoprolol, Metoprolol, etc.) would provide a more safe profile regarding respiratory issues.
Nevertheless, the best strategy to follow is to maintain the lowest effective daily dose, that doesn't manifest such adverse effects.
Another issue to consider would be reviewing your respiratory function by means of respiratory function tests.
In case you have available tests results, I would be glad to review them and give a second professional opinion.
You may upload them here on HCM.
Let me know if you have any other issue of concern!
Regards,
Dr. Iliri
I would explain:
Detailed Answer:
Hello!
You are right about a potential connection between Propranolol and breathing issues.
Beta-blockers are well-known at producing some adverse effects like respiratory distress, bronchospasm and even wheezing, etc. in certain predisposed individuals.
And this is true especially when using non-selective beta-blockers (like Propranolol, etc.).
Switching to selective beta-1 blockers (like Nebivolol, Bisoprolol, Metoprolol, etc.) would provide a more safe profile regarding respiratory issues.
Nevertheless, the best strategy to follow is to maintain the lowest effective daily dose, that doesn't manifest such adverse effects.
Another issue to consider would be reviewing your respiratory function by means of respiratory function tests.
In case you have available tests results, I would be glad to review them and give a second professional opinion.
You may upload them here on HCM.
Let me know if you have any other issue of concern!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Dr.
I have uploaded an ecg which was taken at an urgent care hospital a couple of weeks ago. After experiencing a fast heart rate (~105/min) for ~6hrs, I decided to stop by the urgent care. After taking the ecg and reviewing it, he said I may have heart inflammation and told me to go to an ER. I didn't think it necessary but he insisted. So I went to ER and they did the blood testing (CBC differential, etc) but everything was normal. I would appreciate your second opinion on the uploaded ecg.
I have uploaded an ecg which was taken at an urgent care hospital a couple of weeks ago. After experiencing a fast heart rate (~105/min) for ~6hrs, I decided to stop by the urgent care. After taking the ecg and reviewing it, he said I may have heart inflammation and told me to go to an ER. I didn't think it necessary but he insisted. So I went to ER and they did the blood testing (CBC differential, etc) but everything was normal. I would appreciate your second opinion on the uploaded ecg.
Brief Answer:
I am waiting for your ECG
Detailed Answer:
Hello again!
I re-checked several time for any uploads, but there isn't any on the system yet.
Probably an error may have occurred.
Please could you try to upload the ECG again?
Regards,
Dr. Iliri
I am waiting for your ECG
Detailed Answer:
Hello again!
I re-checked several time for any uploads, but there isn't any on the system yet.
Probably an error may have occurred.
Please could you try to upload the ECG again?
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sorry about that. I just uploaded and I checked that it was successfully uploaded. thanks.
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello!
After reviewing your uploaded ECG, I would explain that besides RBBB, no other cardiac conductance abnormalities are present.
Considering your history with breathing problems, I recommend discussing with a pulmonologist to see the opportunity of performing the above mentioned tests (pulmonary function tests).
From he other side, I would add that your ECG photo shows evidence of epsilon wave presence, which raises suspicions about a possible right ventricular cardiomyopathy.
Coming to this point, besides a careful cardiac ultrasound, it is advisable to undergo a cardiac MRI test in order to rule in/out such a suspicion.
You should discuss with your doctor on the above mentioned issue.
Kind regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello!
After reviewing your uploaded ECG, I would explain that besides RBBB, no other cardiac conductance abnormalities are present.
Considering your history with breathing problems, I recommend discussing with a pulmonologist to see the opportunity of performing the above mentioned tests (pulmonary function tests).
From he other side, I would add that your ECG photo shows evidence of epsilon wave presence, which raises suspicions about a possible right ventricular cardiomyopathy.
Coming to this point, besides a careful cardiac ultrasound, it is advisable to undergo a cardiac MRI test in order to rule in/out such a suspicion.
You should discuss with your doctor on the above mentioned issue.
Kind regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
