What causes bradycardia, tachycardia, and palpitations?

Question

Hi doctor,

I am a 43-year-old female having daily bradycardiac episodes (down to 40 when active at work, the heart just drops, I feel it is happening) and tachycardiac episodes all day (ranging from 118 to 160 resting). I have palpitations all the time. I woke up with them at 3 am. I have worn a monitor recently. PVCS upwards to 1,132 each day and 500 PACs a day. I am exhausted. I get dizzy and, at times, short of breath. I have had a few syncope episodes. My cardiologist just stated I have no arrhythmias. I am 142 pounds as well, at 65 inches. He placed me on low-dose Amlodipine for Raynauds. Echocardiography only showed regurgitation in mitral and tricuspid valves. Left ventricular diastolic disfunction. So my question is, should I see another cardiologist?

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Thanks for the query. Please send me your electrocardiogram (ECG), echocardiogram, holter report so I can guide you accordingly. Without these, nothing can be inferred.

Please revert so I can assist you further.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Your echocardiogram shows only mild mitral regurgitation or MR (leakage of blood backward into the left atrium due to a faulty mitral valve, often asymptomatic) and tricuspid regurgitation or TR (a similar condition affecting the tricuspid valve, causing blood to flow back into the right atrium), which are normal. The rest of the echocardiogram is all normal. No need to worry.

Holter monitoring is also normal. Premature ventricular contractions (PVC) and premature atrial contractions are normal occurrences in normal people. The burden is less than one percent. They are considered a high burden when they are more than 10 percent. Regarding postural tachycardia syndrome (POTS), it occurs when one stands up from a lying position. Heart rate increases suddenly with palpitations and dizziness and normalizes in some time. BP remains normal. Your average heart rate is 78, which is perfectly normal.

The lowest heart rate is 50, which is normal in sleep. Orthostatic hypotension is when blood pressure drops upon standing. Vasovagal is when both of these drop upon standing. A tilt table test is done to confirm these. What is your average blood pressure? Amlodipine, which You are taking for Raynaud's, is also an antihypertensive.

I hope these recommendations help you.

Feel free to reach out if you have any further questions or doubts.

I hope this answer helps you.

Thank you.

Answer 3

Hi,

Welcome back to icliniq.com.

I understand your frustration and concern.

Please be sure I am here to help you. Your 30-day Holter monitoring did not show bradycardia, though it can occur in normal people if it is sinus bradycardia, especially at the time of rest. How do you count heart rate? The best way is manual counting. Non-medical wearables may not show correct info in some cases. 45 heart rate is considered normal in healthy people, and if it is asymptomatic, The tilt table test formally assesses heart rate and blood pressure drops or elevations upon standing from a recumbent position. If u have symptoms upon change of posture, I recommend a tilt table test.

POTS (postural orthostatic tachycardia syndrome), vasovagal, and postural hypotension can all be assessed using a tilt table test. Your Holter did not show any single episode of atrial fibrillation. Wearables may show wrong information at times, as I told you. Now note when you feel bradycardia, count your heart rate manually for one minute. Count your heart rate and check your blood pressure when you have dizziness. Also, blood pressure and heart rate should be checked while lying and standing. Please ask someone to stand by your side if you feel dizzy or fall. He or she may keep you from falling.

I hope these recommendations help you.

Feel free to reach out if you have any further questions or doubts.

I hope this answer helps you.

Thank you.