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Question: I have had several sinus tachacardyia lately after 14 months no issue. Prior SVT and then A-Fib with rapid ventricular response which resulted in cardioversion. Identified sleep apnea severe obstructive and no central. Determined I was at 83 oxygen level at night and machine was not accurately flowing thus machine was bad. Had another sleep study and the pressure was increased to 10. That morning I felt great and heart was perfect. each beat seemed good and was not contracting hard like before. 1st night on machine slept well but was tired and I yawned alot. After I ate my pulse elevated to 112-120 but the pulse was fast and not hard beating so although beating fast I didnt feel as bad as before.Took a 25mg lopressor and went up to my room and put cpap on in dark room and layed down. After 45-1hr pulse is back to normal. What was odd is my Blood pressure was 129/83 but pulse was 112. It did elevate to 148/89 with a pulse of 120. The Blood pressure seemed normal yet heart was racing?
Will it take a few days for my cpap to re oxygenate my body for it to get better and stop the tachacardyia?
This sinus tachacardyia seemed different, almost like I exercised but it seemed normal and not a stressed heartbeat. Could this have been anxiety?
I was prescribed bulspar for my nerves last week but stopped them yesterday after it was discovered my cpap was faulty causing all these issues. I felt I didnt need them because I felt the issue was discovered that was propably causing my issues?
They are still prescribing a holter monitor for 2 weeks that will record every heart beat. Should I exercise a bit to get my heart rate up?
Will it take a few days for my cpap to re oxygenate my body for it to get better and stop the tachacardyia?
This sinus tachacardyia seemed different, almost like I exercised but it seemed normal and not a stressed heartbeat. Could this have been anxiety?
I was prescribed bulspar for my nerves last week but stopped them yesterday after it was discovered my cpap was faulty causing all these issues. I felt I didnt need them because I felt the issue was discovered that was propably causing my issues?
They are still prescribing a holter monitor for 2 weeks that will record every heart beat. Should I exercise a bit to get my heart rate up?
Brief Answer:
I need answers of a few questions.
Detailed Answer:
Hi,
Wellcome to Health Care Magic.
I am Dr.Muhammad Ahmad. Resident Cardiologist, I have read your question and will try to answer you in detail.
I need you to answer a few questions of fine for my help.
1) Did you ever get a heart attack?
2) What does your echo report say?
3) The severe SVT you talked about, was it a single episode or you got a number if episodes like that?
4) What is your Height and weight?
5) What is your heart rate normaly?
6) When are you up for Holters?
7) when tachycardia happened and you were cardioverted , did you lose consiousness during tachycardia?
8) what do you mean by rapid ventricular responce was it ventricualr tachycardia for ventricular fibrillation? ( if you can tell me?)
9) Do you think your heart issues is related to you CPAP and apnea?
Im waiting for your input
I need answers of a few questions.
Detailed Answer:
Hi,
Wellcome to Health Care Magic.
I am Dr.Muhammad Ahmad. Resident Cardiologist, I have read your question and will try to answer you in detail.
I need you to answer a few questions of fine for my help.
1) Did you ever get a heart attack?
2) What does your echo report say?
3) The severe SVT you talked about, was it a single episode or you got a number if episodes like that?
4) What is your Height and weight?
5) What is your heart rate normaly?
6) When are you up for Holters?
7) when tachycardia happened and you were cardioverted , did you lose consiousness during tachycardia?
8) what do you mean by rapid ventricular responce was it ventricualr tachycardia for ventricular fibrillation? ( if you can tell me?)
9) Do you think your heart issues is related to you CPAP and apnea?
Im waiting for your input
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1-Never. I had 3 episodes of SVT from Sept 2013 to Nov 2013. The last episode in Nov 2013 I was in AFib and pulse of 174. Cardizem reduced heart rate but still Afib so decision was made to do Cardioversion.
2-Echo came back fine both in Nov 2013 as well as my recent event of Feb 16 2015. All structural components were good including valves. 1st test in 2013 was tred mill with rate to 162 all good. Feb 16 2015 was nuclear test with shot to elevate heart rate. All reports normal.
3-The SVT appeared first in Sept 2013 sinus rhythm, beared down with paremedics and the SVT broke and rate reduced. these original episodes occured upon waking up in morning. The recent events all have occurred mid day after eating.
4-6'4 300 pounds
5-When cardioversion occurred, they put me in 25mg Lopressor and 20mg lisinopril for bllod preesure. This resulted in 138/93 Blood pressure and 75 heartbeart. After Feb 16 2015 event they doubled the Lopressor to 50Mg x2 feeling I may be nervous with events (anxiety). This results normally of 125/75 with 65 heartbeat.
6-It should come within 1 week. It will record everything for 2 weeks and button if I feel event to focus in on for data retrieval.
7-Never lost consciousness, just scared but they gave me cardizem in rescue squad and rate dropped to 90 but still was in AFib. Cardioversion occured 7 hours later
8-I was in Afib but had a fast heart rate of 174. I have attached the discharge sheet
9-Yes, I have severe sleep apnea AHI of 11.9. Once on beta blocker (Lopressor) and CPAP I was good for 14 months. Last 2 weeks tachycardia started happening but in sinus rhythm. It was determined my machine was only putting out half the pressure, basically cpap machine was not operating correctly. Wife said I was snoring in mask. After sleep study 2 days ago they raised my pressure from 8 to 10 and I got a new machine. Last night I slept well but I was yawning through the day. After lunch I noticed about 45 min later my pulse went up but it was fast not hard contractions like earlier in week.I did take a 25mg Lopressor (extra 1/2 dose) after it went up this afternoon and I think 1 hour later it started worked so I laid down with CPAP mask and it went back to normal. As I am typing pulse is 130/78 and 69 pulse.
I think the CPAP was an issue and that has been corrected. I think however something is triggering the Tachacardyia but event today was mild. Is it anxiety, is it my body trying to settle down after the apnea issues? why is it happening after I eat? You think I need a mid day dose of Lopressor? One last thing, prior to cpap issue being discovered my pulse would race after very little movement even walking and would stay there. I felt my heart beat was over reacting to the activity I was doing?
2-Echo came back fine both in Nov 2013 as well as my recent event of Feb 16 2015. All structural components were good including valves. 1st test in 2013 was tred mill with rate to 162 all good. Feb 16 2015 was nuclear test with shot to elevate heart rate. All reports normal.
3-The SVT appeared first in Sept 2013 sinus rhythm, beared down with paremedics and the SVT broke and rate reduced. these original episodes occured upon waking up in morning. The recent events all have occurred mid day after eating.
4-6'4 300 pounds
5-When cardioversion occurred, they put me in 25mg Lopressor and 20mg lisinopril for bllod preesure. This resulted in 138/93 Blood pressure and 75 heartbeart. After Feb 16 2015 event they doubled the Lopressor to 50Mg x2 feeling I may be nervous with events (anxiety). This results normally of 125/75 with 65 heartbeat.
6-It should come within 1 week. It will record everything for 2 weeks and button if I feel event to focus in on for data retrieval.
7-Never lost consciousness, just scared but they gave me cardizem in rescue squad and rate dropped to 90 but still was in AFib. Cardioversion occured 7 hours later
8-I was in Afib but had a fast heart rate of 174. I have attached the discharge sheet
9-Yes, I have severe sleep apnea AHI of 11.9. Once on beta blocker (Lopressor) and CPAP I was good for 14 months. Last 2 weeks tachycardia started happening but in sinus rhythm. It was determined my machine was only putting out half the pressure, basically cpap machine was not operating correctly. Wife said I was snoring in mask. After sleep study 2 days ago they raised my pressure from 8 to 10 and I got a new machine. Last night I slept well but I was yawning through the day. After lunch I noticed about 45 min later my pulse went up but it was fast not hard contractions like earlier in week.I did take a 25mg Lopressor (extra 1/2 dose) after it went up this afternoon and I think 1 hour later it started worked so I laid down with CPAP mask and it went back to normal. As I am typing pulse is 130/78 and 69 pulse.
I think the CPAP was an issue and that has been corrected. I think however something is triggering the Tachacardyia but event today was mild. Is it anxiety, is it my body trying to settle down after the apnea issues? why is it happening after I eat? You think I need a mid day dose of Lopressor? One last thing, prior to cpap issue being discovered my pulse would race after very little movement even walking and would stay there. I felt my heart beat was over reacting to the activity I was doing?
Brief Answer:
Things are getting clearer ...!!
Detailed Answer:
Hi,
Thanks for such a detailed reply and reports i am getting a clear picture of your issues ,
I can now tell possible causes of tachycardia and cause of your heart rate increase after you eat, i will also give you tips to control this thing.
I just need to get some more info from you this will enable me to give you a better answer , I would like you to add some more info about following points:
1) Does tachy cardia happen after every single meal , or when you do some binge eating?
2) Did your doctor tell you that your weight is most likely the cause of sleep apnoea and you need to reduce it?
3)Are you doing anything to reduce it?
5) At what times you take lopressor?
4) At what time the tachycardia episodes happen these days? do they usually happen in evening? 5pm-9pm? or there's no pattern?
5) Does your pulse usually stay regular ? or it beats in irregular intervals?
6) You were started on XARELTO tablets... are you still taking those or left? if left then why?
7)Was your T3,T4,TSH done by doctor? was it ok ?
8) what about cholesterol?
9) Do you have your stress test(radio test with increased heart rate using drugs) reports?
Pardon me for asking so many questions , but i would like to come up with a more helpful answer this needed more info after your reply.
Dr.Muhammad Ahmad
Resident M.D. Cardiology.
Things are getting clearer ...!!
Detailed Answer:
Hi,
Thanks for such a detailed reply and reports i am getting a clear picture of your issues ,
I can now tell possible causes of tachycardia and cause of your heart rate increase after you eat, i will also give you tips to control this thing.
I just need to get some more info from you this will enable me to give you a better answer , I would like you to add some more info about following points:
1) Does tachy cardia happen after every single meal , or when you do some binge eating?
2) Did your doctor tell you that your weight is most likely the cause of sleep apnoea and you need to reduce it?
3)Are you doing anything to reduce it?
5) At what times you take lopressor?
4) At what time the tachycardia episodes happen these days? do they usually happen in evening? 5pm-9pm? or there's no pattern?
5) Does your pulse usually stay regular ? or it beats in irregular intervals?
6) You were started on XARELTO tablets... are you still taking those or left? if left then why?
7)Was your T3,T4,TSH done by doctor? was it ok ?
8) what about cholesterol?
9) Do you have your stress test(radio test with increased heart rate using drugs) reports?
Pardon me for asking so many questions , but i would like to come up with a more helpful answer this needed more info after your reply.
Dr.Muhammad Ahmad
Resident M.D. Cardiology.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1-When I eat usually a large meal. I would tend to eat large lunches and a large dinner for years. Lately this is an issue. Every event lately was after eating with 30 minutes. Eating smaller meals doesnt appear to increase heart rate.
2-weight does a play a part, in fact I was actually 314 when the Feb16 event occured. Scared to eat alot and I have lost 14 pounds. Still 50 pounds over from where I was 6 years ago. yes I need to lose weight
3-yes, I have decided a few weeks ago i need to get the weight off, even discussed a few months ago about a band system. I just need to eat less.
4-usually 2pm-6pm and usually there is some type of food eaten. Original situations in 2013 was only in morning after waking up.
5-Sinus rhythm, beats are normal on every ekg 12 lead. I will say however from feb 16th till the new machine my heart beat contraction was very strong. instead of boom-boom it was BOOM-BOOM. Also heart beat would over react to any movement. If I went up stairs it would go up but stay up for 10 min. Last few days it goes up but recovers after 2 minutes.
6-they took me off Xarelto 6 months ago since everything was good. They only put me on after the cardioversion temporarily.
7-I will check but if its thyroid they stated all good. They were checking for thyroidism but all blood tests were normal. I even asked about this and they said thyroid was normal.
8-Cholesterol I'm not sure but I haven't had any issues nor do I have diabetes.
9-I will have to get. Cardiologist stated all tests including stress test were normal no arrhythmia and efraction rate 67%. Heart was structually solid. I was released from Hospital.
One last thing, I do check my heart rate probably too often. I can tell you that my heart rate is a normal boom-boom and the contraction of the pumping action seems normal. When these events happened my pulse seems to be tense and reacting to every little movement and the heart seems like it wants to run away and the contraction seems very intense with each beat. Yesterdays event however just seemed to be fast and the pumping contractions seemed normal. I did take an extra Lopressor 25mg and laid down which helped. Still feel something is causing these events.
thank you for helping
2-weight does a play a part, in fact I was actually 314 when the Feb16 event occured. Scared to eat alot and I have lost 14 pounds. Still 50 pounds over from where I was 6 years ago. yes I need to lose weight
3-yes, I have decided a few weeks ago i need to get the weight off, even discussed a few months ago about a band system. I just need to eat less.
4-usually 2pm-6pm and usually there is some type of food eaten. Original situations in 2013 was only in morning after waking up.
5-Sinus rhythm, beats are normal on every ekg 12 lead. I will say however from feb 16th till the new machine my heart beat contraction was very strong. instead of boom-boom it was BOOM-BOOM. Also heart beat would over react to any movement. If I went up stairs it would go up but stay up for 10 min. Last few days it goes up but recovers after 2 minutes.
6-they took me off Xarelto 6 months ago since everything was good. They only put me on after the cardioversion temporarily.
7-I will check but if its thyroid they stated all good. They were checking for thyroidism but all blood tests were normal. I even asked about this and they said thyroid was normal.
8-Cholesterol I'm not sure but I haven't had any issues nor do I have diabetes.
9-I will have to get. Cardiologist stated all tests including stress test were normal no arrhythmia and efraction rate 67%. Heart was structually solid. I was released from Hospital.
One last thing, I do check my heart rate probably too often. I can tell you that my heart rate is a normal boom-boom and the contraction of the pumping action seems normal. When these events happened my pulse seems to be tense and reacting to every little movement and the heart seems like it wants to run away and the contraction seems very intense with each beat. Yesterdays event however just seemed to be fast and the pumping contractions seemed normal. I did take an extra Lopressor 25mg and laid down which helped. Still feel something is causing these events.
thank you for helping
Brief Answer:
Things are controllable
Detailed Answer:
Hi,
Thanks for writing back in such detail and providing me with really useful documents which helped me to understand the issue and helped me to come up with an answer.I have seen the hospital stay pics too...
It's a pleasure to know that you don't have a major heart diseases apparently, and your reports are good too, You seem to have two main issues Heart rate and sleep apnoea , and i will try to touch both in my answer.
Apnoea:
Sleep apnoea in your case has 90% to do with your weight, more fat in body increases more fat in tongue and pharyngeal muscles tongue get heavy and it falls back on your respirator passage closing it, if you can lose your weight
, if you can lose 50 pounds you will see a marked improvement in both your heart and apnoea issues, your ideal target is 200 pound , you got to lose 100 ponds and believe me if you can do it there is every chance that 80% of your problems will leave you by themselves and your medicine doses will be reduces too, it sounds hard but commitment, a good trainer, and determination can make you do it.
HEART:
What did you have:
It was A-fib and your ventricles were producing PVC (premature ventricular contraction) , that's what ECG machine called "rapid vent response". Well that wasn't dangerous neither A-fib is dangerous , but PVC can change into ventricular tachycardia which is life threatening emergency so they cardioverted you.
What to do next?
1) Number one priority is that we control heart rat normally at 60-80 and during exercise under 130.. this is already happening well in your case, I don't think there is any thing to worry specially if your heart is beating after regular intervals not irregularly...Even if its in A-FIB (irregularly irregular beating) still rate control is first option.
2) Second thing we do is to find focus of ischemia or dead cell patch in heart , which was NOT present in your heart which is a good news.
3) Third thing we do is electro physiological test , Main stay of this testing is Holter Monitoring, I will suggest you to get it done as soon as possible and when it's being done, don't halt your activities,, lead a normal life , in fact exercise too ,,, so that your response of food exercise can be recorded.
4) If Holter finds a significant problem, then tests are done to find out the focus which is producing those rapid electric waves causing heart to contract.
5) After finding the focus if doctor finds indication he can use "catheter ablation " technique to kill that focus and patient no more suffers tachycardia , at least from that focus.
Why tachycardia on eating:
Our body is smart, when we eat , body sends its blood to our intestines so that blood can absorb food particles and carry this nutrition to all parts of the body, when blood drains from other parts of body and less blood is left for vital organs,, heart beats fast and force fuly to compensate the deficit, this is just a normal process , happens in me, in you and all in all other people living, specially those who have a habit to take big meals, big meals need more blood to get absorbed and more blood drained from body means more stronger heart beat.
You are sensing this more because you are conscious about your beats..
Your ejection fraction is 65% and that's just great and tells me how good your heart is.
If you have any questions about ablation or something you are welcome to ask.
What can be reason of tachycardia:
1) Anxiety
2) You are over weight so heart needs to beat more to compensate bigger body.
3) Low oxygen due to sleep apnoea so heart has to compensate the oxygen deficit, as your apnoea is getting better you might have noticed that heart is getting better too.
4) There my be a point in heart which is letting impulses run hey wire this will be found after your doctor gets Holter results .
SUGGESTIONS:
1) Don't panic .
2) Go for holter's and you can share the results with me for further guidance if you feel like.
3) After Holter talk to your doctor if you need any medicine change or Catheter Ablation.
4) You can do exercise start with what you can bear , in which your heart stays in limits then gradually step up as your body gets used to it.
5) Don;t eat big meals eat 5 smaller meals if you eat 3 big ones..
6) Try to reduces weight , you might want to join a gym under a good trainer.
7) Don't worry about normal increase is heart rate with meals , anxiety , anger and exercise that is just normal..but yes if its more than 140 then take half lopresor.
8) Your don't need to take lopressor three times a day as such coz it can make your heart get real slow its 69 now overdose will make it 50 this will not be good,
9) When beat is high stay calm and lie down , wait for it to get slower , dont take lopresor immediately ,,keep it as last resort.
10) There are many methods to reduce heart rate immediately like valsalva maneuver and carotid massage but please please please learn carotid massage before you do it.. and never ever do it on both sides at the same time, it can prove dangerous , it can lower heart rate dangerously, but well it's a useful method if done right.
11)Your one and only aim is to lose weight .
Hope I have answered your query. If you have any further questions I will be happy to help if not then don't forget to close the discussion and rate it.
Wishing you good health !!
You can always get back to me directly at :
http://doctor.healthcaremagic.com/doctors/dr-muhammad-ahmad/69304
Dr.Muhammad Ahmad
Resident M.D. Cardiology.
Things are controllable
Detailed Answer:
Hi,
Thanks for writing back in such detail and providing me with really useful documents which helped me to understand the issue and helped me to come up with an answer.I have seen the hospital stay pics too...
It's a pleasure to know that you don't have a major heart diseases apparently, and your reports are good too, You seem to have two main issues Heart rate and sleep apnoea , and i will try to touch both in my answer.
Apnoea:
Sleep apnoea in your case has 90% to do with your weight, more fat in body increases more fat in tongue and pharyngeal muscles tongue get heavy and it falls back on your respirator passage closing it, if you can lose your weight
, if you can lose 50 pounds you will see a marked improvement in both your heart and apnoea issues, your ideal target is 200 pound , you got to lose 100 ponds and believe me if you can do it there is every chance that 80% of your problems will leave you by themselves and your medicine doses will be reduces too, it sounds hard but commitment, a good trainer, and determination can make you do it.
HEART:
What did you have:
It was A-fib and your ventricles were producing PVC (premature ventricular contraction) , that's what ECG machine called "rapid vent response". Well that wasn't dangerous neither A-fib is dangerous , but PVC can change into ventricular tachycardia which is life threatening emergency so they cardioverted you.
What to do next?
1) Number one priority is that we control heart rat normally at 60-80 and during exercise under 130.. this is already happening well in your case, I don't think there is any thing to worry specially if your heart is beating after regular intervals not irregularly...Even if its in A-FIB (irregularly irregular beating) still rate control is first option.
2) Second thing we do is to find focus of ischemia or dead cell patch in heart , which was NOT present in your heart which is a good news.
3) Third thing we do is electro physiological test , Main stay of this testing is Holter Monitoring, I will suggest you to get it done as soon as possible and when it's being done, don't halt your activities,, lead a normal life , in fact exercise too ,,, so that your response of food exercise can be recorded.
4) If Holter finds a significant problem, then tests are done to find out the focus which is producing those rapid electric waves causing heart to contract.
5) After finding the focus if doctor finds indication he can use "catheter ablation " technique to kill that focus and patient no more suffers tachycardia , at least from that focus.
Why tachycardia on eating:
Our body is smart, when we eat , body sends its blood to our intestines so that blood can absorb food particles and carry this nutrition to all parts of the body, when blood drains from other parts of body and less blood is left for vital organs,, heart beats fast and force fuly to compensate the deficit, this is just a normal process , happens in me, in you and all in all other people living, specially those who have a habit to take big meals, big meals need more blood to get absorbed and more blood drained from body means more stronger heart beat.
You are sensing this more because you are conscious about your beats..
Your ejection fraction is 65% and that's just great and tells me how good your heart is.
If you have any questions about ablation or something you are welcome to ask.
What can be reason of tachycardia:
1) Anxiety
2) You are over weight so heart needs to beat more to compensate bigger body.
3) Low oxygen due to sleep apnoea so heart has to compensate the oxygen deficit, as your apnoea is getting better you might have noticed that heart is getting better too.
4) There my be a point in heart which is letting impulses run hey wire this will be found after your doctor gets Holter results .
SUGGESTIONS:
1) Don't panic .
2) Go for holter's and you can share the results with me for further guidance if you feel like.
3) After Holter talk to your doctor if you need any medicine change or Catheter Ablation.
4) You can do exercise start with what you can bear , in which your heart stays in limits then gradually step up as your body gets used to it.
5) Don;t eat big meals eat 5 smaller meals if you eat 3 big ones..
6) Try to reduces weight , you might want to join a gym under a good trainer.
7) Don't worry about normal increase is heart rate with meals , anxiety , anger and exercise that is just normal..but yes if its more than 140 then take half lopresor.
8) Your don't need to take lopressor three times a day as such coz it can make your heart get real slow its 69 now overdose will make it 50 this will not be good,
9) When beat is high stay calm and lie down , wait for it to get slower , dont take lopresor immediately ,,keep it as last resort.
10) There are many methods to reduce heart rate immediately like valsalva maneuver and carotid massage but please please please learn carotid massage before you do it.. and never ever do it on both sides at the same time, it can prove dangerous , it can lower heart rate dangerously, but well it's a useful method if done right.
11)Your one and only aim is to lose weight .
Hope I have answered your query. If you have any further questions I will be happy to help if not then don't forget to close the discussion and rate it.
Wishing you good health !!
You can always get back to me directly at :
http://doctor.healthcaremagic.com/doctors/dr-muhammad-ahmad/69304
Dr.Muhammad Ahmad
Resident M.D. Cardiology.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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