You've Got To Be Kidding Me.....

[cardiactec]

My cardiologist called me today to talk about my rhythm strips from last week that demonstrated a very sudden onset/offset tachycardia with a rate of 278 BPM. he told me tonight that though IT COULD BE ectopic atrial tachycardia, it COULD very well JUST BE sinus tachycardia which he referred to as "POTS GONE BAD" .........................??

Have any of you ever had a heart rate of 278 that was considered "pots" or "sinus tach"????? I have never ever ever heard of a sinus tachycardia THAT FAST, nor have I ever heard of a sinus tachycardia that has such a sudden onset and offset with symptomatically and morphologically on ecg.........

Either way, he's still doing an EP study on me though..............

[pat57]

I have no idea.. the following looked pertinent

http://www.emedicine.com/ped/topic2534.htm

The diagnosis of AET is based on the presence of a narrow complex tachycardia (in the absence of aberrancy or preexisting bundle branch block) with visible P waves at an inappropriately rapid rate. The rates range from 120-300 and are typically higher than 200 bpm, although physiologic rates may be observed. The P wave axis is usually abnormal, although a focus near the sinus node can be mistaken for sinus tachycardia. Similarly, the P wave morphology may be abnormal. Onset of the tachycardia occurs with a P wave identical to the subsequent P waves. The tachycardia may exhibit a "warming up," which refers to a progressively shortening P-P interval for the first few beats of the arrhythmia. Similarly, a "cooling down" may be observed at its termination. First-degree atrioventricular (AV) block is typical and second-degree AV block is common. The tachycardia cycle length and degree of AV block are influenced by the autonomic tone.

[Guest tearose]

I didn't think this was so unusual actually. Are those with POTS and PSVT that rare?

Yes, I do understand. Just this past trip to Mayo they captured my "symptom"...during my ttt...thank goodness!!! I was very fortunate to have them recording the whole onset and progression and end. I have now a documented PSVT run that scared the techs and left me very pots symptomatic and fatigued like I try to explain.

They wanted to do a EP study but I chose to decline. I just do all I can to avoid more physical drain on my body. I have to use compression, all that stuff you already know. My PSVT triggers are mostly identifiable to me, so maybe I am just not worried...should I be?

Why do you need an EP study? Do you not have any idea of what is triggering them?

My triggers are: no compression, extreme fatigue, poor sleep without daytime naps, not replenishing electrolytes after regular SVT runs.

Should I read more on PSVT? Now you have me wondering.

tearose

[morgan617]

psvt, atrial tach, but not "just" a tachycardia. It's getting to the point where nothing surprises me anymore. Heart rates of 29 are okay, 7-8 second pauses are fine, even if very symptomatic and vtach is benign unless it actually kills you, then it's something to be concerned about. So big deal with a rate of 278. I have given up on the whys and what fors with this stuff any more. What does it take for cardiologists to be concerned about arrythmias any more?????

Is your EPS scheduled? Are you okay with someone that wishy washy doing it??? Not that it seems there's anything better out there any more. Good grief....morgan

[Ernie]

Hi,

I think we have to be on the edge of death but with a high probability of resuscitation for them to be interested in our case!!!!!!!!!

[Rachel]

Hmmm... I thought the rhythm strips showed that it wasn't sinus tach. Is the doctor questioning the strips? I'm glad he's still doing the ep study on you. It will be good to (hopefully!) get some answers from that.

I've had heart rates over 200, but never with a sudden onset/offset. My rates would jump quickly with exercise (more quickly than they should have) and go over 200. Resting, however, was always under 200.

Best of luck with everything. Do let us know how the EP study goes.

Rachel

[bgsu4]

I have been giving stress tests since 1995 in college and the real world and have never seen a sinus tachy of 278 bpm. ****, for that matter I have only seen about 10 that have barely cracked 200 in max testing college age people. I just love the POTS GONE BAD crack, what an ***.

I have just started getting either a SVT or atrial tach and have ended up in the ER 3x in the past few months. Caught it on the monitor twice and once the EP and I agreed no SVT, this last time looked like SVT. I feel like crap afterword and and the trigger twice has been going to the bathroom. The Doctor I had today was around 70 and he knew about POTS and took it seirously(**** the whole ER in Lakewood knows about it after the last few months) but he told me that some doctors will take POTS and throw it in the wastebasket. I just love how serious some of these people take their jobs. I told him to line them all up outside and I'll throw them in the dumpster.

I really hope you get to the bottom of this, I've heard different things from different docs and I am frustrated. I had the first cardiologist say it was an SVT at 122 and 138 bpm (during sleep with my holter), then the EP said it wasn't SVT and I had to agree I didn't see it either, the last one we caught sure seemed like SVT at 172bpm and the tech who recorded it said SVT. I just want to know what it is, hopefully ablate it (my neuro is very concerned about the treatment since my resting rates are in the 40's and he seems a little scared of ablation) and get on with just dealing with POTS.

I wanted to ask you one question since you are around this alot more than me. I have been active since I was a little kid. Was an athlete in high school and college and exercised all the time as an adult. I never had any problems that showed up on weekly stress tests in school or even when I first got a stress echo when my POTS was young. I think my neuro is concerned about ablation because of the whole you don't ablate pots but they would be ablating an accessory pathway if they can trigger it during the study; right? I spent only one week in a ep lab and saw lots of things but nothing with POTS. I'm pretty sure my wonderful overactive vagal nerve (I hope I get a new one for X-mas) is very influential in all of this but it would only be causing the stimulation that triggers the accessory pathway; right? Anyway, I hope the EP study goes well, they find it and ablate it. I really admire you because if I had a HR of 278 (I can barely stand the 170's without it being from exercise) and the doctor was could be this or could be that, I think I would blow up on them.

[cardiactec]

I dont know , I personally believe the cardio is saying such things because he has yet to come to the realization that he may have been wrong for the past few years.....and he doesnt want to own up to it. we'll see what happens with the EP.........

The EP is being scheduled today.......

I am having the EP because I'm highly highly symptomatic with this "other" heart rhythm..........heh, I'd think anyone with rates that high would be symptomatic, not much perfusion happening at 278.............at least I dont handle it well, cant speak for everyone.

I, too, have been doing stress testing for about 4 years and I have never ever ever ever ever seen anyone's heart rate pass 200 - even the pedi's that I do!

This rhythm has a definite abrupt onset and offset and this type of behavior is not typical of a sinus originating tachycardia - unless the rules have changed!

yes, as for accessory pathway, they'd ablate that in someone with pots - as long as they stay clear of the sinus node in a pots patient (they are even moving away from sinus node modification even in patients with inappropriate sinus tach that isnt necessary induced with upright posture).........the rule of thumb is to target the irritable foci and if it happens to be the sinus node itself, they dont touch it.

as far as i have been told, from a mayo clinic cardiologist a couple weeks ago, PSVT is not generally found in the pots patients, only sinus tach - so yes, those with both pots and PSVT i guess are rarities.

got to run for now. i'll let you know any further info regarding all this...............

talk soon all!

cardiactec.

[flop]

Hi Angela,

maybe they need to reconsider the "POTS and SVT don't go together theory" - I have a rhythm strip from a holter monitor with P waves all over the place (after QRS complex, during the T-wave and in the QRS) my EP consultant said it was atrial tachycardia even though the QRS rate is below 100 (I was asleep at the time so wasn't aware of any symptoms).

I did manage to get to 218 on my stress test and maintained that for over a minute before asking the consultant if he was trying to kill me - wish I'd kept quiet and seen quite how fast I could get it to go as I was only jogging (13 mins into full Bruce protocol).

Let us know how the EP study goes and what it shows.

Flop