Brief Answer:
No need to panic / Get invesigated

Detailed Answer:
Dear friend,
Welcome to Health Care Magic

     Rates of 180 are SVT not sinus tachycardia…
     A swollen nose is not likely to do this… decongestants (Medicines like Phenylephrine used for ‘cold’) may do…
     Episodes during sleep make Panic less likely... Anxiety leads to fast rate / fast rate leads to anxiety – a vicious cycle sets in.

     Irregular heartbeats need to be DOCUMENTED by ElectroCardioGram (EKG). Standard ECG records the electrical activity of the heart, for a few seconds. It can detect the arrhythmia occurring during that time only. If the episode occurs randomly or precipitated by a specific activity like exercise, one needs Holter or event monitor. Holter records for days; Event monitor for weeks / Holter records continuously / Event monitor only at certain times .

     Anaemia / Anxiety / Alcohol / Tobacco (smoking) / Caffeine (too much tea, coffee, cola) / Fever / Infection / Pain / Stress / Thyroid / electrolytes / At times, abnormal nerve paths in the heart (bypass tracts) or disease of the conduction system may be responsible!
     ECHOcardiogram is necessary to see the heart valves (Mitral Valve Prolapse) / heart muscle (Cardiomyopathy) and heart function (Ejection fraction, wall motion abnormality) / clots...
      TMT – Treadmill exercise ECG; may be done to evaluate ischemia (reduced blood flow / Coronary Artery Disease)
     If there are no clues and if the problem is still bothering to the extent of interfering with life style, Electro Physiological Studies (EPS) may be done. Though the test is the gold standard, it is INVASIVE and is not generally done unless there are compelling indications. This super-speciality expert is called ELECTRO-PHYSIOLOGIST. The treating doctor may suggest them depending on need, based on his assessment of the situation.
     Many cases of palpitation are benign, especially when associated with normal ECHO and may not require treatment, If you also have symptoms like blurred vision, dizziness, loss of consciousness, shortness of breath, chest pain along with this, you need urgent work up
     The first line medicine is generally beta blockers, like Metoprolol – slow release and small dose. It will benefit both anxiety and missed beats.
Your doctor will give provide prescription and follow up

Take care     
Wishing all well
God bless

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Brief Answer:
variable / generally 150

Detailed Answer:
Hi

There is no watershed.... Sinus is less than 150; there is large overlap – theoretically, rates 220 minus age could still be sinus / P waves are discernable here
SVT is higher, onset and offset is abrupt; P waves difficult to see… Again, it is basket term for several arrhythmias arising above the ventricles…

Only an Electrophysiological study can clinch a definite diagnosis..

Regards

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Brief Answer:
Investigate to elucidate

Detailed Answer:
Hi

Slow onset and offset / relation to stress – favour sinus.
The situation of threat described is typical of sinus.

And stress can lead to SVT too!

There is gross overlap… neither the patient NOR THE DOCTOR can be sure - in the given instance – unless investigated further

In most cases, the basis for SVT –say bypass tracts (abnormality in nerves of the heart – Conduction System)– are present at birth. They generally manifest far later in life – at times, they are detected during routine examination… They may not manifest at all…

It is wiser to get investigated to find a treatable cause and prevent future recurrences…

Regards

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