Heart & Cardiology/Atrial tachycardia


Hi Mr. Ahmed,

For the last 3 months or so I seemed to have developed an annoying problem relating to my heart. I am a 25 year old medically healthy female but do have anxiety problems (revolving around these heart problems I'm having).

I have been to the hospital twice for this condition. Both times resulted in requests for me to have a holter monitor fitted. Once I was finally able to see the cardiologist, there was no mention of a holter monitor and instead I was told rather quickly that I had atrial tachycardia (based on short ECGs) and was given the beta blocker Metoprolol. I am not very happy with this outcome.

Firstly, during the day I am actully totally fine. Yes I notice my heart rate go up a bit if I move suddenly but I figure that is normal and doesnt go above 90 I think. I am able to do physical activities around the house with no problems and feel quite good about it! I could be fitter, but dont want to push myself too hard. Bascially during the day i have no problems with this unless my anxious thoughts take over.

At night, it is a slightly different story. I go to bed around 9.30 - 10.00 and fall asleep with no problems. However at almost exactly 11 pm (about an hour after falling asleep) I wake up suddenly with the tachycardia! I would say heart rate around 120, and beatinf strongly. And this will last for maybe half a minute, sometimes a minute. I dont undertand why this happens at night - at the exact same time each night and only once each night, and this has been giving me anxiety.

I do not want to take the beta blockers because my blood pressure is perfect and my resting heart rate is in the ideal bracket - as i mentioned i dont have any problems during the day so I dont want to be affected by the side effects of those betablockers. My life other than the tachycardia at night is totally fine.

I wanted to know if you may be able to shed some light on this if you had heard of somethinf aimilar happening and perhaps on the best way to proceed.

Thank you very much for your time.



I would suggest the following.  You should have an echocardiogram to assess the underlying structure and function of the heart. You should have a monitor, and it would be useful for further characterizing the arrhythmia, its length, the way it starts and stops and its frequency. Once an atrial tachycardia has been diagnosed the management essentially depends on how symptomatic it is. A beta blocker would typically be first line, the reason being to try control the tachycardia once it starts and possibly prevent it, however if you can't tolerate that then there are other medications that can be tried. If you are significantly symptomatic despite medical treatment then an electrophysiology study and an ablation procedure can be attempted. I recommend that you go and see an electrophysiologist.

Hope that was helpful.  

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Mustafa Ahmed MD


Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease


Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology


Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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