Shall I get the chemical stress test for tachycardia?

Question

Hello doctor,

I am a 55-year-old postmenopausal woman, who is 223 pounds and 5 foot 8 inches in height. I have no known heart conditions except for many PVCs and PACs. I was recently diagnosed and picked up on a 48-hour Holter with atrial flutter. The doctor wants me to have a chemical stress test for what I have been experiencing now for about a year. Once every four to seven days, tachycardia wakes me up and it only happens at night time and never during the daytime. In the middle of the night when I am sleeping I feel very hot. And, when this is happening my heart rate shoots up from 120 to 170 BPM and will last anywhere from 5 to 10 minutes and slowly starts to come down. Yes, I do feel anxious when this is happening and I have had panic attacks. Before, they do not feel like panic attacks, but it is still uncomfortable and worrisome. This is driving me crazy. There is no shortness of breath or dizziness. My TSH and T3 are normal.

I went to the gynecologist and had a full workup for hormones and all tests were normal. My bloodwork was normal with my cardiologist. My HbA1C was normal. I lost my son before 1.5 years. I cried every day for one full year and I am still heartbroken. Now, I do not want to use that as my reason for tachycardia, because this wakes me up out of a dead sleep. I feel very hot and my skin is red when this is happening. I have to get up and walk around because it is bothersome. Any of your answers and ideas would be very helpful. My gynecologist does not think that has anything to do with my hormones. I do not know if adrenalin rises in the middle of the night with postmenopausal women. And, my cardiologist has no idea of what this could be.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

Episodic tachycardia in the setting of PAC and PVC (premature atrial and ventricular contractions) is suggestive of arrhythmia and may be atrial fibrillation or flutter. We should try to find the cause of it. Do you smoke or have alcohol or any other stimulant drugs? Do you suffer from snoring, interrupted and unrefreshed sleep, daytime sleepiness, headaches, etc? Is there any history of exertional chest pain? Since your Holter has not picked anything, the next step is the stress test. There is no harm in undergoing it and it will help us to rule out ischemic heart disease as well.

Do you have had any episodes when you were on Holter? If not and you are having those episodes more frequently now, then you can consider wearing Holter again. Otherwise, undergo the stress test. The next option is electrophysiological studies and it is an invasive test, but will diagnose and treat the arrhythmia in the same setting. I guess, the echo must be normal before starting Flecainide. Regarding treatment, I would suggest beta blockers like Metoprolol 25 mg to 50 mg according to heart rate and Flecainide should be a pill in pocket approach, that is as and when needed.

I hope this helps.

Thank you.