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PA says my 5/day tachycardia, bifascicular block normal

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Posted 2/27/2023 3:48 PM (GMT -5)
I got a new cardiologist after previous one retired. Got COVID for the second at Christmas and have had frequent tachycardia episodes with shortness of breath, higher BP since then. I was prescribed ECG, Echo, and monitor for a week.
Results were bifascicular block, with relatively normal ejection fraction, heart size and systolic and diastolic function.
The monitor caught sinus SV tachycardia 36 times, rate up to 193, sometimes lasting an hour. There were some PACs and PVCs but no atrial fibrillation.
In the past I've had occasional tachycardia events that sent me to the hospital when they were several hours long, always triggered by my sulfite allergy. But since COVID I'm getting tach several times daily. It wakes me up every couple of hours at night, sometimes bad enough to make me get up and find the Atenolol, which will slow the rate when Valsalva and other maneuvers won't.
The PA called after I asked what was the next step in treatment, and she said my heart was normal. Really?
Posted 2/27/2023 6:21 PM (GMT -5)
Alcie, I know nothing about bifascicular block so I looked it up at the Cleveland Clinic. From what I read there it appears to have 4 different classes. In the worst case scenario it looks like either a defibulator or pacemaker can be implanted if a person meets the requirements.

I would consider looking for another cardiologist for a 2nd opinion.

Take care.
Posted 2/27/2023 7:55 PM (GMT -5)
For now I'm trying Atenolol daily instead of just PRN. I read a journal article that said beta blockers make things worse for heart blocks. But that's all the suggestion I got from the PA, and she wanted me to get on Toprol, which I had just tried again and still didn't tolerate - which the cardiologist had prescribed before the tests.

Finding any sort of doctor is incredibly difficult since the pandemic, even for something critical, especially when you live 30 miles out of town. It takes a minimum of 3 months to get an appointment 20 miles from home, and then you get to see a PA. That's what I have for a PCP and a gastroenterologist. And you'd better know what your disease problem is and have a good diary of your conditions, treatments and drug intolerances with you.
Posted 2/28/2023 2:58 AM (GMT -5)
Hi there.

Yeah the toprol may be tolerated second time around,
this does happen for some.

Keep strong, sending positives.
Your diary is awesome, good stuff. HT
Posted 2/28/2023 8:36 AM (GMT -5)
In addition to 25mg Atenolol daily (small dose) I have stopped caffeine (which was only half-caf).
No withdrawal and tach and chest pain have reduced some.

Keeping a food diary worked to find my sulfite allergy, so I expect keeping a drug diary will help me find treatment that works for tachycardia. I have 3 pages of drug reactions from the past 20 years, so I know what heart meds to avoid by looking back to treatment after heart attack that long ago (triggered by sulfite in cereal with dried fruit).
Posted 2/28/2023 11:46 AM (GMT -5)
This condition is caused by the electrical system of the branches. I am sure you know about junk/garbage on the internet when reading or looking things up. An example when my husband needed a pacemaker he had to see a specific dr that deals with the electrical systems of the heart. This was not anything his cardiologist handles including the yearly checkups on the pacemaker.

I would go ahead & make an appointment, you can always cancel it if you feel you won't need the appointment.
Posted 2/28/2023 2:50 PM (GMT -5)
Alcie:

You need an appointment with an electrophysiologist for an EP study. I have SVT (and now potentially AFIB), and have had cardiac ablation twice. I'm scheduled for another EP study, ablation, and potentially a defibrillator, in a couple of weeks. My heart issues are electrical.

Sharon
Posted 2/28/2023 6:25 PM (GMT -5)
SD, I post here, and read some, but look up medical and scientific studies, more than one, to get actual information. I recommend that to everyone! Thanks for recommending second opinion.

SharonZ, Thanks for the info! I wasn't aware that ablation was done for SVT. Since I already have two blocks, I would think ablation would make things worse.
Yes, my problem is electrical, often triggered by vagus nerve which was unhappy with a gut problem (often sulfite allergy).
I've read that beta blockers are not good for SVT, but will read further.
Thanks for mentioning EP. I'll look into getting second opinion, not with just another cardiologist.
Posted 2/2/2024 3:07 PM (GMT -5)
I had to double my dose of Atenolol to get tachycardia events to lessen. I can't take it until my blood pressure is high enough, usually after breakfast.
I also just figured out I have to avoid chocolate. A couple of chocolate covered cookies or a Hershey's milk chocolate bar will trigger a delayed tachycardia reaction.
Posted 1/22/2025 2:20 PM (GMT -5)
I got referred to an electrophysiologist cardiologist a few months ago. After looking at all my history and tests he says I have atrial tach, not exactly what the cardiologist was saying. (still have bifascicular block)
The EP has had me trying different arrhythmia meds, but only one did stop the tach, and I didn't tolerate it. It had me crashed on the couch, not able to even cook food. And the meds caused tinnitus and hearing loss! I look up all meds before taking them, several of them I knew I couldn't take because they have sulfites (my allergy).

The worst problem is getting in contact with the doc. The nurse never answers the phone, if I call on Thursday she doesn't get back to me until Monday. She send a couple of prescriptions, but her opinion now is I just need to get ablation. The first I can get an appointment with the doc, even virtual, is 6 weeks. So now I am taking nothing.
Meanwhile my tach problem is getting worse. HR ranging from over 150 jumping down to 40 and immediately back up, lasting for hours. At least once a day. It's painful too!

I'm not completely sure the trigger is completely within my heart. I know for sure it used to be only from my esophagus (sulfite allergy). 15 years ago my 'heart attack" which was a spasm in my LAD was caused by sulfite in food. Now eating anything hard like toast will trigger tach. (Look up cardio-esophageal reflex.)

I wish I had something for at least relief from the heart pain. I guess I'll talk to my PCP, but she's overworked too.
Posted 1/23/2025 12:10 PM (GMT -5)
Alcie:

You are correct about getting an ablation. I also have a loop monitor implanted that actually transmits data through my cell phone to the EP. This way if there is an issue, or you want to transmit your symptoms, you can do that. I have to say that I've had four ablations. Two for tachacardia, one for Atrial Flutter, and the last for complete AFIB. I have my EP's phone number if I need to contact him in an emergency.

Good luck, Alcie - keep us posted.
Posted 2/2/2025 5:23 PM (GMT -5)
Headaches last several nights that stop when the tachycardia stops. Pain keeping me from sleeping more than a couple of hours.
The cardiologists' gatekeepers (I call them Cerberus and Anubis) are keeping me from getting appointments or messages through to the doctors. Regular cardio visit is for October, I was able to get Anubis to give me a refill on Atenolol.
Cerberus (guarding the EP) says it's ablation or nothing because I had a televisit where I was started on the first antiarrhythmic drug, which was intolerable. She prescribed the next two which didn't work. Almost all the class 3 antiarrhythmics have a SO2 hanging on them, so I dare not even try them.
I know eating triggers most of my daytime tach. How will ablation stop that? How would they even figure out which side to burn? I'm already not thrilled about having a hole punched in the septum that isn't guaranteed to close.
I got an appointment with my PCP's PA next week. I'm barely functioning - exhaustion, difficulty breathing, diarrhea, ... another headache coming on - this one's accompanied by irregular tach.
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