AboutDavid Richardson Expertise Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.
Experience Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.
Organizations Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..
Publications Circulation, American Heart Journal, Hypertension.
Education/Credentials M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.
Awards and Honors Gold Heartt Award from American Heart Association in 1995.
Question I have had short episodes where my heart feels like it is racing, I get dizzy, and sometimes nauseous, off and on my entire life. Early this year - some time in February - I contracted a virus and the "spells" got considerably worse. I asked my doctor (family practice) about it. He had me take metoprolol for a few weeks, and then wean off it slowly. Several months passed, where I noticed these episodes were happening more often, and were more severe - to the point of nearly passing out. Several times, people I was with pointed out that I looked "blue." I brought it up to my doc, we thought it was probably just stress.
Then, in August of this year, I got into some wild parsnip. I ended up going to my doctor about the burns. While I was there, my pulse was recorded at about 150 or so. He asked me if it went "that fast" often. I told him it often went over 160. I don't know that he believed me, but he did decide to order an event monitor since I often go weeks without any episodes at all.
Two weeks passed, and I finally had an episode of high heart rate. We don't have a landline at home, so I waited until the next morning to call in the recording. Less than ten minutes after doing so, my doctor called and wanted me to go to the emergency room for evaluation. I wasn't able to - we were on our way to a funeral. He hesitantly agreed to let it go, as long as I promised to go in if it happened again.
It did.
I saw a cardiologist the next day, in the cardiology urgent care clinic. He reviewed my event monitor tracings with me, and said that I clearly has PSVT. Because of the speed and the presence of symptoms, he felt it was important to treat. He referred me to an electrophysiologist for an ablation, and started me on 50 MG of Metoprolol twice a day, with instructions to go up to 100 MG twice a day (or 50 four times) if needed.
After spending several weeks on the higher dose of metoprolol, I saw the electrophysiologist. I had a 12-lead that morning which came back nearly perfect, except for a few PVC's. The EP walked in with the strips from that EKG and informed me that I had no need of his services. He went on to suggest that I look up inappropriate sinus tachycardia on the internet, since that was what I had.
I left, confused. One doctor saying I have SVT, and it needed to be treated. The other saying IST, no need to treat it.
In all my research, I've learned little. IST seems to be very benign - definately something I would "prefer" over PSVT, or AVRT. But from what I've found, it doesn't fit. SVT of some form seems to fit better.
The biggest thing that makes me doubt IST is my resting heart rate. The majority of the time, my resting heart rate is between 55 and 65. For a 26 year old woman, I feel like this is excellent. My resting pulse hasn't really changed at all since starting the metoprolol. My pulse does increase to around 100 when nervous or stressed (i.e. sitting in the exam room waiting for the cardiologist), which sort of fits with IST.
Since starting the metoprolol, I've found that there are fewer episodes, but they seem to be a lot worse when they do happen. When it happens now, if I check my pulse, it's always at least 180. The event monitor strips show that most of the "symptomatic" episodes involve a heart rate of around 220-240. If it stays high like that for more than a few hours, my hands, feet, and lips turn a grayish-blue color and I start feeling really crummy.
I have found things that sometimes help - the valsalva thing, cold water on my face. Sometimes I'll be sick during the episode, and vomiting seems to trigger it to slow down.
To me, this just doesn't mesh well with what I've learned about IST. Am I wrong to be pursuing a third opinion on this matter? Does this sound like IST to you? What questions would you recommend I ask?
Answer Dear Jenna,
Sounds more like SVT. SVT would start and stop abruptly, in one heart beat, whereas IST would speed up and slow down gradually over several minutes. I guess you should seek a third opinion. Ask if it really is SVT and what meds will be more effective than metoprolol. Flecainide and sotalol are more effective and are safe for someone with normal heart structure and function. You probably should have an echo before taking either.
Please write back if this note doesn't answer all your questions, and please let me know what you find out.
