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Heart & Cardiology/IST, Abnormalities, possible answers


Hi David,

I saw your profile on allexeperts, I'm actually an expert on here and a counsellor myself.  

However, for over 6 years I have suffered from Inappropriate Sinus Tachycardia with High Blood pressure.  My family Dr, or GP is at a loss as to the cause of my Tachy.  Without Beta Blockers the tachy is constant/sustained.  One minute I was a healthy woman and next, boom... tachy among other things.

I have seen 4 cardiologists, 3 endocrinologists, several GPs (General Practitioners) and was even sent to a shrink at the very beginning who instantly wrote to my GP stating that my condition is phyiscal and to investigate further (that was in 2007).

None of them know the cause of the Tachy.

All bloods are normal
Pheo tests were normal
Thyroid tests were normal
Everything normal
Before this happened I was a very healthy young woman in her late 20's, I used to go running a lot, I did a lot of dancing, I did weights, I was very healthy.  Always busy, always on the go.  I had actually applied for a job in the Police Force before I got pregnant and was due to start my basic training 6 months after having my child.

But I now and since when my problem started I experience fatigue, intolerance to minimal exertion, tachy before I was on the beta blockers, sometimes also when on them, high blood pressure which is still pre hypertension even on the BB's (I'm on 75mg Atenolol a day).  I experience a lot of general aching and circulation problems which seemed to occur before going on BBs too.

Last year I had an attack of SVT, I get them from time to time when I get a burst of adrenalin (extreme situations of anger or distress, last year's was after a male friend became aggressive with me when he turned up at my house drunk and I ended up in an ambulance with SVT).  During this attack the ambulance crew did an ECG and it showed a Right Atrial Abnormality.  

However when the BBs (Beta Blockers) are working this abnormality never shows up on my ECGs and has only appeared when I get the SVT or before the time I was put on the BBs in the first place.

First they said it was a Right Bundle Branch Block; which for a healthy woman I wouldn't have considered I'd have that, and then they said it wasn't that, and that it was an Atrial Abnormality.

My Tachy started after having my first child.  I developed High Blood Pressure on the day after giving birth, the labor ward staff kept me in an extra night then discharged me after no symptoms showed up despite hypertension.  It was still high but not massively.  For weeks after, I was feeling generally unwell and actually felt like I was "wired" I felt like everything had sped up, I felt like I'd had lots of coffee or something.  I was tested for Hyperthyroid and the results were normal.  My heart rate and blood pressure at one appointment were so high that I was admitted to the Investigation Unit at the hospital, only to be let out in the early hours of the morning with the verdict of panic attack which it wasn't.

All bloods had showed normal.

So I wonder:

Could the constant hypertension after the birth be a possible cause for the sustained tachy that I developed?  

It's been 6 years; I am getting worse in that I now struggle to climb stairs even on beta blockers. I'm now pretty much housebound, apart from the days when I can rely on transport provided by my husband or taxi cabs direct to work.  I am seeing a neurologist because I am now getting headaches, pins and needles in my arms and legs on waking, spots and flashes in my vision and all sorts; I'm still pre-hypertensive, on the BBs.

Cardiologists have discharged me having come to the conclusion that there's an outside cause and it's outside of their field.  The other specialists have done their tests and also sent me on my merry way.

I have two children now (my son is 6 and my daughter is 2 1/2), I'm newly married, I run a business in photography and fashion which I adore more than anything, and my illness is making it all difficult to cope with.  I have now developed a kind of depression just simply through my anger and frustration at myself for getting ill.  I'm paying for private counselling for this.

Still no answers at 6 years I have started a National Campaign here in the UK to push the National Institute for Medical Research to look further into the causes of IST after I found a support group.  All women, all between 20 and 40 years of age and all with IST.  I have a media company involved, a petition running and a video campaign also.

But... I digress.  

Right Atrial Abnormality - What is it?  Is this damage to my heart from the hypertension causing the tachy?

And if this is the case, HOW do I get a Dr to give me an echo examination.

All I've had was 1 echo 6 yrs ago showing this apparent Bundle Branch which is now appearing as an abnormality.  I have not been offered any more echoes.  

I've had more ECGs than hot dinners.

I've never seen an EP (Electrophysiologist), yet a lot of IST patients I have met - have.

Advice on what Right Atrial Abnormalities are would be great.
Advice on how to communicate my requests for further tests would be great.

Much appreciated.

Thank you for your time.


Hello Samantha,

EKG's are no good at diagnosing right abnormality and your echo showed no right atrial enlargement, if I read your note correctly.  Echo can't see Bundle branch block.  So I'm confused.   Is your struggle to climb stairs the result of breathlessness?  Could it be pulmonary arterial hypertension?  Ask your doctor for another echo looking for pulmonary arterial hypertension.

Soory to be o little help.  Please write back if you think I could help.

David Richardson

Heart & Cardiology

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David Richardson


Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.


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.

Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Circulation, American Heart Journal, Hypertension.

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.

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