Transient episodes of tachycardia

[DwayneEMTP]

Hey all,

So, twice during the last week I've had single instances of transient episodes of tachycardia that have awaked me during the night. They were about 5 days apart or so.

(Disclaimer. No opinions given here will be considered advice, nor will change the course I choose to follow regarding this issue. This is posted for educational and discussion purposes only.)

I awoke to feel my heart pounding, was a bit flushed. Though not diaphoretic, I had that prickly feeling in my face and arms that seems to precede it. Slight dispnea, no chest pain or pressure, slight dizziness, but I'm unsure if that was from physiology or from anxiety over the episode.

My pulse rate would run up to around 130, pulse bounding, I was very cardiac aware so unsure if there was anything unusual there or if my attention made it seem that my heart was beating harder than usual.

The first episode lasted (not timed, my 'feeling' only) maybe 4-5 mins with me kind of freaking, (breathing slowly, trying to stay calm) out before it occured to me to try and v/v (vasovagal) it down, which I was able to do by holding my breath and bearing down. Rate quickly (15-20 secs) dropped to around 80 (baseline is 60ish), stayed there for "a couple of minutes" and then over approximately a minute and a half to two minutes crawled back up to the 130's. I was again able to v/v back down. I v/v four or five times over, what Babs tells, me was a half hour or so before things seemed to settle down and stay put.

The second episode was more or less the same though the duration was approx. 15 minutes this time. Was able to mitigate several times with carotid massage. (It was interesting to try these techniques on myself. It finally occurred to me to have Babs get me a cold towel for my face to see how that compared, but the issue didn't repeat for me to try it. Though it will be on the top of my list for next time.)

No other s/s that I'm aware of surrounding these episodes or in daily life.

49 years old, 6'/220lbs, asymptomatic during regular exercise, lifetime smoker, no significant previous medical history, no n/v, chest pain/pressure, has regular physicals/ECGs due to work, no illegal drug use, no prescription meds, Melatonin periodically for sleep, but not on these occasions, OTCs periodically for head/backache, baseline vitals P 60ish, BP 126/74, RR 12ish with no history of respiratory issues, no recent illness, no unusual stresses.

It did kind of feel like times gone by when I'd have an anxiety attack, but there was no tachypnea and controlling my breathing didn't seem to mitigate the issues in any way.

So what do you think? I've googled it and visited my favorite med pages and can see where this is sometimes caused by meds, which don't apply here, and other times by cardiac blocks, though that usually causes more regular and persistent symptoms if it causes any....It's curious...

Dwayne

[Curiosity]

Electrolyte imbalance (poor diet), stimulants (caffeine), smoking, stress

Those were the causes given to me by my doc for the frequent PVCs I was getting. I would suddenly feel like my heart was going to explode out of my chest. I sometimes find myself with a sudden spike in hr to around 120. Usually happens later in the day after a coffee and smoke diet though.

[Kiwiology]

Clearly it is the stress of not having come to New Zed and had a BBQ with us ... well its kinda rainy here this weekend, might want to come next week.

[Arctickat]

Get back to the jungle, you're in withdrawl.

[island emt]

Were you home in bed with your wife instead of a PNG sheep??? :-}

Just kidding

It sounds like time to see the doc and describe the S&S and possibly a holter monitor for a couple days to see if it can be captured.

49 is NOT too young to have cardiac issues. Not something to fool around with.

Make the appt NOW

[Kaisu]

I echo island.. Good advice. Do it!

[DwayneEMTP]

So, bless you both for your concern, (cincerly) but you all suck at scenarios...

What is your treatment, advice, differential, diagnosis,? (I swear, if you claim that EMS doesn't diagnose I'll kick your balls/ovaries right up next to your tonsils)

[ERDoc]

Could be paroxysmal SVT or afib, reflux, pheochromocytoma, cardiac ischemia. Have I scared you enough to get you to a doctor? Workup would include EKG, Holter, bmp, troponin, TSH, 24 hour urine to start. I think a little pt education is in order to discuss the seriousness of any chest symptoms in a middle aged, life long smoker who knows better.

[Kaisu]

... and he calls me pigheaded. Get your fat ass to the doctor Dwayne, or I will storm down there and kick the farts out of you...

[rock_shoes]

Could be paroxysmal SVT or afib, reflux, pheochromocytoma, cardiac ischemia. Have I scared you enough to get you to a doctor? Workup would include EKG, Holter, bmp, troponin, TSH, 24 hour urine to start. I think a little pt education is in order to discuss the seriousness of any chest symptoms in a middle aged, life long smoker who knows better.

Seriously, listen to what ERDoc is saying if you haven't already. I do however expect that you've had proper follow up and are now posting it as a case study. In my experience you can be stubborn but you're not a complete dumbass and would follow up appropriately.

In the interest of aiding the differential, any recent cough, cold, flu, or vaccinations (generally any potential exposure to an infective process be it viral, bacterial, parasitic, or even fungal)? Any relevant family history (CAD, diabetes, arrhythmias, etc.)? How about heart tones? Everything lubbing and dubbing the way it's supposed to? You didn't happen to have a monitor to throw yourself on while this was happening did you? How about vitals during the episode?

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