Still Tachy after all this time

I have sick sinus with a healthy splash of tachy-brady. This comes after three ablations for afib and double valve replacement. My heart has always been an overachiever. :) Since they put in a pacemaker to help with the brady part, I am still dealing with the tachy part. My heart rate will zoom up to 115 while I'm sitting still. Super uncomfortable and makes it hard to breathe. My doctors keep patting my hand and acting as though none of this is a big deal. It feels like a big deal. Has anyone else experienced this?


4 Comments

Love the title to your post!

by crustyg - 2020-01-16 14:11:46

Are you on any meds to attempt to control the tachy episodes?  Has your EP doc any idea where they come from?  RA, LA?  Or - perish the thought - short runs of V-tach?

What shows up in your PM logs?

115bpm wouldn't usually be enough to cause breathlessness, *but* you mention valve replacements, so your heart health may not be that good.

Patients with WPW who get spontaneous tachy episodes can quite quickly feel terrible when they have an attack, but they are normally running at 200bpm or more.

Have you tried physical tricks to force your HR down? The usual ones are carotid-sinus massage or the forced Valsalva manoeuver.  Placing your forehead in a bowl of iced-water can also work, but it requires equipment, while the other two are available wherever you are.  And, of course, there are YouTube videos for them...

tacky rates

by islandgirl - 2020-01-16 14:27:33

My orginal problem was SSS.  If it is an atrial tach, and 115, my EP told me they are near impossible to ablate.  Sedation suppresses those arrhythmias.  I have them occasionally, and most recently when I was in my EP's office, with a rate between 113-115.  While there he fooled around with my PM (I have an ICD), as my atrial node won't maintain a heartbeat when he drops my rate down to 30, but when I get tachycardia, it won't slow down.  I converted in the office on my own, but only for a few minutes, and when I got up to leave it started again.  We all have different heart problems, so I'm not sure what you can do.  I also get atrial tach into the 160s, so he's concerned about that rate because my ventrical is only beating at half that rate.  

He has added a new prescription to my cocktail of heart meds, a drug called Corlanor 5mg 2x/day, for 1 month.  It's very expensive, and I went online and learned it's a new drug, in use since 2015.  If I need to renew it, I will contact the manufacturer for a discount.  I think over the couple of days it has actually helped.  I've been taking it about a week.

Thanks, crustyg

by rsj - 2020-01-16 16:42:09

I am currently taking sotalol for the rhythm and rate, but it isn't doing much to stop the tachy episodes. The PM logs didn't show much at first because they were set to 200. They adjusted it to 120, but still I'm rarely up that high. Frustrating!

You're right that I shouldn't be short of breath at that low of a rate, but since my heart is hot garbage, everything for me is amplified. I know to check my HR when it feels like I can't breathe/someone is sitting on my chest. Sometimes coughing will bring the rate back down, but it doesn't always work. I will have to try the ice water method. If it doesn't work at least it will be refreshing.

I have another appointment coming up and have been tracking everything. So far I don't see any rhyme or reason to any of it, and I'm hoping to get some answers soon.

Coughing can be like a very short Valsalva manoeuvre

by crustyg - 2020-01-16 18:59:30

If coughing works for you sometimes, then you should really give the Valsalva manoeuvre a try.  You should be able to do it for 15-30s depending on your heart health, and that might prove more reliably effective than coughing.

HTH.

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