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Suggest Treatment For Tachycardia Caused By Marijuana
Question: Recently, I've been experiencing a dramatic increase in PVC/PAC/ectopic beats. At times my heart rhythm feels chaotic. Also, the thumps in my chest that normally happen when exercising are getting stronger, like a club is hitting my chest.
I have a hard time exercising; partly because of fear, but weightlifting did make me excessively short of breath the other day. And cardio workouts are tolerable but cause abnormal beats.
My history includes elevated systolic BP (never clinical, though), recently elevated diastolic (85 diastolic), one ecg with equivocal long qt. I exercise and lift weights so probably have enlarged heart from that (that's just an assumption).
I also had cannabis-induced tachycardia for four hours last spring, and heart hasn't felt the same since.
I am 29 yo male.
How bad does this sound? I know it pretty bad, but I'm worried about my stress echo next week... when my heart gets beating very fast (like with extreme exercise) it can't maintain normal rhythm without extra, premature, or mis-fired beats).
I have a hard time exercising; partly because of fear, but weightlifting did make me excessively short of breath the other day. And cardio workouts are tolerable but cause abnormal beats.
My history includes elevated systolic BP (never clinical, though), recently elevated diastolic (85 diastolic), one ecg with equivocal long qt. I exercise and lift weights so probably have enlarged heart from that (that's just an assumption).
I also had cannabis-induced tachycardia for four hours last spring, and heart hasn't felt the same since.
I am 29 yo male.
How bad does this sound? I know it pretty bad, but I'm worried about my stress echo next week... when my heart gets beating very fast (like with extreme exercise) it can't maintain normal rhythm without extra, premature, or mis-fired beats).
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
Regarding your concern about heart rhythm issues, I would like to explain that since ectopic beats and chaotic rhythm are triggered by physical exertion, the most probable explanation seems to be an increased sympathetic nervous system tone (with increased blood levels of epinephrine and norepinephrine).
From the other part, cannabis may also be responsible for stimulating sympathetic nervous system and decreasing parasympathetic tone, leading that way to increased risk for tachycardia, atrial fibrillation and ventricular ectopic beats. This may be also emphasized by adversely affecting coronary microcirculation and altering electrical activity of Purkinje fibres.
Nevertheless, I recommend you to not worry too much, as far as you have a normal cardiac structure and function, and you are not any more on cannabis influence.
I recommend performing an ambulatory 24 to 48 hours ECG monitoring (Holter) for a better investigation of your arrhythmic events during physical exertion (qualitatively and quantitatively).
Also a complete blood count, thyroid function tests and blood electrolytes level should be checked to rule out any underlying abnormalities.
Your stress cardiac ultrasound will definitely elucidate your heart reaction (functional properties) during physical exertion.
Meanwhile, I recommend you to avoid strenuous training (weight lifting) until all the recommended cardiac tests are concluded.
Hope to have been helpful to you.
Feel free to ask me whenever you need!
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
Regarding your concern about heart rhythm issues, I would like to explain that since ectopic beats and chaotic rhythm are triggered by physical exertion, the most probable explanation seems to be an increased sympathetic nervous system tone (with increased blood levels of epinephrine and norepinephrine).
From the other part, cannabis may also be responsible for stimulating sympathetic nervous system and decreasing parasympathetic tone, leading that way to increased risk for tachycardia, atrial fibrillation and ventricular ectopic beats. This may be also emphasized by adversely affecting coronary microcirculation and altering electrical activity of Purkinje fibres.
Nevertheless, I recommend you to not worry too much, as far as you have a normal cardiac structure and function, and you are not any more on cannabis influence.
I recommend performing an ambulatory 24 to 48 hours ECG monitoring (Holter) for a better investigation of your arrhythmic events during physical exertion (qualitatively and quantitatively).
Also a complete blood count, thyroid function tests and blood electrolytes level should be checked to rule out any underlying abnormalities.
Your stress cardiac ultrasound will definitely elucidate your heart reaction (functional properties) during physical exertion.
Meanwhile, I recommend you to avoid strenuous training (weight lifting) until all the recommended cardiac tests are concluded.
Hope to have been helpful to you.
Feel free to ask me whenever you need!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello,
Blood tests (electrolytes, thyroid, magnesium) were normal.
Stress test showed three PVCs; two during 15 minutes of exercise, and one after during recovery. I felt one of them.
Despite this, Dr says test was "normal." I dont have details on echo, but that was said to be normal.
With this in mind, is there any further testing to consider (of course with Dr consult)?
Blood tests (electrolytes, thyroid, magnesium) were normal.
Stress test showed three PVCs; two during 15 minutes of exercise, and one after during recovery. I felt one of them.
Despite this, Dr says test was "normal." I dont have details on echo, but that was said to be normal.
With this in mind, is there any further testing to consider (of course with Dr consult)?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hi again,
Coming to this point, where cardiac ultrasound coupled with stress testing resulted normal (as three isolated PVCs are completely clinically unimportant), I would explain that you are not at risk of continuing your physical exertion.
But, at one condition; you should exert following a well scheduled physical training; possibly under the supervision of a certified exercise instructor.
You shouldn't practice those physically overloaded weight lifting, as it doesn't yield any additional benefits from a normally scheduled training.
From the other part, as I explained you before, an ambulatory ECG monitoring test (Holter) would be necessary to conclude over PVCs trend during the day-night interval.
Regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hi again,
Coming to this point, where cardiac ultrasound coupled with stress testing resulted normal (as three isolated PVCs are completely clinically unimportant), I would explain that you are not at risk of continuing your physical exertion.
But, at one condition; you should exert following a well scheduled physical training; possibly under the supervision of a certified exercise instructor.
You shouldn't practice those physically overloaded weight lifting, as it doesn't yield any additional benefits from a normally scheduled training.
From the other part, as I explained you before, an ambulatory ECG monitoring test (Holter) would be necessary to conclude over PVCs trend during the day-night interval.
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My Dr did have me do a 48 hour Holter, which initial report said was "normal." I don't have info as to how many PVCs there were in 48 hours.
Some days/periods of time have many, many PVCs. Other periods of time they go away. Although the last few weeks have been very bad with a lot of PVCs.
Some days/periods of time have many, many PVCs. Other periods of time they go away. Although the last few weeks have been very bad with a lot of PVCs.
Brief Answer:
That frequent palpitations feeling should be further investigated.
Detailed Answer:
Hi,
As your doctor has considered your previous Holter normal, then there must have been quite a few ectopic beats without any clinical significance.
Regarding your actual feeling of more frequent ectopic beats, probably it's the right time to discuss with your attending cardiologist for a new Holter tests.
I also encourage you to consider the above mentioned advices about physical training.
Best wishes,
Dr. Iliri
That frequent palpitations feeling should be further investigated.
Detailed Answer:
Hi,
As your doctor has considered your previous Holter normal, then there must have been quite a few ectopic beats without any clinical significance.
Regarding your actual feeling of more frequent ectopic beats, probably it's the right time to discuss with your attending cardiologist for a new Holter tests.
I also encourage you to consider the above mentioned advices about physical training.
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes, thank you for the insight. Now, for my last follow-up question.
Echo showed "trivial" regurgitation in both mitral and tricuspid valves. 62 EF. Structure and motion normal.
My 12-lead ekg showed QTc of 495 ms, with T-U fusion noted. It also had nonspecific T-wave abnormality, noting "myocardial changes" (this was listed on 12-lead ekg report done a week before the echo)
My blood potassium was normal. With a normal echo, does the T-U fusion indicate anything bad (such as CNS issues)?
Thanks for your insight..
Echo showed "trivial" regurgitation in both mitral and tricuspid valves. 62 EF. Structure and motion normal.
My 12-lead ekg showed QTc of 495 ms, with T-U fusion noted. It also had nonspecific T-wave abnormality, noting "myocardial changes" (this was listed on 12-lead ekg report done a week before the echo)
My blood potassium was normal. With a normal echo, does the T-U fusion indicate anything bad (such as CNS issues)?
Thanks for your insight..
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
As your cardiac ultrasound confirms normal heart structure and function, that is not the case with your ECG.
QTc interval seems to be prolonged (>450 ms) and some nonspecific T wave abnormalities need to be differentiated (is it a congenital long QT syndrome or another conductance disorder).
A direct review of your ECG recordings is necessary to rule out also a false ECG machine interpretation.
A differential diagnosis should be done regarding T-U wave interaction, as there are many several patterns of T-U waves ( positive, inverted, etc) interaction, but generally speaking a serious cardiac implication is hardly drawn by just an isolated T-U wave pattern (whichever it could be).
So relax! There is nothing to worry too much about T-U wave interaction, as they are frequently superimposed.
If you could upload the underlying ECG recordings, it would be helpful in giving a more direct professional opinion.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
As your cardiac ultrasound confirms normal heart structure and function, that is not the case with your ECG.
QTc interval seems to be prolonged (>450 ms) and some nonspecific T wave abnormalities need to be differentiated (is it a congenital long QT syndrome or another conductance disorder).
A direct review of your ECG recordings is necessary to rule out also a false ECG machine interpretation.
A differential diagnosis should be done regarding T-U wave interaction, as there are many several patterns of T-U waves ( positive, inverted, etc) interaction, but generally speaking a serious cardiac implication is hardly drawn by just an isolated T-U wave pattern (whichever it could be).
So relax! There is nothing to worry too much about T-U wave interaction, as they are frequently superimposed.
If you could upload the underlying ECG recordings, it would be helpful in giving a more direct professional opinion.
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
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