Just Flat Out Tachycardic.

[cardiactec]

Hi OLL,

i havent tried any calcium channel blockers. not sure why my cardio is being so hesitant to try other betas with me, cuz the 10 he's tried already arent working - and there are PLENTY more to choose from/try.

my P waves are extremely peaked and wide and all go in the same direction (upright). typical sinus P waves should be of low amplitude (not peaked) and uniform in a low amplitude shape.

my P's stay the same, they are uniform, and dont change from beat to beat or from valsalvas, carotid massage, or med injections. they are crazy looking both in sinus rhythm and in sinus tachy. you cant even differentiate my T's from my P's at all when i'm tachyn out (even at low tachy rates) cuz my P's are so huge that the T's get burried in them. they look like huge huge mountain peaks. at first they thought this was pulmonary HTN or some sort of right heart failure (cuz that is how P's would look with pulmonary disease or right sided heart issues) but they ruled it out with a cardiac cath (they put a cath in my pulmonary artery and measured the pressures, which were normal). so after they ruled THAT out, they were trying to differentiate whether my wierd P's were from an atrial tachy or sinus tachy - and they did that just by simple maneuvers they had me do - valsalva, carotid massage, etc - and concluded sinus in origin because the P wave never changed from it's bizarre strange looking state to another shape or morphology.

i am surprised morgan, that you had an ep study/ablation- unless your ekg looked really messed up, i am shocked a doc proceeded in that direction. i will admit, i have a VERY SMART EP DOC and do trust him, but even as smart as he is, he admits himself my ekg's 'dont look right' but yet still doesnt procede with an EP study. i'd be surprised by any doc, whether very fast tachy or not that looked typical of a sinus tachy, to go in with a cath and ablate - especially if it was posturally driven by TTT like yours morgan. sorry you've gone through all you've gone through.............even hearing your story though, i still have to follow what i believe would be best for me. i really want an EP study, not an ablation but just plain old mapping, just to see what's up. and they wont even do that. i'm surprised cuz i showed my ekg (the one with my rates at 190) to one of the other EP docs that works directly with MY ep doc and asked him flat out "where in the conduction system is this rhythm originating". and he looked at me and told me he wouldnt be able to tell me that unless they did an EP study on me! argh! and this guy works directly with MY ep doc and is just as smart as him! so i said "so you cant say definitively that this is coming from the sinus node" and he flat out said "no". ...........................so..........there ya go. it may or may not be sinus originated. nothing can be black and white until someone makes it appear either black OR white, and the only way to do that is to visually see the conduction pathways. heh, and the only way to do THAT is by EP study.............

[kmpower]

So can you ask your EP doc about what his colleague said?

Do you have any earlier-in-life EKGs with normal shaped P waves?

Have you tried begging? Bribery?

OLL

[cardiactec]

OLL,

hahaha. you are too funny! oh yes, every bribery, begging, and whining trick in the book i've tried and no success.

i am a little hesitant to tell my EP that his colleague told me that he couldnt tell me where the rhythm originated cuz i dont want to make it sound like my doc doesnt know what he's talking about, cuz i know he does. i think if i did approach my EP doc about it, and tell him what the other doc said, that he would say that he doesnt know my history like he does, that he has a better understanding of the rhythm in itself because he has been more involved in my case instead of just simply looking at one of my ekg's and making a call that cannot be made as to where the rhyhtm is originating.

i do have some ekg's like from when i was 18 or so, the P waves arent as peaked, and look more normal. the EP doc has seen these, and i think he doesnt see any difference cuz he never jumped on anything after seeing the ekg's. the mayo clinic EP doc, said that the P waves could just be peaked because of excessive catecholamine's flooding in my system. i thought that sounded a little far fetched to be honest and not even sure how electrically that would change P wave morphology THAT much. cate's have an effect on HR but not on amplitude, so not sure where he came up with that? he said it COULD be a possibility. i think at that point he was just reaching for anything to say to make sense of this.........

[kmpower]

Wow, you are in a pickle.

Because I am still in my own learning process, I will check out my resources and see what I learn about the sharp Ps. My EP said he was surprised that my stack of EKGs showed only sinus tachy, but I did not have readings from many of my episodes. He said he would not even suggest ablation if there were a problem near the sinus node and that BBs may be the best Tx.

Do you know what an acousticardiogram is? It is not an echo but rather graphs out the sound waves; it is described as "a stethoscope with a college degree". It is cheap and noninvasive and may provide more info.

It is interesting in a cosmic sort of way that you are a cardiac tech and having these experiences.

OLL

[morgan617]

I live in an area where no one knows anything, and at the time i was desperate for a "cure" I find out info and give it to my docs, not the other way around.

I actually did NOT want the eps and ablation...I didn't have a good feeling about them messing with something they didn't know much about. My hubby, pcp, and eps all kind of pushed me into it. (the opposite of you cardiotech) but they could see me going downhill from the sheer exhaustion of all the tachycardia.

They saw it as the only hope to help me. That eps actually sent me a letter, asking me to leave his practice when it made me worse, and my pcp and hubby live with terrible guilt over it.

I can see where a doctor would want the choice of being able to ablate if he's already in there, it's very invasive and complicated. Especially if you have the mapping. My procedure was eight hours long.

I also understand your thoughts of something happening so they are forced to do something. It's like the fainting thread here, but it's only good in theory a lot of times. They thought I was crazy when I didn't faint and now think It's psychogenic when i do. I can assure you my broken ribs and concussions aren't psychogenic. Sometimes you just aren't going to win.

You are clearly not willing to settle and that's not a bad thing. My only counsel is to use your energy wisely...

OLL, you really have to make this decision with your doctor. My experience is not everyone's experience. The eps I have now thinks very differently than the one I had previously. I just like the way this one thinks better. I really don't want to sway anyone one way or another, but do want my experience out there. It's good to know how others have done, whether good or bad.....good luck to both of you....

[cardiactec]

hi OLL,

i havent heard of an "acouticardiogram". interesting.

i actually enrolled in my cardiovascular technology program before i ever knew or had anything going on heart wise with me. the irony i know! i think it was actually like a year before i started in my program (i signed up and got in two years before i actually started the program) that i started getting symptomatic. so before i ever started in on clinical rotation in cardiology, i already knew all the tests fairly well, CUZ I HAD BEEN PUT THROUGH THEM ALL! i guess all of this perhaps could be somewhat of a blessing in disguise considering i was WAY ahead of the gang academically in med terminology, the dynamics of cardiac testing and how they worked, instrumentation, etc from having been personally exposed to it all first-hand, as both an student observer AND a patient.....

[MightyMouse]

Dr. Grubb is an EP Cardiologist.

http://utmc.utoledo.edu/physicianapp/physingle.jsp?ID=75

[Guest dionna]

my heart is just out of control and nobody is doing anything to get it down to normal rates cuz they all say "you have pots and if we give you any more beta blocker to try and slow you down, you are going to pass out, cuz the problem with pots is that the blood is rushing to your legs and your heart is doing what it should by compensating so you dont pass out, and if we hinder that compensation mechanism, you'll pass out". i have NEVER passed out and i thought that BP wasnt the problem with pots patients anyway?

i am way late on this and i only read your original post so i am probably way out of the subject now but i just wanted to say...

i am a fainter and i faint because of my blood pressure crashing (BP was 37/? TTT). i also have NCS though. i was on propanonal for 5 months and was bedrriden the last 2 months. i was passing out literally every time i stood up! my room mate had to dress me, bathe me, hold me up on the toilet, feed me, etc...

if you really don't think it would bother you then i would ask the docs if they would atleast give it a shot. i asked my doctors all the time if they would let me try different things or to tweak their suggestions to better suit me. some times it worked out better and some times it didn't. i wish you much luck.

dionna

[bttrflyamby1981]

Hey Dionna,

I just seen that you had tried propananol. My nero put me on that to treat my migraines. When I went to the Internal meds they took me off of it right a way. That stuff can make you so much worse feeling huh.

[kmpower]

Hi Cardiactec,

Interesting history. You must certainly be an understanding tech when working with patients.

I did a quick search of wide, sharp P waves and found the following at a pediatric cardio site:

P wave amplitude varies little with age and is best evaluated from lead II, V1, or V4R. Wide P waves indicate left atrial hypertrophy, and P waves taller than 2.5mm in lead II indicate right atrial hypertrophy.

So, because the morphology doesn't change no matter what, and the direction is uniform, maybe there is some hypertrophy?????

OLL

[cardiactec]

hey OLL,

yes, this is what i was saying. right heart problems (such as right venticular hypertrophy, right atrial enlargement, and if right heart pressures are high enough than pumonary HTN or chronic obstructive lung problems as well - since the right heart is connected to the lungs directly, if one has gone bad the other tends to as well. they checked me for all this via echo. normal heart chambers, normal size, all normal except for MVP finding. they even did a catheterization (right heart) to determine truly if i had pulmonary HTN. usually with echo you can tell if someone had pulmonary HTN just by pressures that you can measure in the chambers, but they were so sure of pulm. HTN with me cuz of those darn looking P's, that they went the extra step and put me through the invasive right heart cath just to be sure that i didnt have pulm. HTN ...........

when THAT came out normal, then they did the tilt and found my rates surged from 100 supine to 170-190's standing - and the P waves didnt change, even though bizarre as they were from baseline - didnt change at all from normal sinus to sinus tachy at 190's...........and then they did valsalvas, carotid massages and stuff to see if they could change the morphology that way, and with those maneuvers, my rhythm showed no change in P wave morphology and a progressive slowing of the rate. this is typical of a sinus mechanism, the progressive slowing, not abruput. if it had been atrial tachy (like they were trying to distingish btwn from sinus mechanism) the atrial tachy would have (typically) abruptly stopped the tachy with those maneuvers, usually either proceding or preceeding by a PAC or PVC. there are certain criteria they look for, different characteristics of the rhythms, how they break from tachy to normal sinus, and how they originate, to make a diagnoses btwn one rhythm or another. and since my tachy was a gradual slowing with those maneuvers, instead of abruptly stopping, they are concluding it to be a sinus node mechanism.

however, all that being said, sometimes you cannot simply go by non-invasive measures to try and determine the absolute source or origin of the tachy because even classified a "sinus node mechanism" this is still a very "non-specific" diagnoses. it doesnt nessarily 100 percent mean TRUE sinus tachy. there is a thing called SA nodal reentry tachy that presents very similar to sinus tachy. it could also BE sinus tachy but being caused from an actual sinus node abnormality and not from problems with sympathetic innervation to the heart from neurological/autonomic problems. you dont know until you test the SA node out yourself via EP study. they have found primary sinus node abnormlaities in people with pots that have undergone EP studies but those that they ablated with this abnormality, the majority of them were still left with POTSY symptoms so..........i'm sure there were SOME that benefited from the ablation, but whehter or not you will be the one to benefit or be worse from it, that is a risk that you must be willing to take.........call me crazy, but i'd take the risk if they found a primary sinus node abnormality with EP study and decided to ablate.......that's just me though............

[kmpower]

Hi again, just back online.

Thanks for taking the time to type all of that out. From what I have been learning and your example, I appreciate that even sinus tachy is a general diagnosis. When there is IST, who is to say what is appropriate or not? Compensations are critical in physiology. Morgan was apparently compensating better before they ablated her. My friends were not.

If my rates went as high as yours I would think the same way you do. It might be better to ablate even if you will need high-low pacing; this is my thinking during an episode. The feeling of being out of control rate-wise is terrible as everyone on this forum knows.

But my rates don't go as high and I know more of the reasons why they do -- eat more than I should (I am careful, but sometimes I don't realize I am overdoing until too late), lie down or bend over too soon, stand and bend without moving enough, etc. Stress might raise my baseline a bit, but will not trigger a tachy episode. When I am more stable rate-wise, I worry that ablation would make me worse in an unpredictable way.

Back to you...if you have MVP, have you had it awhile? Could you just have a really efficient (if unpleasant) compensation for it with the atrial rates? I have read and heard from many sources that MVP can be considered a magnesium deficiency. I know some people who no longer have orthostatic issues due to MVP just from taking sufficient Mg of the right form for them.

I am really not trying to suggest treatment here, or be simplistic after what you have been through, but the MDs who are nutritionally oriented seem to all say that if you had only one treatment and were stuck on a desert island and had any cardiovascular symptoms, it would be Mg. And serum tests do not show the common deficiency.

Please keep me posted about your thought processes and tests and I will do the same.

OLL