sinus node arrest with nodal escape rhythm

[persephone]

My cardio at home (non POTS expert, although he has heard of it- which is a BIG thing in the UK!) says this is what he thinks he's seeing when I get an dizzy spell.

Anyone else have anything like this? Is this the sort of thing tha tPOTSy people would havean ablation over, or rather, did have an ablaiton for in years past?

Any feedback gratefully received!

P

[Laura]

Hey Perse, Have you been thouroughly checked for a pheochromocytoma? It can present with exactly your symptoms. Here is a very interesting article... I don't know how to post a link, so I am going to post the article. Hope that's OK! It's from PUBMED site.

[sinus node dysfunction with intermittent sinus arrest and AV-nodal escape rhythm as initial manifestation of pheochromocytoma]

Bruch C, Dagres N, Wieneke H, Herborn C, Brandt-Mainz K, Erbel R.

Westfalische Wilhelms-Universitat Munster Innere Medizin C Albert-Schweitzer-Str. 33 48129 Munster, Germany. bruchc@uni-muenster.de

A 25-year-old male student complained about episodic palpitations, dizziness, nausea and headache 5 years prior to presentation. No otorhinolaryngic, neurologic or gastrointestinal causes were identified. Several ECG recordings revealed sinus node dysfunction with intermittent sinus arrest and AV-nodal escape rhythm. The patient was given a permanent DDD-pacemaker. Six months later, the clinical symptoms were unchanged. During an attack, physical examination revealed paleness, diffuse sweating and an arterial blood pressure of 250/130 mmHg, which decreased to 120/80 mmHg within a few minutes. Abdominal ultrasound and abdominal computed tomographic scan demonstrated the presence of a large (6.4 x 5.5 cm) left-sided adrenal mass. Two 24-h-urinary collections demonstrated elevated noradrenaline (mean 315 micrograms/24 h, normal < 80 micrograms/24 h) and adrenaline (mean 268 micrograms/24 h, normal < 20 mg/24 h) levels. Blood samples, which were drawn during excessive blood pressure rise, revealed elevation of plasma catecholamines (6.793 pg/ml for adrenaline (normal 50-150 pg/ml) and 10.424 pg/ml for noradrenaline (normal 200-500 pg/ml), so that the diagnosis of pheochromocytoma was considered established. The tumor was successfully removed during laparascopic surgery. After surgery, the patient remained well and normotensive. Three months later, several long-term ECG recordings showed sinus arrhythmia with no evidence of sinus arrest or AV-nodal escape rhythm, so that the DDD pacemaker was turned off. This case underlines that sinus node dysfunction with intermittent sinus arrest and AV-nodal escape rhythm is a potential early manifestation of a pheochromocytoma. These changes seem to disappear after successful removal of the tumor.

[persephone]

Thanks Laura...yes, I *did* read this article just yesterday, thanks! I've just had my catecholamines done this week, but I don't know when I'll get the results.

Thanks so much for the helpful pointers though. Have you had the same problem? If I do have the pheo-impossible-to-spell-or-indeed-type-thing, how easy is it to sort out?

Thanks in advance, P

[Laura]

Hi! I'm glad they are checking into this for you! I have had the pheo work-up quite a few times and all came back negative for me. I have high BP spikes with my increased heartrate, and other similar symptoms, so this was something that was investigated. I was tested for catecholamines several times over the span of a year as you may have negative results if you are tested when you are not actively having an episode. It's difficult to say how easily this could be sorted out as it depends on size, location, type... but generally they try to remove the pheo by laproscopic surgery. Many of the pheo symptoms overlap with POTs symptoms, so this is not to say that this is what is going on, but very good to have ruled out especially with your BP climbing so high at times! I am sure there are alot of others out there with better pointers than me, I just thought that article was very interesting! Oh, did they do the 24hr urine or the bloodwork? Laura

[Merrill]

You might check in with Runnergirl (via email or PM) and/or read her posts within the last year ... she knows quite a lot about the pheo thing, and has lots of good advice on the topic, testing, etc.

m