How to Slow Down Tachycardia Once it Starts?

[Gena]

I am often plagued with major tachycardia episodes at night when getting out of bed or waking up from a nightmare. Does anyone have any tips for slowing your heart rate down once you're in the middle of a full blown attack? My HR is normally in the 50s, but when I have a bad episode it can get into the 140s which causes really bad chest pains and shortness of breath. I've listed some things below that I have tried...does anyone have any other tricks they use that I'm not aware of?

I try not to panic as I know that just makes things worse. But every time I start to think, Oh God, this is it..this is the big one and I won't make it!

I've tried slow, steady breathing exercises, which work some times, but not when my heart is racing out of control. At first, focusing on my breath just seems to make my HR worse.

I try visualization of peaceful, relaxing places.

I try talking out loud. (Sometimes this helps, but I can't talk to much, because I start to feel oxygen deprived).

Distractions like turning on the TV sometimes help.

Someone told me to cough several times, but this doesn't seem to help.

Any ther suggestions??

[Ernie]

Have you tried a beta blocker. It takes about 15-20 minutes to slow my heart down.

Ernie

[Gena]

I tried taking a calcium channel blocker for about 5 days, very low dosage, but my BP would get too low while sleeping and it made me feel really weak and lethargic in the mornings.

My doctor didn't want me to put me on a BB for fear of my HR getting too low. It gets in the 40s while I'm sleeping sometimes. Does your heartrate get too low from the BB?

Do you actually take a BB when you're having a tachycardia episode? I thought your were supposed to take them at the same time every day and not just for when you're having symptoms.

[DancingLight]

gena,

i always just have to wait it out...which stinks! i have had those episodes in which my system is so wired, i can't sleep and i just feel soooo miserable.

i don't actually have the tachycardia anymore b/c i am on a beta-blocker, but i still have the sensation that my heart is going to leap out of my chest it is pounding so hard. sometimes it takes hours to wait it out....usually i have to lie still as much as i can.

the only thing that sometimes works for me...is taking a bit of xanax...sometimes it can nip a spell in the bud but not always. i only take 1/4 to 1/2 of a .25 mg pill...so i am not worried about that being a problem in thelong run.

i, too, do meditation, deep breathing, restful music, etc. i try being in the moment vs. distracting myself with tv or book on tape (tv makes me feel worse)...but usually nothing works.

sorry...not helpful i know...but i just wanted you to know that i get those feelings to and have tried all the things you have too...the good thing is...at least you can usually wait them out. although there are a few times i thought it would never end! but it always does!

emily

[RunnerGirl]

Hi, Gena. Just FYI, I'm an endurance athlete (recreational marathon runner) and my HR is also in the 50s (when my autonomic nervous system is behaving!) during waking hours, particularly in the evenings. When I sleep, it drops into the 40s. So, I, too, had concerns over my HR dropping TOO low with the addition of a beta blocker. Nevertheless, at least three different doctors have suggested I would be FINE taking a LOW DOSE of a cardio-selective beta blocker.

Fortunately, I haven't needed to take a regime of beta blockers, though I have taken a small dose here and there when my RH was particularly fast or irregular. Perhaps, as Ernie suggests, you could see about taking the beta blocker on an 'as needed' basis, since your tachycardia is clearly eposidic. On the other hand, a very low dose of a cardio-selective beta blocker taken regularly may not cause your resting heart rate to drop more than a couple of BMP, but may ward off the really bad episodes of tachy before then begin? Just a thought. I would discuss this is more detail with your cardiologist.

I'm not suggesting the lower heart rate isn't a real concern. It may be, and your doctor certainly knows best. But if you are a particularly fit individual, as I am, then your lower heart rate is simply the result of your heart being able to pump the same volume of blood as someone with a higher heart rate in fewer beats. In other words, your heart is more efficient. So, your heart rate dropping from the upper 40s to the lower 40s on a low dose of beta blocker would be unlikely to cause you any major symptoms or problems. But someone beginning with a resting HR in the upper 70s (who has a less efficient cardiovasuclar system relative to yours) dropped to the lower 40s would likely experience A LOT of symptoms. Hope that makes a little sense?! :-) I think the key with beta blockers is not as much where your resting heart rate eventually lands with treatment as the MAGNITUDE of the CHANGE in resting heart rate. Small change = fewer side effects.

Good luck to you! I know these episodes can be frightening - hang in there!

RunnerGirl

[MomtoGiuliana]

Gena--I am so with you--and everyone-- regarding such episodes. They are awful. I get them at night especially too. I also get it after eating--for some reason, adrenalin kicks in overtime for me after I eat (anything)--at times. I have not been able to find anything to slow my hr once it kicks into this pattern, except a very low dose beta blocker. I stopped using it for two months, but have started again after the most difficult past couple of days I have had for awhile. I take 5 mg of pindolol in the AM and 2.5 mg at night before bed. I do my best to avoid using medications, but the beta blocker helps so much that I think I will be relying on it in the years to come.

I am also curious about the comments made in response about occasional use of the beta blocker on an as-needed basis. When I stopped using it two months ago, I had to "wean" off it slowly (as my doctor directed me to do). I didn't realize it could be used as needed--but maybe some can be used that way? Or maybe my doctor was just being extra cautious? He told me I could go ahead and restart it, if I found I needed to.

Katherine

[blackwolf]

I found that Calcium channel blockers were uneffective for me. I currently take 25mgs of Toprol every morning and an additional 25mgs if I get tachy at night. this works great for me. I reciently started theophylline(an asmtha drug) to control my tachy and SOB. The Tachy was cut in half at least if mot more and I have a lot more stamina to get throught the day. I was able to cut my dose of Toprol down from 50mgs in the am and 25mgs if needed at nite to my current dose. You have to give the calcium blockers more time. I find one of my best distractors is a noise machine. I learned biofeedback many years ago and have tought myself to bring my heart rate down, it still takes 10 to 12 minutes. Have you ever concidered a table top water fountain, flowing water is a quick relaxer for me. Good luck and I hope you find something that helps.

Blackwolf

[Guest Julia59]

I know the feeling also. Unfortunately, my tachycardia can still happen on 20mg. of propranolol three times a day. I have been on that dose since 1990. I have tried to go off it once in 1992 and had horrible spells and had to go back on it.

I lowered the dose to about 30 mgs a day over the course of 8 years until I crashed and got diagnosed with POTS in 2001. Then I was up to 80 mgs a day and would still have break through tachycardia. I was in Sympathetic nervous system over drive.

I have been able to control it, or atleast calm the spells faster by diverting my attention----BUT IT IS SO HARD------but it has been done.

I would also get spells after eating----and often at night---so I often wonder about the connection---as it seems to be this way for a lot of us.

Dr. Bolognese in New York said something interesting to me at my appointment in July. But in a way I kind of knew, but was still a little surprised because I have always wondered. He said my sympathetic nervous system is really irratated, and I thought he said it may be connected to my cervical spine/brain stem problems----------------kind of foggy on that, so..............

My HR does not get real bad---but still gets just over 100 or in the upper 90s, even on 60 mg of beta blockers a day. I know when it's high because i'll feel very wired. I don't get real bad anxiety with it as the wellbutrin helps with that now---low dose---100mg SR once a day.

I still hate the creepy crawleys though---thats what I call these episodes.......

Julie :0)

[ramakentesh]

i find that a tablet of propanolol works wonder for a bad tachy attack - any less and its not enough. I only take them currently on my bad days as they tend to effect my sleeping.

[Gena]

Thank you all for those responses. I was hoping to find a magic solution to stopping tachycardia, but I guess there's not one that does it for everyone!

It sounds like some people do take a BB only on an as needed basis. I might try talking to my doctor about that possibility.

Blackwolf, you mentioned biofeedback. What types of methods do you use and where did you learn them? I went to my first session with a therapist last week, but I was not impressed with her knowledge, equipment or methods. She is the only person in my town that offers it. She's new at it and still learning. There used to be a great biofeedback specialist in my town, but he's retired.

Are there any good CDs/books on biofeedback that I could get to practice on my own? Thanks again everyone for your help!

[DancingLight]

i would like to know about the biofeedback too...

i have done the jon kabat-zinn mindfulness approach...but sometimes, it just doesn't cut it...

how does the biofeedback differ exactly. i haven't quite figured that all out yet...

emily

[MomtoGiuliana]

I also learned a bit of biofeedback last year when I was disabled by POTS. My GP was convinced I was mentally ill and so I agreed to see a psychiatrist. The psychiastrist determined that I was not mentally ill, and she thought that I might find some relief from seeing a psychologist with training in biofeedback (and hypnotism--tho he didn't recommend that in my case for whatever reason). I did find biofeedback helpful. He used a computerized system that I was connected to electrodes connected to me to teach me deep relaxation through breathing. I know it sounds simple--but as we all know too well, it is very hard for us POTS patients to relax--even when we get to a point of non-function. He is a strong believer in the mind/body connection and the value of deep relaxation as a tool for healing--and I am too b/c I think it was an important aspect of my healing process. Anyway, as you breathe, the computer screen shows muscle activity, and I would try to keep that below a certain level by employing the breathing techniques. Once you learn how to do it using the machine, you can replicate it at home (which is important--you use the machine to learn technique which you then continue to practice on your own.) Biofeedback is used for other things too, but this is the only way he used it with me. It is non-invasive and worth exploring.

[blackwolf]

Dear Gena and Emily, The current biofeedback methods I use are a mismatch of what works for me. I use three different things. This is what I learned just after being dx with Fibro and was not to happy with the pain meds we were trying.

1 Find a place to relax. I prefere a recliner or a cushion on the floor with my feet on the floor(for best results try to keep your back straight).

2 Find a good relaxing tape/cd, I prefere a continious cd set on repeat and head phones for the best effect(quite is not an option in my house). Personally I like thunderstorms.

3 I started with just learning how to breath, yes breathing. I had to learn to use my stomach to take a really deep breath. now it is second nature.

4 Pulse, I learned to take my pulse to 60 bpm. I learned with a machine my therapist had and then bought myself a pulse/ox finger thing.

5 Use pictures or imagine where you want to be and relax. Sounds easy right, NOT!

It took me 3+ months to learn this. I was taught at a chronic pain clinic in Sioux Falls SD. I would ask for a refural to a place that does it. If you have to travel ask for a "loaner machine" to pratice on, I did. It was covered by my insurance as physical therapy. I hope you are as lucky.

Blackwolf

[ethansmom]

All great suggestions above! I would really like to try biofeedback as well, and it sounds like the relaxation techniques would really help.

I don't get as many of these tachycardia episodes as I used to, because I've been able to identify certain foods/beverages and other things as triggers and try to avoid them (i.e. carbohydrates, sugar, caffeine, exercising too close to bedtime). But I do still have heart-pounding some nights when I am trying to sleep, and for those I just have to wait it out. Sometimes it helps to get up and walk around for a bit, and lay back down slowly. I think my hormone fluctuations cause this to happen every few weeks or so, because they seem to happen in clusters (2-3 nights in a row). I no longer take a beta blocker. I hope you can find some releif!!

[justin]

gena.

the following are some short-term *cures for severe crisis type tachy episodes.

1) some paramedics taught me this trick. you do deep breathing, except between the inhale and the exhale you wait for 2-3 seconds and bear down slightly on your diaphragm. then you exhale more slowly.

so: deep regular breath. hold and tighten your stomach muscles a couple seconds. exhale. repeat. apparently, this acts on the vagus/vagal nerve to slow your heart rate.

2) elevate your legs really, really high (i usually put my legs straight up against the wall).

3) this works if you have someone with you. ask them to breathe deep and regular, and try to copy their breathing. try to focus on them and not on yourself. this will avoid you getting yourself worked up about your HR/palps which will of course make them worse.

[Gena]

Thanks Justin. I'll try those tips next time and let you know if they work!!

[llp479]

Have you ever tried putting ice on the back of your neck? This was suggested to me by my EP and it has helped me significantly. I even carry one of those snap ice packs in my car in case it happens while driving.

[JLB]

Are you keeping your fluid levels up?

[Guest GayleP]

Sometimes warming my hands helps when I'm tachy. I take a heating pad that I can nuke in the microwave and put my hands over it.

I learned that in boifeedback.

GayleP

[JLB]

Gayle, that's interesting - I sit cross-legged on my bed, darken the room, and place my heating pad under my thighs or my feet. Meditate for a while.

For some reason, if I rock slowly back and forth then, it calms me.

[EarthMother]

Ice.

On my wrists or actually in my shoes, seems to help stabalize me when I start racing.

You are also welcome to download any of my relaxation mp3s for free if you think they might help. Just send me an email of the title you would like and I'll send you a private download for POTS friends.

EM

www.coolkarma.com