Need advice on tachycardia before GP appt tomorrow please

[Mewmin]

I have been experiencing tachycardia for a few months, mainly when standing up or doing exercise. I had an ecg at the GP where my heartrate increased by 35bpm on standing which they said was abnormal and referred me to a cardiologist. I did my own research and it looks clear I have the symptoms of Postural Orthostatic Tachycardia Syndrom (Pots) as I have other symptoms like fatigue, dizziness, tremors etc.

I've had a load of tests including 24hr ecg and the cardiologist has diagnosed "random tachycardia" and given me beta blockers. He said it definitely wasn't Pots as my pulse didn't increase when I stood up in his office. But the ecg at the GP did show this, taking my pulse at home with an oximeter confirms it and I'm sure that the tachycardia episodes I had on the 24 ecg corresponded with standing up (which I had to note down in the diary with the 24 hr ecg).

I've googled and can't see any such thing exists as "random tachycardia" or just tachycardia on its own. I don't know why the cardiologist would dismiss the possibility of Pots so quickly. But he has given me beta blockers, which is the same treatment I would get for Pots. So why is he so adamant its not Pots?

I have an appointment with the GP tomorrow and want to be able to ask the right questions. So just wondering if random tachycardia is a "thing", whether I should get a second opinion, and should I e.g. ask the GP to take my pulse on standing and see what happens?

Have you had covid-19? I have and random tachycardia is still an issue for me a year later. I don't fit the classic POTS diagnosis, it is on mild exertion for me aswell as sometimes just random

I think I had it in March 2020 but obviously not confirmed from back then. But these issues have only been in the last three months. Have you seen a doctor for your tachycardia?

Cardiologist may have just being trying to put the term "paroxysmal" into lay-persons language - as "random".

But they mean pretty much the same thing - "paroxysmal" just means it happens from time to time and doesn't have a clear trigger.

I've had random episodes of unexplained tac all the time, had the full investigations done and no one can find a trigger. I actually now thing it's related to anxiety!

Just explain what you have here and see what the GP says, you can ask for a referral for a second opinion though!

Is paroxysmal tachycardia the same as supraventricular tachycardia?

I just don't feel confident in the cardiologist as it felt like he dismissed what I said.

I do think it could be related to stress/anxiety but wanted to rule out anything else first. But if it is anxiety related would beta blockers actually be any long term help?

Is it dangerous ie could it cause any future heart problems/clots etc?

If you can afford to, go private for a consultation with a heart specialist £400-£500. You probably need an exercise ECG as well as a normal one and NHS don't appear to prioritise these at present unless you're showing signs of imminent heart failure.

Idiopathic tachycardia is possible. A consultant should do suitable tests to investigate POTS and other possibilities as well as a scan of your heart and checking you exercise.

There are different types of paroxysmal tachycardia - and paroxysmal supraventricular tachycardia (SVT) is one of them. Actually there are also various types of SVT.

When you had the 24 hour ECG did it record any episodes where you experienced tachycardia?

Where are you op? I'm going to see Nicholas Gall, who is connected with King's hospital in London, but also has clinics in Kent. He is a pots specialist and was recommended to me by an EDS support charity as an expert in pots. He is a neurocardiologist. There is a year wait to see him on the NHS, but privately you could see him much sooner.

Did you not have the tilt table test?

You want a tilt table test. I've been denied one. I do have dysautomnia but it looks like it's regular dysautomnia, not POTs.

I am going to make a serious suggestion here and I don't want you to think I'm being rude or goady.

Stop looking up things on Google.

Your Cardiologist will have had 15 year min training to be a consultant, and trust me, getting to be a consultant cardiologist is not easy. Let him diagnose and treat you. If you don't trust him, ask for a second opinion - from another cardiologist, not google.

@DPotter

I am going to make a serious suggestion here and I don't want you to think I'm being rude or goady.

Stop looking up things on Google.

Your Cardiologist will have had 15 year min training to be a consultant, and trust me, getting to be a consultant cardiologist is not easy. Let him diagnose and treat you. If you don't trust him, ask for a second opinion - from another cardiologist, not google.

To add to this - the cardiologist will have been focused on testing for and ruling out the most serious causes of tachycardia. E.g. electrical and structural problems with the heart.

So you can take some reassurance from what they have concluded.

@DPotter

I am going to make a serious suggestion here and I don't want you to think I'm being rude or goady.

Stop looking up things on Google.

Your Cardiologist will have had 15 year min training to be a consultant, and trust me, getting to be a consultant cardiologist is not easy. Let him diagnose and treat you. If you don't trust him, ask for a second opinion - from another cardiologist, not google.

Whilst I agree with this, POTS is relatively unclear, and many cardiologists don't regard it as a proper condition, or don't recognise the positional change as causing the tacky.

So if you can ask for a second opinion, to include a tilt test, that would be useful. In the meantime beta blockers are standard and low risk treatment for tachy with unknown cause or caused by position change. So your diagnosis may not be clear, it your treatment is.

SVT section here useful https://www.bhf.org.uk/informationsupport/conditions/arrhythmias

I had/have POTS symptoms. But the tilt table test didn't show the response required, although I actually tanked my blood pressure and passed out at 10 minutes. The cardiologist just diagnosed 'inappropriate sinus tachycardia' - "your heart just goes crazy when you do anything". My heart rate used to regularly go to 160bpm just walking up a small slope, loading the dishwasher, etc. Eventually I was prescribed Ivabridine (typically used for angina), which just knocks off about 20bpm from my heart rate and fludrocortisone, which helps my BP to stop the postural dizziness.

My heart rate is still high. I can't use a Fitbit because it thinks I'm doing cardio workouts when I'm sitting on the sofa watching TV. But the difference is incredible. A few days ago I forgot to take my pills. I suddenly thought 'I feel awful...', then when I put a sats probe on my finger my heart rate was over 150bpm.

Pots can present that way round lougle!

@titchy

Pots can present that way round lougle!

Yup, I just didn't have it in me to argue. I have treatment which vaguely helps and I can function. I was at the point that I couldn't even do basic housework because I'd feel faint and dizzy.

Thank you for the comments. The consultant cardiologist I saw was private and he did an echocardiogram and 24 hr ecg.

I initially spoke to my GP who was quite dismissive but ordered an ecg and blood tests. Bloods all fine but the ecg was abnormal as I went from around 70 to over 110 when I stood up. So he called me the day he got the results and referred me to the cardiologist.

The 24 hr ecg showed "random" (according to the cardiologist) episodes of tachycardia but I was pretty aware of my heartrate the whole time and found my heart was racing only when standing up from sitting or doing something like walking upstairs. So it seems odd to me that he would say the episodes were random and not connected to me standing up.

I also went for a run while wearing the ecg and my heartrate went up to 175 which he said was normal. I noticed it took a really long time to come down after the run but he didn't say anything about that.

I assume he won't send the actual 24hr ecg report to the GP will he? Just his letter summarising his findings?

I am comforted that nothing serious was found but it does give me a sense of distrust that he was so dismissive of me telling him I got the symptoms only when I stood up. He was so adamant that it wasn't Pots. I mentioned that the ecg at the GP showed tachycardia on standing and he just waved his hand dismissively and said "I took your pulse when you were standing and it was fine".

At least least treatment for Pots and whatever he has diagnosed is the same. But I'm also a bit concerned that I have low blood pressure (which I told him) and Raynauds (which I didn't tell him as he didn't ask and I didn't know it would be relevant) and when I looked up bisoprolol it said not to be taken if the patient has low blood pressure or Raynauds.

Thank you for the recommendation of a specialist in London/Kent. I am in the SE so that might be possible, but not sure if I want to go through the anxiety of more tests and appointments just for a possibly more "correct" diagnosis if the treatment is the same anyway.

I just hope that the GP can give me some more information.

@Lougle do you mind me asking if you are slim? My GP originally said that all these symptoms are common in "young" slim women (I'm 44 so was quite pleased to be described as young!) and not necessarily a medical condition. But that was before he saw my ecg, at which point he seemed to change his tune.

@Mewmin yes. I used to be extremely thin before children. Now I have a bit of a tummy but size 10, BMI 22. Relatively tall at 5'8".

Dd has same diagnosis - also skinny (BMI just about ok at 18.5)

Thanks, when you say the same diagnosis do you mean Pots or tachycardia?

Try and get a referral to Guys Hospital. I got a diagnosis of POTS and orthostatic hypotension following a tilt test there. Took 20 years of symptoms to get a diagnosis.

Same as lougle. But waiting (forever, thank you pandemic) for a tilt test because consultant suspected pots as well.

I've just had the letter from the consultant and it is worded differently from what he said to me yesterday. He said that my symptoms do often correspond with changes in posture but there are times when I have tachycardia not on a change of position, so for that reason he has diagnosed sinus tachycardia rather than Pots as its not consistent. So that makes a bit more sense.

But he has put loads of inaccuracies in the letter. Eg says I don't feel faint when I told him I do, that there is no history of diabetes but he didn't even ask me this and I did have gestational diabetes twice, and that I have no chest symptoms when I told him I get a tight chest. It doesn't help me to trust him!

I'm off to the GP soon so will see what he makes of it.