peregrine

1 I've had two, although they both predated the POTS symptoms starting. What's the viable alternative, besides losing the tooth? The two root canals I had were to fix a dead nerve root (trauma due to a fall) and to deal with an exposed nerve root (too many fillings on the tooth). As far as I know there's also no metal involved unless you have a metal crown on top of the tooth that had the root canal; the filling is usually gutta percha (a natural latex rubber from a tree from Indonesia) and thus won't conduct. But I'm not sure we're talking about exactly the same thing?

Thanks so much, dizzyizzy - that's incredibly helpful! Just to make sure I know what you're saying (and to try to put it into an image) - basically, SVT is like a square wave where you go up from normal to high immediately and then down back to normal from high at some point later, again immediately? And POTS/dysautonomia arrhythmia is more like a sine wave - it goes up and down with a slope rather than immediately? If I'm understanding that right, then what I seem to have all the time is POTS-type stuff. If it weren't for the weird p-wave morphology, I wouldn't even suspect an SVT (in my case the atrial tach) at all. I don't get random jumps in heart rate - or at least, if I do, they're not symptomatic. So I could have had that my whole life and not noticed, maybe, and noticing the development of POTS is what led to the diagnosis of the atrial tachycardia as well? What you describe as sudden, unprovoked rapid heart rate is something I've never felt; I always have that slow build-up, and it's almost always after doing something like standing up or doing exercise. And yeah, afterwards I'm always wiped, but it's easy to stop it by just sitting/lying down; it never just fails to stop. Thanks for the extra info on the ablation. Will definitely skip that. In my case (with atrial tachycardia) the doctor said that they wouldn't necessarily be able to find the extra pacemaker cells to ablate if they couldn't trigger the abnormal p-wave morphology, so it might not even work, which made me even more hesitant to consider it. I'm glad that I had read stuff on dinet before so I knew to refuse initially! re: medication - the electrophysiologist said that we're trying calcium channel blockers because of my mood episodes - apparently beta blockers can trigger/worsen depression - but that if those don't work we can switch to an anti-arrythmia drug. But I hear those come with a very low (but it's there) risk of sudden cardiac arrythmia/death, and I'm not so keen on that. So far the calcium channel blocker doesn't seem to do anything for the dysautonomia stuff other than perhaps slowing the tachycardia a little bit. My resting heart rate is usually around 60 (although the Holter got down to the upper 40s overnight), so they weren't worried about that.

Also, Chaos, if you find citations or studies on ablation in POTS/arrythmia folks, I would be much obliged. (I don't need pdfs, since I'm at a university, but anything would be quite helpful!) Also also, if anyone knows of a dysautonomia specialist in the Pacific Northwest (I'm in WA), that would be wonderful; the NDRF site doesn't have anyone within the region.

Thanks for the info! In my case the atrial tachycardia is definitely present (as Chaos notes), but unlike someone with just standard atrial tachycardia I have an orthostatic component as well (hence the lightheaded while walking stuff and other things the rest of you folks talk about). So it seems like both a general electrical system issue (I think of it as an independent city state of cells in my heart that have decided that also being a pacemaker is fun) as well as something with dysautonomia. Got a referral today for Neurology from my primary care; she says I "keep her on her toes" and agrees that ablation is not the right idea at this moment.

The last two root canals I had they offered me music. I had actually brought my ipod and noise reducing earbuds, and I had copied a meditation CD that I own onto the ipod. They also gave me a blanket for my legs (it was a bit chilly). Between those two solutions I was pretty good, but I always have been for dental stuff. Still, if you can't tolerate the meds, or even if you can (I use Ativan from time to time myself), it's worth a shot just to calm you down. The noise reducing earbuds or noise cancelling headset are great because they help tune out some of the sounds of the drill. Best of luck!

I worried about that too, and asked the cardiac EP about it when I saw her last week; we had originally thought that my orthostatic stuff and tachycardia were due to Cymbalta until it didn't go away when I stopped taking it. She noted that it (along with Wellbutrin) can be prescribed to help with orthostatic issues, and told my psychiatrist not to worry about med restrictions when prescribing things. Now back on the Cymbalta; orthostatic stuff does seem somewhat worse, but it's hard to say yet. As a side note, the rheumatologist last week said that if you have problems with norepinephrine (for me it causes tooth grinding (and yes, I have a guard) and insomnia, as well as general muscular tension) you might want to avoid Savella; he said it has 10 to 100 times as much norepinephrine reuptake action as Cymbalta.

The cardiac EP put me on 120mg nightly last week. So far it does seem to be decreasing the heart rate (not my resting HR, just the exercising HR, and only the high end of it); note that she put me on it for the atrial tachycardia rather than orthostatic stuff. It doesn't seem to do anything for the spaciness, nausea, sweating, other autonomic nervous system stuff; just the heart rate.

Thanks for the info! She was pretty specific about it being another arrhythmia as well ("... the Holter is quite suggestive of possible atrial tachycardia and not simply IST"). Going back and rereading her clinic notes (I love docs that send you clinic notes!), she noted specifically that "it may be hard to sort through a clear diagnosis if autonomic testing, such as a tilt table test, produces an actual supraventricular tachycardia [aka the atrial tachycardia she mentions earlier] as opposed to simply IST." Still, I can live without a fully firm diagnosis as long as I can start doing something about it.

1 Saw the new cardiologist (an electrophysiologist, specifically) two weeks ago. She diagnosed me with some type of supraventricular tachycardia (most likely atrial tachycardia, she thinks unifocal) based on the p wave morphology of my Holter monitor. She also said that the symptoms I've been having are more closely linked with some type of dysautonomia (separate from the atrial tach and not due to an electrical pathway malfunction). Hilariously I almost fainted during our appointment when she started discussing catheterization. She said she could refer me to a neurologist to talk about the dysautonomia (she thinks it's probably POTS), but that they wouldn't be able to figure much out because of the atrial tachycardia, so it might not be worthwhile. She did put me on diltiazem (120mg nightly) which is helping with the tachycardia, but the spacey feelings I get when walking/standing (which are my worst symptom) aren't getting any better. Seeing my primary care doctor tomorrow; I might ask her about a referral to Neurology. She's been really helpful and very supportive this entire time, so I think she's got my back. So... is it possible to have both a dysautonomic condition *and* an arrythmia? And, if so, how do you treat them? I'm nervous to get catheterized because of the info on dinet about it not helping with POTS (and leading to dysautonomia at times). Thanks a ton!

Diagnoses: POTS (or something like POTS, but they won't send me to Neurology because of the arrythmia), plus an atrial tachycardia (based on the p wave morphology on my Holter). Originally thought to have been triggered by Cymbalta (for fibromyalgia and hypermobility syndrome pain), but now they're not sure.