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EKG in PCP office showed normal rhythm but fast beat (I was…

EKG in PCP office showed...
EKG in PCP office showed normal rhythm but fast beat (I was nervous) so she referred me for a 48-hour holter monitor. Those results showed rhythms coming from sinus node with alternating Bradycardia and tachycardia episodes. PCP referees me to a cardiologist and didn’t really give any further details (even when pressed). What could this mean? Is it life threatening?
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Answered in 7 minutes by:
3/7/2018
Dr. Muneeb Ali
Dr. Muneeb Ali, Intensivist
Category: Cardiology
Satisfied Customers: 10,281
Experience: I am a certified critical care specialist with experience of working in cardiology for over 2 years including CCU and CSICU
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Hi,

Welcome to JA and thanks for this question. I'm sorry to hear about your symptoms. can you tell me your age and gender? Also, do you have a history of any other medical illnesses? Are you on any medications?

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Customer reply replied 5 months ago
I’m 30 year old female. I am 7 weeks postpartum and had a c-section at 37 weeks due to mild preeclampsia (which was diagnosed at 36 weeks). I was put on beta blockers (Labetalol) for 4 weeks until my BP returned to normal which it now is - took last dose of beta blocker about 3 weeks ago. I have anxiety and OCD and take Klonopin daily (1mg 2x/day). Otherwise I have no other health issues (to my knowledge)

Thanks for the additional information, let me just write down an answer for you and ill get back to you in a few mins. If you get a phone call request, that is an automated site response. I DID NOT send it. Thanks!

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Well from what you are describing these symptoms can be due to a couple of conditions. the first one which comes to mind is that you could have developed a condition known as sick sinus syndrome. This is a condition in which you can develop symptoms of a slowed heart rate and a rapid heart rate which can alternate between the two quite often. This can even occur within the space of a few minutes. Usually, this occurs in patients who have pre-existing heart disease or patients above the age of 50 but it is not uncommon to find this problem in younger patients as well. A subset of this condition is referred to as tachy-Brady syndrome which corresponds well to your symptoms as well. In most patients of your age group, the problem can be a tachy-Brady syndrome.

We would have to rule out causes like infections, medication side effects including the beta blockers and Klonopin which can sometimes cause a slowed heart rate, toxins among others. But it can also be genetic in nature as well. Sometimes it can be the result of the pregnancy, in the 3 months following pregnancy the heart can sometimes increase in size and that is referred to as postpartum cardiomyopathy. This cardiomyopathy, unlike others, is COMPLETELY reversible. It would be diagnosed on a simple echocardiogram.

Regardless of the cause, most cases of the sick sinus syndrome or tachy brady syndrome would be treated with treating the underlying cause first and then start you on medications to control the rapid heart rate and a pacemaker to control the slow heart rate. It depends on the severity of the symptoms. Now, this does not mean that you will definitely need a pacemaker but it does mean that you need further makeup to determine the cause.

Do you have any more questions?

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Customer reply replied 5 months ago
Interestingly this was all found on a fluke - I don’t have any symptoms (lightheadedness, dizziness, palpitations, etc). If there are no symptoms what would they be treating?Would it be possible that episodes of anxiety (I was VERY anxious while wearing the holter) and Klonopin side effects (being on 2mg per day is a new dose for me - until a couple weeks ago I was only taking .5mg per day) would cause the shift between fast and slow?

Yes, it is entirely possible that it could be the result of anxiety and Klonopin, it would depend on the severity of the bradycardia and the tachycardia. In the absence of symptoms, i think those readings are not likely to be severe. So it is entirely possible that these changes are the result of anxiety and medications.

Do you have any more questions?

I sincerely ***** ***** I have helped you and that I have earned my 5-star rating today! Please remember to rate my service by selecting the 5 stars at the top of the screen (rating me now does not close your question). We can continue here until you are satisfied, simply use the reply box and let me know. Thank you!. You can also ask questions from me directly by going to the link below,

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Customer reply replied 5 months ago
At this time is there any cause for alarm - is this a fatal or life-threatening condition?

No, i don't believe so, it would have been concerning if you had any symptoms but in the absence of symptoms I don't think there is any reason to be concerned about this being a life-threatening condition.

Do you have any more questions?

I sincerely ***** ***** I have helped you and that I have earned my 5-star rating today! Please remember to rate my service by selecting the 5 stars at the top of the screen (rating me now does not close your question). We can continue here until you are satisfied, simply use the reply box and let me know. Thank you!. You can also ask questions from me directly by going to the link below,

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Dr. Muneeb Ali
Dr. Muneeb Ali, Intensivist
Category: Cardiology
Satisfied Customers: 10,281
Experience: I am a certified critical care specialist with experience of working in cardiology for over 2 years including CCU and CSICU
Verified
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Customer reply replied 5 months ago
Thank you for your time.

You are welcome

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