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What Causes Postural Tachycardia Syndrome?

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Posted on Mon, 4 May 2015
Question: I just woke up from bed and noticed my heart was racing a little bit and my stomach felt uneasy. I sat up and drank some water and took deep breaths and my heart rate went down to 56 bpm. Then I started getting some etopic beats. I had a heart work up 2 months ago and it showed 150 PACS and 15 isolated PVC which my cardiologist said we're benign. I have a structurally normal heart.
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would suggest some clues to this issue.

Detailed Answer:

Hello XXXX!

I understand your concern, and would like to explain that all the above prescribed clinical scenario derives from a certain nervous vegetative settings; that is waking and standing up produces an exaggerated heart beat racing, which from the other part is completely resolved by water intake and some deep breaths (which are also some practical triggering maneuvers, that increase parasympathetic response (increasing vagus efferent impulses), and controlling that way the heart rate.

These somewhat exaggerated vegetative responses may be set up this way, influenced by several factors, such as orthostatic intolerance or some kind of partial dysaoutonomia, manifested with postural tachycardia syndrome, or may be triggered by psychological factors, like accumulation of stress and anxiety,etc.

I would recommend to perform a new medical check up by your doctor, and investigate again some of these proposed triggering factors.

Hope to have been helpful to you.

Feel free to ask me whenever you need. Greetings! Dr. Iliri
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ilir Sharka (4 hours later)
Hi Doctor I'm a little bit confused. Does this mean there is something wrong with my heart? I don't know what orthostatic intolerance is. Is this an illness? Also what is dysautonomia? I'm worried about all this stuff but even my cardiologist doesn't seem to pay attention and thinks I'm fine
doctor
Answered by Dr. Ilir Sharka (2 hours later)
Brief Answer:
Your cardiologist has advised you right.

Detailed Answer:
Hello again XXXX!

I would like to assure you that nothing is wrong with your healthy heart. There are just some exaggerated reflexes that control your heart beating rate in different situations. You need to relax your mind from all the unpleasant thoughts that are coming around you.

I recommend you to find alternative ways to control your anxiety. Breathing techniques are known to be effective. Diverting the attention to pleasurable activities like dreaming of vacation to your favorite place can also be effective.

As I have advised you before, you should engage yourself in physically active daily practice, and relief your mind form all these health concerning issues.

This is the right way to face with your health status dilemma.

Wish you a good health! Dr. Iliri
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ilir Sharka (28 minutes later)
Hi doctor Thank you for telling me this I guess I'm more afraid of the symptoms as they are scary.

I want to work out and my cardiologist says I can start working out I'm just afraid because of the episode that happened to me last year when I was working out. I was at the gym and did a lot of cardio 1 hour and 15 minutes and also weights. When I was at the end of the workout my heart rate went to 190 and I got a little disoriented. I started panicking after this and they called the ambulance. My BP spiked to 210 over 100. They did ecg on the spot everything normal just high BP. They took me to hospital and did several ecg on the way my BP went down to 150 over 90 by the time we got to the hospital. They did more tests at hospital and everything was normal. I did not eat well the whole day before going to the gym. Doctor thought it could be dehydration or drop in blood sugar from not eating but no definite explanation. I did 2 stress tests after this everything normal. What could have caused this? That is why I got scared to exercise. Could it have been etopic beats? I didn't have any during stress test
doctor
Answered by Dr. Ilir Sharka (53 minutes later)
Brief Answer:
Exercising and being active is part of a your healthy life.

Detailed Answer:


Hi!

I understand your concern about what happened to you last year.

Uncontrolled high BP, and a bit confusion has raised to you the dilemma of any possible complications when exercising. Probably you don't need to train that way. Just be active waking or playing football, basket, cycling or swimming. There is no need for a competition. You should start exercising very gradually, increasing your straining step by step 5 minutes each turn. Keep in mind that just 1 or 2 miles waking a day is quite enough. No need to do cardio for extended hours or weight lifting.

Greetings!
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Ilir Sharka (7 hours later)
Doctor Thank you for explaining this all to me I think I'm finally ready to accept the problem I have right now and deal with it which is mainly my anxiety and stress. When I have pvc or pac after eating a meal are those also benign? I notice after eating a meal sometimes I will have an increase. I just wanted to make sure these will not harm me. Thank you for all that you have done for me
doctor
Answered by Dr. Ilir Sharka (6 hours later)
Brief Answer:
You are welcome!

Detailed Answer:

Hello XXXX!

Your rare ectopic heart beats after meals are totally harmless and benign. Don't worry about them!

Just keep dealing with your anxiety, and you will feel better.

Wish you a good health! Dr. Iliri
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Ilir Sharka (6 hours later)
Doctor I have one last question and I promise I will close the discussion and all my questions will be answered. Someone on a health board told me that frequent PACS are an indicator of oncoming AFib. He stated that in a study done almost all subjects who suffered from frequent PACS (more than 200 in 24 hours) developed AFIB and more prone to stroke. Is this study correct? He said most doctors say that PACS are benign but frequent PACS are worrisome. This worries me because my first holter showed 925 PACS over 48 hours. My second showed 150 PACs.
He said that this can happen in young and otherwise healthy subjects
doctor
Answered by Dr. Ilir Sharka (3 hours later)
Brief Answer:
I have an explanation about this story.

Detailed Answer:

Hi XXXX!

I would like to answer your last question with a similar analogy: Almost 99% of patients suffering from lung cancer are cigarette smoker, but not all cigarette smoking people develop lung cancer.
So, a majority of A-fib patients may have experienced ectopic heart beats apart from A-fib, but I assure you that not all patients with ectopic beats, will develop A-fib. Both a-fib and ectopic beats are expressions of certain cardiac diseases. Atrial ectopic beats (PACs) are not an etiologic factor (cause) for a-fib. So, the interpretation of that health board person, is not correct. You are a healthy person. The only virtual disease, that you may possess, stay in your mind; it is not real.

Hope to have been helpful. Greetings! Dr. Iliri
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Ilir Sharka (3 hours later)
Doctor Thank you so much for explaining it to me this way. No other doctors have ever taken the time. I understand that not everyone with etopic beats automatically gets afib. With the Pacs are they forever or do they pass?
doctor
Answered by Dr. Ilir Sharka (22 minutes later)
Brief Answer:
No chances that PACs will be disturbing your future health.

Detailed Answer:

Hi XXXX!

I don't think that PACs with be present permanently during your life. They are actually so rare and will dissipate with aging, as your vegetative nervous overreaction to several triggering stimuli will disappear. So relax! PACs are currently non-significant and will be even more in the future.

Wish you a good health. Dr. Iliri


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Ilir Sharka (29 minutes later)
Thank you so much doctor for all you've done for me. You have explained more to me than my own doctors!
doctor
Answered by Dr. Ilir Sharka (1 minute later)
Brief Answer:
You are welcome!

Detailed Answer:

You are welcome!
Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 9536 Questions

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What Causes Postural Tachycardia Syndrome?

Brief Answer: I would suggest some clues to this issue. Detailed Answer: Hello XXXX! I understand your concern, and would like to explain that all the above prescribed clinical scenario derives from a certain nervous vegetative settings; that is waking and standing up produces an exaggerated heart beat racing, which from the other part is completely resolved by water intake and some deep breaths (which are also some practical triggering maneuvers, that increase parasympathetic response (increasing vagus efferent impulses), and controlling that way the heart rate. These somewhat exaggerated vegetative responses may be set up this way, influenced by several factors, such as orthostatic intolerance or some kind of partial dysaoutonomia, manifested with postural tachycardia syndrome, or may be triggered by psychological factors, like accumulation of stress and anxiety,etc. I would recommend to perform a new medical check up by your doctor, and investigate again some of these proposed triggering factors. Hope to have been helpful to you. Feel free to ask me whenever you need. Greetings! Dr. Iliri