Ectopic Atrial Tachycardia

[Guest GayleP]

I just got back from my cardiologist who I really like. This is the second time I 've been to him. However I felt a little rushed and didn't get to ask a lot of questions.

I had an event monitor for a month which showed the usual PVC's, PAC's and a PSVT.

It also showed one episode of Ectopic Atrial Tachycardia that lasted over a minute. My cardiologist thinks that while it's "impressive" it's also "benign" and nothing to be too concerned about. He says if I get more of them I can always have an ablation.

Does anyone else get this kind of tachycardia and is it really just nothing? An ablation seems like a risky thing to do because they often don't work.

I hate the words"impressive" and "benign", they don't really mean anything to me. I don't know how having a lot of tachy incidents can be nothing and how can something be impressive and benign at the same time?

Thanks,

GayleP

[MightyMouse]

I really think your questions are something a doctor should address--perhaps you could call and get clarification?

Nina

[Guest GayleP]

Nina,

I actually just did that. I called my cardiologist and spoke with the nurse and gave her some questions to ask the Dr. He was rushed druing my appoinment and I think I just needed some reassurance from him.

I mainly posted to see if anyone else has had this kind of tachycardia. It's a little scary having something else besides PVC's and PAC's which I'm getting very used to. And it felt like my cardiologist was minimizing it. I wanted to see if other people might have the same thing and have also been told it's nothing.

Plus, I know others have had ablations.

GayleP

[Guest GayleP]

Just another thought. I'm always so afraid of bothering my doctors that I feel bad calling them with questions.

This time I decided that I don't care if I'm bugging them, it's normal to have questions and it's my right to get them answered. I always feel like they think I'm anxious if I have questions which is silly.

Gayle

[Herdswoman]

Been there, done that........I hope the following example can clarify it:

In my 30's I tolerated my tachy arrhythmias much, much better. In fact, there was one shift where I put myself on monitor just to see how fast I did go. Put the EKG patches on, threaded the cables under my scrubs and tucked the monitor into my back pocket of my pants. I worked most of a 12 hours shift with a heart rate between 130 and 150. I lived like that for years.

Impressive? Yep.

Benign? Yep.

Benign because I could tolerate it: I had no symptoms, no shortness of breath, no cool, clammy skin, no syncope, no nothing. Benign just means harmless, benign does not necessarily mean normal.

Impressive because my body DID adjust to it and I could work a full patient load like that. Shoot, out of 22 post open heart patients, I had the most abnormal rhythm. Woo hoo! Give the nurse a prize!

I'm not sure what he meant by "ectopic" episode. We used to refer to ectopic beats as those which came from some source outside the usual conduction tract. Don't know how - or if - that differs from saying PSVT. Tomato, to-mah-to. I'm so old I still use the phrases VPB's and APB's

So reading between the lines, he said that if your tachy arrhythmias start to cause symptoms THEN you can look at the option of ablation.

Somewhere in another thread I posted about patient monitoring. I'll reiterate here briefly: The first rule of patient monitoring is to TREAT THE PATIENT, NOT THE MONITOR. If you as the patient are doing okay, let it ride.

And consider finding a cardiologist who doesn't rush you. Is this guy also an electrophysiologist (i.e, the one who would do your nearly-proposed ablation?)

[MomtoGiuliana]

Herdswoman

Your answer was very interesting to me. I appreciate that there are many nurses like you on this forum who can help us interpret technical things a bit.

When you say you tolerated tachy arrythmias much better in your 30's, do you mean you have more symptoms now? Would significant symptoms possibly mean the arrythmias are no longer benign?

Thanks, Katherine

[blackwolf]

Dear GayleP

I would check with your doc for a better explantion. If nothing else get a second opion. Good luck,

Blackwolf

[corina]

Hi Gayle,

I'm proud of you for asking your doctor the questions you have. When doctors are in a rush THEY make you feel bothering them. In fact you're just a very normal patient who has a couple of questions, why shouldn't you. Well done!

Corina

[JLB]

Very well done. Good for you.

Can anyone explain to me what these feel like? I get heart rhythm disturbances that feel very different from the usual PVCs. They haven't happened all that often, but the sensation I'm thinking about feels pretty ominous when it happens.

[Herdswoman]

When you say you tolerated tachy arrythmias much better in your 30's, do you mean you have more symptoms now? Would significant symptoms possibly mean the arrythmias are no longer benign?

Yes, at 43 I have a ton more symptoms now. Dizziness, shortness of breath, extreme fatigue, yada yada yada....

Funny, at 31 I thought I would always just have this weird heart rate that didn't amount to much. It would just be kinda there, be benign. Course, I thought I would always be a size 12 Classic Fit too and we can see how THAT turned out!

The people who you really need to be careful of who use the word BENIGN are the cancer docs. Then the connotations are much, much more serious.....and of course, in their world, the opposite of benign is malignant. Bad joo joo and we don't want to go there.

But "benign" the way this MD is using it, it's just an adjective. I would say that in most instances - anywhere in the body - if something (tissue growth, heart rhythm or even a good fart) isn't causing a problem, it can be said to be benign. Once the tissue growth hurts, the heart rhythm produces symptoms or the fart erupts in church it quits being benign.

Generally, in cardiology, there is a progression of adjectives that are used to give a general description of a problem and are not diagnostic statements in and of themselves, e.g., benign, then symptomatic, then problematic, etc. They're just words..... how you feel is what matters!!! (To go back to the fart in church analogy: If you stay cool and look accusingly at your spouse when that happens, you'll be looked at as being benign and the congregation will see him as symptomatic. It's not problematic unless there's a lingering odor....)

The point at which we see arrrhythmias as no longer benign is something that is very individualized. I guess mine quit being symptomatic and started being problematic when I could no longer physically compensate for it, when my world became more limited. It quit being benign a long time ago and started being symptomatic.......so slowly and so insidiously I never really saw it sneaking up on me.

Bottom line: if it's causing a problem, it's no longer benign. And it's always a good idea to go back to your MD for clarification......especially if something here has seemed to make sense and you want confirmation.

[MomtoGiuliana]

Thanks Herdwoman...

I guess there is such a grey area when in comes to diagnosing and treating arrythmias.

How do you know the dizziness, shortness of breath and fatigue are caused by your arrythmias, and not by something else? I ask this b/c I have these three symptoms from time to time (had them constantly for awhile) and I thought these were brought on by autonomic dysfunction in general (a variety of causes, I guess--but primarily pooling of blood below the heart), and not by arrythmias that I also had, and still have from time to time.

I guess the other thing I am getting at too is that I am kind of scared sometimes about what the future could hold for me and others on the board my age or younger, with this condition. I know that it is impossible to predict, but it seems like there are a number of women in their 40s and 50s on this board who have experienced a worsening of symptoms over the years to the point that they are disabled by it enough to retire early, etc. Anyway, I know you don't have answers to this concern, as the medical establishment doesn't either, at this point, except to say that most people with POTS "recover".

I wish you the best.

Thanks, Katherine

[Guest GayleP]

Thanks everyone for your responses.

Herdswoman, thanks so much for your explanation of things. I wish our doctors could do the same thing. I am very impressed that you could work with such a high HR. And I know what you mean about symtoms becoming more of a problem as you get older.

I had an arrhythmia since 1993 ( I was in my 30's) and it really caused no problems. It got worse after my brain surgery in 1995 which is also when my dysautonomia kicked in.

Katherine brought up the million dollar question. How do you know if your symtoms are heart related or from the dysautonomia? I feel lightheaded and fatigued a lot of the time and I don't know what's causing it. I don't have POTS but I do have dysautonomia which can cause a high HR. I also am afraid of what the future holds as my symtoms seem to be getting worse.

I think I'm going to make another appointent with my cardiologist so we can sit down and go over some of this. Or request that he call me. I'm really worried about this and don't want to sit on this until my next appointment which won't be for a year. I'm also going to request a print out of my event recordings.

JLB, I wasn't even aware that I was having this Ectopic Atrial Tachycardia in the sense that when I pushed the button on the event recorder I thought I was just having some PVC's. I did feel the PSVT, I could feel my heart racing.

Thanks again,

GayleP

[Herdswoman]

Thanks everyone for your responses.

Herdswoman, thanks so much for your explanation of things. I wish our doctors could do the same thing. I am very impressed that you could work with such a high HR.

GayleP

I was young and naive. I was still a size 12. Perhaps the size of my rear end increases with wisdom???? No? I guess correlation does not prove causation.

Katherine sure did bring up the $1,000,000 question. I have no idea if my symptoms are from POTS or dysautonomia. Like many of you, I am waiting for an appointment with Dr. Grubb. But I'm not holding out any great hope for answers. For years, I blamed my asthma for my shortness of breath, because I still thought I was having a benign tachycardia. (Most of the time I also imagined I would again be a size 12). But we did a cardio-pulmonary stress test that really told the tale. I do peak flows religiously now when feeling 'twitchy" or short of breath. Peak flows help me separate pulmonary from cardiac origin as the treatments are very different. (There's a really funny story about peak flows and me having no clue......but another time.)

I think the source of symptoms - POTS vs. dysautonomia - really doesn't matter much, since all the treatment is aimed at symptom relief. It's an interesting question, a great theoretical debate and there's probably a Nobel Prize for Medicine in it. But right now, POTS vs. dysautonomia is not much more than a high stakes cold virus. I mean, does it really matter if we get Cold Virus A or Cold Virus B if there's no cure and the treatment is the same? All we can do for either A or B is relieve symptoms: rest, Kleenex, tylenol/motrin and decongestant/antihistamine.

When the day comes that medical science has more answers, THEN it will matter.

Right now all we can do for POTS or dysautonomia is relieve symptoms: rest, beta blockers, salt, fluids and florinef. And the beat goes erratically, rapidly on.......

I'm curious what Grubb will have to say, but I'm not looking for any revelations. No clouds parting, no doves descending, no miracle cures. In the meantime, I am blessed by what I have: a supportive husband, a wonderful child, health insurance, a new bunch of folks in a great support group and a comfortable bed when I feel crappy.

Oh, thank you for the compliment. Be sure to tell your MD to compare cardiac problems to farts in church if he wants people to understand what he's talking about. Seriously, I loved patient teaching and if I could make people laugh the lesson would stick and patients wouldn't stress as much. Laughter is the best medicine.

[Merrill]

And you're giving us all a healthy dose! (laughter, that is! ) Thanks for that...I enjoy your wit enormously.

I agree w/what you said, by the way--in the world of dyautonomia/pots, managing the symptoms as best you can is really what matters. I for one try not to focus too much on the whys and wherefores...I'll go nuts w/all that information (or following one lead after another). Just tell me how to live and what interventions (medicinal and/or behavioral) to try and I'll let the rest of the detail fall away.

Take good care,

Merrill

[Guest Julia59]

Amy,

You made my day! Got to have a sense of humor or we would all go nuts. It's nice to laugh at some of this crazy stufff we go though. I don't have a lot of the arrithmias, but you gave a lot of good information to help me understand these crazy PVCs---or whatever thay are.

There is only one time I can think of where I thought me life was going to end. Scared the day lights out of me. I was not diagnosed yet----it was about a week before I was. I was in the mall. I felt a little better that day, so I picked up my walking pace a bit. I stopped for a pretzal---and a frozen lemonaid. Walking back towards the exit I felt a weird rush/heat sensation then it flet like my heart was trying to stop----then after that there was a really fast HR. during the whole thing, there was a grey out and tunnel vision which passed in about 10 seconds.

I didn't know weather to sit, s---, keep walking, or lay down. I slowly crept to the exit and to my car and drove myself to ER. As you can guess---I was given an antacid. This is how I finally got in to see Dr. Grubb---I guess the resident--female finally went beyond the antacid fase. I first had a TTT that was normal, but I saw Dr. Grubb anyway in only a week. He diagnosed the POTS-----and he also set me up for an EP study.

I never had the EP study. I chickened out, but Dr. Grubb said if I didn't have any more of the same episodes he didn't feel pressed to do the EP study. I have had other PVCs---or skipped beats ect. but have not had anything like that again. I came close a couple of times, but still not like that. I still sometimes wonder what that was all about----perhaps a sudden BP fall..? Could be from all this brain stem stuff I have going on. I fill you all in later----so much to think about...

Just wanted to tell you that you made me laugh----but then I ended up rambling on and on....................

Julie :0)

[Guest GayleP]

Herdswoman,

I love the "farts in church". Thanks for the laugh. I'll have to think of that when I'm having an incident. Laughter always helps.

Julie,

I also have brain stem involement in a sense because my brain surgery was very close to my brain stem. Don't know how it all fits in. I'm not neurologically very sound because of the surgery. It's all so confusing at times.

The cardiologist wanted to know how things were at home. I'm not sure why he asked that unless he thinks anxiey and stress are causing my arrythmias. Of course I'm anxious. And of course I tried to hide my anxiety from him which only makes things worse. Home is fine, it's the least of my worries. My husband is really supportive so I'm not sure why this doc had to play therapist.

BTW, what is an EP study? Is that wherer they go up your groin into your heart? What all does it tell?

GayleP

[blackwolf]

Man, if we could all talk on the phone, it would be a so grand. Thanks for the laugh, I needed it.

My cardio is really good, he waits and lets me ask all my questions. He had about 20 minutes between appts. I am never rushed.

Julie- Hey, have you been in my head, that is what often happens when I'm out and about.

Blackwolf