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What Should Be The Heart Beat Rate When Suffering From Sinus Tachycardia?
Question: I am a 40 years old female diagnosed with breast cancer in 2010. Had modified radical mastectomy for right breast, chemo and radiation. In 2010 I started feeling palpitations and had rushed to the ER several times. My heart rate is 110-115 most of the times. I did an echo in 2010 which came normal except for mild M and mild TR. I repeated the echo in 2012 and cam with same result. I saw a cardiologist in 2012 who put me on event holter monitor and result was normal. I have a history of GAD and panic disorders. The psychiatrist prescribed Lorans 1 mg and Cipralex 10 mg which I did not use the last because afraid of side effects.
I am on Tamoxefin and baby dose aspirin.
The palpitations recently within the last year have been so annoying. They wake me up from sleep, my heart pounds so hard as if it wants to get out of my chest. Sometimes it beats steady but too strong. It happens mostly in the morning when I wake up and fades during the day and so on. Normally my heart rate could be 100 or 110. When no palpitations it could be 90 or 90+. I also experience lately buzzing and vibrating sensation in my chest at the time of the palpitations and sometimes I feel as if my heart is shivering.
I saw 9 cardiologists and they all did an echo which came normal except for trivial MR.. They prescribed Cardex 2.5 mg but did not take it since it was debatable between my doctors.
I sometimes feel heart fluttering and heart murmur, an extra beat or a skipped beat. I had 50 ECGs done and all came normal with sinus rhythm or sinus tachycardia.
I am on constant fear and worry that I will get a heart attack, I anticipate the upcoming beats and fear from any flutter.
My questions are:
1. What XXXXXXX heart beats is acceptable for sinus tachycardia? I mean can my heart suddenly go wild and crazy and beat over 150? If this happens is it still normal?
2. Do I need to conduct further testing? My blood works are all normal?
3. I tried other tools to lower heart rate like cold water, breathing..etc but did not work?
4. Am I at risk of heart attack or heart disease?
My symptoms are:
Palpitations
Dry mouth
sweating from left hand only
Pressure in the neck at times of palpitations
Unsteadiness (not dizzy or light headed) but I just feel imbalanced
History of low blood pressure 100/60 always
Very thin 39 kg and height is 167 cm
I am on Tamoxefin and baby dose aspirin.
The palpitations recently within the last year have been so annoying. They wake me up from sleep, my heart pounds so hard as if it wants to get out of my chest. Sometimes it beats steady but too strong. It happens mostly in the morning when I wake up and fades during the day and so on. Normally my heart rate could be 100 or 110. When no palpitations it could be 90 or 90+. I also experience lately buzzing and vibrating sensation in my chest at the time of the palpitations and sometimes I feel as if my heart is shivering.
I saw 9 cardiologists and they all did an echo which came normal except for trivial MR.. They prescribed Cardex 2.5 mg but did not take it since it was debatable between my doctors.
I sometimes feel heart fluttering and heart murmur, an extra beat or a skipped beat. I had 50 ECGs done and all came normal with sinus rhythm or sinus tachycardia.
I am on constant fear and worry that I will get a heart attack, I anticipate the upcoming beats and fear from any flutter.
My questions are:
1. What XXXXXXX heart beats is acceptable for sinus tachycardia? I mean can my heart suddenly go wild and crazy and beat over 150? If this happens is it still normal?
2. Do I need to conduct further testing? My blood works are all normal?
3. I tried other tools to lower heart rate like cold water, breathing..etc but did not work?
4. Am I at risk of heart attack or heart disease?
My symptoms are:
Palpitations
Dry mouth
sweating from left hand only
Pressure in the neck at times of palpitations
Unsteadiness (not dizzy or light headed) but I just feel imbalanced
History of low blood pressure 100/60 always
Very thin 39 kg and height is 167 cm
Brief Answer:
please see details
Detailed Answer:
Dear Madam
1. If you could get an ECG at time of palpitation and it showed sinus tachycardia, or a holter reading reflected sinus tachycardia at time of your symptoms , then it is not a negative finding; it says that you get sinus tachycardia at time of your symptoms. Sinus tachycardia can have very high heart rates, sometime more than 200 beats per minute. There is no definite cut-off, however clinical dictum is to suspect other rhythm disorders in heart rates more than 180 beats per min. Most important factor in work-up of palpitation is establishing rhythm at time of palpitation. If this turns out to be sinus tachycardia, then we look for a precipitating or secondary cause. The causes may include stress, anxiety, panic, coffee, tea, fever, medicines, anemia, thyroid disorders etc. If definite cause is not found and episodes occur repeatedly we call it "inappropriate sinus tachycardia" which is not a common entity.
2. If by this time, the rhythm at time of palpitation has not been diagnosed, further work-up is required to ascertain it. This may include extended holter monitoring or loop recording. The episode should occur during the application of these devices to ascertain the rhythm.
3. The effectiveness of these maneuvers depend upon the mechanism of rhythm disorder. They may not work well in sinus tachycardia and many other rhythms.
4. Episodic increase in heart rate which is possibly sinus tachycardia do not increase the risk of heart attack or heart disease per say. Only persistent increase in heart rate beyond 100 bpm may result into development of tachycardiomyopathy. The most common cause of this weakening of heart is a rhythm disorder called atrial fibrillation , which you do not have. Rather than this episodic increase in your heart rate, the anxiety/ stress associated with it may be more harmful to your heart.
5. The use cardex is common for such patients in our practice. I do not understand what was the disagreement between your physicians.
Hope this helps. Feel free to discuss further.
Sincerely
Sukhvinder
please see details
Detailed Answer:
Dear Madam
1. If you could get an ECG at time of palpitation and it showed sinus tachycardia, or a holter reading reflected sinus tachycardia at time of your symptoms , then it is not a negative finding; it says that you get sinus tachycardia at time of your symptoms. Sinus tachycardia can have very high heart rates, sometime more than 200 beats per minute. There is no definite cut-off, however clinical dictum is to suspect other rhythm disorders in heart rates more than 180 beats per min. Most important factor in work-up of palpitation is establishing rhythm at time of palpitation. If this turns out to be sinus tachycardia, then we look for a precipitating or secondary cause. The causes may include stress, anxiety, panic, coffee, tea, fever, medicines, anemia, thyroid disorders etc. If definite cause is not found and episodes occur repeatedly we call it "inappropriate sinus tachycardia" which is not a common entity.
2. If by this time, the rhythm at time of palpitation has not been diagnosed, further work-up is required to ascertain it. This may include extended holter monitoring or loop recording. The episode should occur during the application of these devices to ascertain the rhythm.
3. The effectiveness of these maneuvers depend upon the mechanism of rhythm disorder. They may not work well in sinus tachycardia and many other rhythms.
4. Episodic increase in heart rate which is possibly sinus tachycardia do not increase the risk of heart attack or heart disease per say. Only persistent increase in heart rate beyond 100 bpm may result into development of tachycardiomyopathy. The most common cause of this weakening of heart is a rhythm disorder called atrial fibrillation , which you do not have. Rather than this episodic increase in your heart rate, the anxiety/ stress associated with it may be more harmful to your heart.
5. The use cardex is common for such patients in our practice. I do not understand what was the disagreement between your physicians.
Hope this helps. Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
thanks for the very constructive reply.
1. If my heart rate goes high, what is the normal course of action, lay down and rest or rush to the ER. Do they give you medications to lower the fast heart rate?
2. Do I need further testing like stress test or tilt table?
3. Is the buzzing and vibrating sensation related to my palpitations?
4. The ECG at time of palpitations in one event showed a systolic beat which the doctor says is benign, is that true?
5. Is mild TR and MR cause of any risk or future developments?
6. If the cause of ST is anxiety would still Cardex be a good option? does it effect my low blood pressure?
7. The cardiologists here never heard or read about inappropriate ST, where can I get more info about it?
8. Is Echo a good tool to measure heart effectiveness and health?
1. If my heart rate goes high, what is the normal course of action, lay down and rest or rush to the ER. Do they give you medications to lower the fast heart rate?
2. Do I need further testing like stress test or tilt table?
3. Is the buzzing and vibrating sensation related to my palpitations?
4. The ECG at time of palpitations in one event showed a systolic beat which the doctor says is benign, is that true?
5. Is mild TR and MR cause of any risk or future developments?
6. If the cause of ST is anxiety would still Cardex be a good option? does it effect my low blood pressure?
7. The cardiologists here never heard or read about inappropriate ST, where can I get more info about it?
8. Is Echo a good tool to measure heart effectiveness and health?
Brief Answer:
Please see below.
Detailed Answer:
Dear Madam
1. If your heart rate increases and you feel bad or symptomatic like marked uneasiness, shortness of breath or altered consciousness, seek help immediately and get medical assistance at once.
2. Every test has specific indications and usefulness. Your symptoms warrant knowing the heart rhythm at time of palpitation which both these tests may not provide. I discussed about further testing in first answer.
3. This may result from mechanism or palpitation or pure anxiety associated with it.
4. "Systolic beat" is not a standard medical term. Most commonly episodic palpitations are cause by premature contractions and post extra-systolic pauses. When these have normal underlying heart on ECHO, they are indeed considered benign.
5. Mild MR and Mild TR may be present in normal individual and they may be precursor of severe lesions. However, they are considered benign when there is no significant valvular lesion or abnormal morphology. Your ECHO reports possibly did not indicate that there is anything related to valve morphology.
6. Yes, if cause of sinus tachycardia is anxiety, Cardex may still be useful. You have "low blood pressure as compared to others" but for your body it is adequate. Yes it does lower blood pressure but does not necessarily means a harm to body.
7. Inappropriate sinus tachycardia is a well known entity in cardiology and can be found in any standard literature related to heart rhythm disorders.
8. As I said previously, all tests are meant for specific purpose and have specific indications. They provide specific information. ECHO do provide us with pumping capability of heart and tell about structural heart diseases.
In general a very good indicator of cardiac health is exercise capacity.
sincerely
Sukhvinder
Please see below.
Detailed Answer:
Dear Madam
1. If your heart rate increases and you feel bad or symptomatic like marked uneasiness, shortness of breath or altered consciousness, seek help immediately and get medical assistance at once.
2. Every test has specific indications and usefulness. Your symptoms warrant knowing the heart rhythm at time of palpitation which both these tests may not provide. I discussed about further testing in first answer.
3. This may result from mechanism or palpitation or pure anxiety associated with it.
4. "Systolic beat" is not a standard medical term. Most commonly episodic palpitations are cause by premature contractions and post extra-systolic pauses. When these have normal underlying heart on ECHO, they are indeed considered benign.
5. Mild MR and Mild TR may be present in normal individual and they may be precursor of severe lesions. However, they are considered benign when there is no significant valvular lesion or abnormal morphology. Your ECHO reports possibly did not indicate that there is anything related to valve morphology.
6. Yes, if cause of sinus tachycardia is anxiety, Cardex may still be useful. You have "low blood pressure as compared to others" but for your body it is adequate. Yes it does lower blood pressure but does not necessarily means a harm to body.
7. Inappropriate sinus tachycardia is a well known entity in cardiology and can be found in any standard literature related to heart rhythm disorders.
8. As I said previously, all tests are meant for specific purpose and have specific indications. They provide specific information. ECHO do provide us with pumping capability of heart and tell about structural heart diseases.
In general a very good indicator of cardiac health is exercise capacity.
sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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