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What Causes Tachycardia With Normal ECG And Stress Tests?

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Posted on Mon, 1 Jun 2015
Question: Hello doctor thank you for taking my question. I had a cardiac work up done which included several ekgs, 2 Echocardiogram, 2 stress tests and 2 48 hour holter and 2 loop monitors for 2 days. My Echocardiogram showed a structurally normal heart with some travel regurgitation. My stress test was passed achieving 90 percent of my maximum heart rate. The holter monitors showed I get some pacs. The most recent holter showed 400 single pacs over 48 hours and 15 pvcs. Always in sinus rhythm. Average heart rate of 71. I had periods of bradycardia approximately 26 percent of the time and 12 % tachycardia. Lowest heart rate was 41 during sleep. I noticed my resting heart rate while watching TV or just sitting at my desk sometimes goes to 55.

I am an axiety sufferer for several years. My cardiologists both say my etopic come from anxiety. I have started cbt therapy for this almost 2 months ago with some improvement. Over the past few days I have felt discomfort in stomach. I do get acid reflux regularly. The last few days it feels like bloating and pressure in my stomach. 2 nights ago while having this bloating I carried my daughter's up to there room and my heart was racing more than usual. I checked my pulse and I'm not sure if anxiety kicked in but the rate got even faster approximately 185 bpm. It lasted approximately 5 minutes and passed with deep breathing and drinking water. Last night it happened again with the same scenario lasting 3 minutes. I feel like the racing heart is connected to my stomach and anxiety. Is this possible? The heart rate felt regular just fast. My cardiologist insists that my heart has no abnormalities and these symptoms do not originate from my heart. Is this dangerous?
doctor
Answered by Dr. Benard Shehu (38 minutes later)
Brief Answer:
Following answer to your query.

Detailed Answer:
Hi XXXX!
Once again I read your query and understood your concerns.

Your palpitations and tachycardia is related to anxiety and/or GERD (acid reflux). GERD and anxiety are the most common cause of palpitations in patients with a normal heart.

You shouldn't worry about those arrhythmias as long as cardiac examinations were normal. Moreover as you are reporting there's a strong relationships between bloating, stomach acidity and symptoms. Once you have experienced tachycardia anxiety has overcome and this has worsened your symptoms.

Hope this will be of help!
Dr. Shehu


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Benard Shehu (46 minutes later)
Hi doctor thank you for your reply. How does the Gerd speed up the heart rate like this? Is it connected to the heart. It is strange that sometimes I don't feel anxious consciously but my heart starts racing. Can subconscious thoughts or adrenaline still be produced because I'm just an anxious person even though I don't feel anxious leading up to the palpitations
doctor
Answered by Dr. Benard Shehu (20 minutes later)
Brief Answer:
Following advice...

Detailed Answer:
Hi back,

GERD and acid reflux increase your heart by increasing adrenaline secretion. Increase adrenaline secretion cause tachycardia even if you don't feel anxious.

Moreover if you are an anxious person GERD will raise further adrenaline secretion and anxiety levels (even if you don't perceive it).

Wish you health!
Dr. Shehu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Benard Shehu (7 hours later)
Hi doctor I appreciate your response I've been trying to get an appointment with my cardiologist but he says I am healthy and he will see me next year. About the etopic I understand that you say rare etopic are well tolerated. When are etopic a cause for concern? Are they always benign with a structurally normal heart? Or do they become dangerous when you have a certain amount no matter what? The first holter I did last year showed 925 PACS In 48 hours the most recent showed less. Also is it common to have etopic over a long period of time such as a few years or more?
doctor
Answered by Dr. Benard Shehu (18 minutes later)
Brief Answer:
Following advice...

Detailed Answer:
Hi back,

You should stay relaxed. Extra heart beats are never a cause of concern in a normal heart. It doesn't meter how much PACs you will have they never can be harmful to you. The only thing they cause is anxiety and discomfort.

Try to stay relax and learn to live with that feeling.

Wish you health!
Dr. Shehu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Benard Shehu (1 hour later)
Hi doctor I have one last question so I can ease my mind and go to bed. There are days when any simple movement like today will make my heart start racing. For example just getting up from a seated position will bring on palpitations. Then other days I will climb my stairs and my heart won't be beating so fast and I'm fine. Does the nervous system or stomach have anything to do with this? I've noticed since my stomach has not felt right the last few days, any movement makes my heart race. Is this connected? I know exertion speeds up heart rate naturally but this is more than that.
doctor
Answered by Dr. Benard Shehu (6 hours later)
Brief Answer:
Following advice.

Detailed Answer:
Hi back,

The mechanism of arrhythmia and palpitations in your case is enhanced triggered heart activity that is caused from anxiety and stomach acidity. In the recent days your problems are more likely related to stomach acidity.

Since the enhanced triggered heart activity isn't on the same level, the same activity in different days it will cause, or will not cause arrhythmia.

You should stay relaxed and keep kalm, there's nothing to worry about.

Wish you health!
Dr. Shehu

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. Benard Shehu

Cardiologist

Practicing since :2004

Answered : 2257 Questions

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What Causes Tachycardia With Normal ECG And Stress Tests?

Brief Answer: Following answer to your query. Detailed Answer: Hi XXXX! Once again I read your query and understood your concerns. Your palpitations and tachycardia is related to anxiety and/or GERD (acid reflux). GERD and anxiety are the most common cause of palpitations in patients with a normal heart. You shouldn't worry about those arrhythmias as long as cardiac examinations were normal. Moreover as you are reporting there's a strong relationships between bloating, stomach acidity and symptoms. Once you have experienced tachycardia anxiety has overcome and this has worsened your symptoms. Hope this will be of help! Dr. Shehu