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?

Just so you're aware of the terminology . . . sinus tachycardia is a general term for a rapid heart rate when the heart is beating in a normal way electrically. i.e. the heart rate is being controlled by something called the "sinus node". This is the part of the heart that normally controls the heart rate. So when you exercise - and your heart rate increases - this is a form of sinus tachycardia and entirely normal.

But episodes of sinus tachycardia can occur at innappropriate times - and therefore be abnormal. E.g. if you have POTS and the heart rate increases innappropriately - this is a form of sinus tachycardia, but sinus tachycardia happening at an innappropriate time.

Thank you that is a helpful explanation. The GP wasn't massively helpful and said everyone gets sinus tachycardia and didn't think it was worth taking the beta blockers that the cardiologist prescribed. I suppose I should be reassured by his laissez-faire attitude but it does the opposite as I feel that he isn't taking my symptoms seriously and how it is affecting my life. So I'm going to try the beta blockers for a while and see if they help.

You said you went for a run - and felt that your heart rate didn't drop very rapidly afterwards? That can just be down to lack of fitness. Would you say you're quite fit? E.g. do you exercise regularly?

Agreed, we all get sinus tachycardia. However it's 'inappropriate' when it occurs at the wrong time. E.g. it's not appropriate to get a sustained tachycardia when you just walk from a-b slowly.

Yet at the same time @bobbiester has a point. It's natural that when something feels bad, we stop doing it. So it's easy to get deconditioned (unfit) and then it makes symptoms even worse.

@Mewmin

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.

My DS has very much the same as you. He saw a cardiologist (nhs) who arranged 24 hour ecg and then electrophysiology study. They were looking for SVT but couldn't find it. The diagnosis was just paroxysmal tachycardia. He takes bisoporal which seems to control it. Coincidentally he also has reynauds.

I have atrial tachycardia though its not thought to be hereditary.

Also OP if you like to Google look up Dr Sanjay Gupta a cardiologist at York who does YouTube videos on a host of heart conditions but mostly arrhythmia. Under the name York Cardiology.

Hi @Mewmin. I started getting random bouts of tachycardia in 2012 in my late 20s (I'm mid 30s now). It was quite often dismissed by doctors as anxiety, even though I knew this wasn't the case. Anyway, a year and a half later I had an ablation where they discovered the cause of it and ablated the rogue area (the doctor doing the ablation said it was unacceptable that I'd been dismissed for so long by medical professionals). The diagnosis was focal atrial tachycardia. The ablation made a huge difference. I still get tachycardia occasionally, but there's nearly always a reason for it like an illness etc. I had Covid in November and it flared up a bit then, but settled back down once I got better. Don't let medical professionals fob you off like I did!

Thanks. Would they have seen atrial tachycardia on the echocardiogram? They seemed to think it wasn't atrial.

I have now taken the bisoprolol for 2 days and feel SO much better. In fact it has made me realise how bad I felt before. I just feel normal again and no longer like I'm always on edge and about to take an exam I haven't prepared for! Still annoyed at the GP's attitude. If this tachycardia was normal why would the cardiologist prescribe anything to control it?

The cardiologist didn't call it inappropriate sinus tachycardia, just sinus tachycardia, and when I asked the GP about this he said that inappropriate sinus tachycardia isn't a term that they use any more, which seems strange as there is loads of stuff on the Internet about it by e.g. Great Ormand Street, British Heart Foundation etc.

@Mewmin

Thanks. Would they have seen atrial tachycardia on the echocardiogram? They seemed to think it wasn't atrial.

I have now taken the bisoprolol for 2 days and feel SO much better. In fact it has made me realise how bad I felt before. I just feel normal again and no longer like I'm always on edge and about to take an exam I haven't prepared for! Still annoyed at the GP's attitude. If this tachycardia was normal why would the cardiologist prescribe anything to control it?

The cardiologist didn't call it inappropriate sinus tachycardia, just sinus tachycardia, and when I asked the GP about this he said that inappropriate sinus tachycardia isn't a term that they use any more, which seems strange as there is loads of stuff on the Internet about it by e.g. Great Ormand Street, British Heart Foundation etc.

The echocardiogram examines the structure of the heart - and aspects of how it's physically functioning as a pump.

It's the electrocardiogram (ECG) that would be used to identify the type of tachycardia someone is experiencing. The electrical signal can be used to work out where in the heart a rhythm is coming from.

Glad to hear the medication is helping.

Just incase you decide you would like to consider seeing the specialist I suggested (london/kent) I thought I would let you know how it went seeing him. He was fantastic, so knowledgeable and has ordered a huge load of tests to get me on the path to getting better. I didnt once feel he was dismissing my concerns, he answered all my questions and I came away with a plan. He is happy to link in with the NHS for tests, and see me at King's College, but I also have the option of seeing him privately if I wish. He said that my symptoms absolutely sound like pots, but that it all needs looking into before he can say for sure. He also immediately said he would refer me to a few other specialists for some of it so it can all be looked at properly.

I was dreading the appointment to be honest, so worried about being dismissed like my awful gp, but it went as well as it could have. I felt awful in the appointment, and struggled to get through the brain fog to understand what he was saying, but he was very patient and clear. I would definitely recommend him.

Thank you. It's good to know that there are doctors out there who listen and take time to explain things!

I'm feeling so much better already on the bisoprolol that I'm happy for the moment without pushing for any further appointments. Whether it's sinus tachycardia or Pots the treatment seems to be the same so although it's frustrating that my GP was so dismissive and the cardiologist was confusing (and didn't write up my notes accurately) at least I know it's nothing serious and the treatment I've been given seems to be helping.

I have to go back to the cardiologist in 6 months for a review. It will be interesting what he recommends at that stage.

I’m a cardiac physiologist so this is my bread and butter so to speak, without the results of your 24 tape it’s hard to say what your problem is tbh. You can have inappropriate sinus tachycardias, where your heart rate raises disproportionately to the activity (this could be when moving from sitting to standing), when it raises without activity, when it stays high for long periods of time etc. You can have supraventricular tachycardias (SVTs or atrial tachycardias) these are usually fairly benign abnormal rhythms (arrhythmias) that originate from the top chambers of the heart (atria), first line therapy is beta blockers, if beta blockers don’t work and the patient is particularly symptomatic they would look at ablations (burning away the small part of the heart responsible for the tachycardia).

The first line treatment for these condition and POTs is the same (beta blockers), we would also advise lifestyle changes like avoiding caffeine, staying well hydrated etc. I can’t say what they actually diagnosed and why it wasn’t pots without knowing the results of your investigations.

Thank you. I had an echocardiogram and 24 hr ecg. The echo was normal, the ecg showed episodes of sinus tachycardia and ectopic activity both during postural change ie just standing up/going upstairs my HR would go to 120 from 70 but he said there were also occasions where this happened and I hadn't noted in the symptom diary that I was doing any in particular (so could well have been postural but I didn't record every single time I stood up, just the times I noticed high HR).

I'm not sure if this is Pots or whether it could be inappropriate sinus tachycardia (IST) as he just diagnosed "sinus tachycardia". The GP interpreted this as "normal" and said we all get tachycardia and I didn't need beta blockers (?!). So I'm confused as to whether I have "normal" tachycardia or IST. In any case I'm feeling so much better on the beta blockers so it seems obvious to me that something was not right.

They didn't give me any lifestyle advice other than to avoid caffeine, which I already do anyway as it makes me shaky.

I guess my main concern is why this is happening now (has been about 3 months). I suspect it is a build up of stress and anxiety as I have felt for a while that I am just full of adrenaline all of the time even when I do everything I can to relax (had CBT, run, do yoga, meditate etc).

The other nagging concern I have is whether I could have an adrenal tumour causing high levels of adrenaline and therefore these symptoms. Neither doctor mentioned this possibility and I felt like they both already thought I was worrying unnecessarily and wasting their time so I didn't feel I could add this question to all of my other questions.

From what you’ve said my feeling is it may be anxiety/stress related, what beta blockers have they started you on?

Bisoprolol 2.5mg.

I don't know what to do if its stress/anxiety I.e how to get better. I've already had CBT for anxiety and spent most of it trying to let myself be persuaded that my symptoms are anxiety and nothing more but then I read about Pots and it all seemed to fit. Which is why I went to the GP and they found that my HR increased by 35bpm just on standing, which is the main diagnosis criterion for Pots, and then I got referred to the cardiologist. So it felt like all of the CBT was pointless as there was a medical reason for my symptoms after all!

I have a disabled DD due to medical negligence at birth so have a hard time trusting doctors, especially if I feel they're not listening to me (which is what happened with my DD). And tend to assume the worst e.g. adrenal tumour rather than just stress.

Now that I'm on the bisoprolol and it has pretty much taken away my symptoms is that more suggestive of there being a medical reason for the tachycardia rather than just stress?

Thank you for your help and advice!

An adrenal tumour I think would mean you're producing adrenaline all the time, so you'd be tachy all the time, so it doesn't sound like that. My dc was told extra salt helps with pots - so if you need an excuse for a pack of ready salted crisps every day you have one

I posted above about my DS. He's 24 and has been absolutley fine since taking the bosoporal.
He was getting tachycardia at random times though much more when stressed and when exercising. He also gets it when he has infection.
The consultant who did his ep study said his heart was very sensitive to adrenaline (they injected him with it) but it wasn't SVT so abalation not approriate.
The main thing DS got out of it was a very long and beneficial discussion about it all. She gave him the confidence to learn to live with it and not limit his lifestyle ( he had been avoiding strenuous activity among other things). He was massively reassurred and that in itself reduced the symptoms. He never touches caffiene and also finds sugar a problem.
He has tried to wean off the bisoporol as he was unhappy with the idea of long term medication but symptoms returned quickly.

Thank you, your DS sounds a lot like me! I've also been very sensitive to caffeine as it makes me shaky and on edge so I suppose it makes sense that I would be sensitive to adrenaline.

Now need to try to find a way to reduce stress!

@Mewmin how are you now ? My dr is thinking of putting me on bisoprolol? Im abit scared yo take it x

@Boph hi! Did the medication really help your son? Xx

@Starrr123 Yes he is well controlled now. Only has issues when he gets a fever or misses a tablet.

@Boph is he able to do normal day to day things ? X