Transcient Tachycardia

[plumbago]

Hi all,

Yesterday morning after eating toast, the last of my breakfast, and while standing doing this and that in the kitchen, I felt my heart strongly in my chest. My rate was increasing, so I sat down and put a pulse oximeter on my finger and my HR was 155. I had to do a couple of vagal maneuvers to get it down (cough, hold breath and bear down). I knew it would go away and it did. After a bit, I took my BP and while it was within the normal range, it was a low normal (96/66). It's likely or at least conceivable it was even lower than that at the height of the tachycardia. On a second BP reading, it came up about 10 points both systolic and diastolic. I did not feel dizzy at any point.

The last time something like this happened was in 2015. (At that time, I saw a cardiologist and more or less got the all clear, just a bit of mitral valve leakage. Got another echo in 2017 and nothing new found at that time. So structurally, I seem to have checked out. I do have PVCs which are very common, and which for me happen at some times more than others, was offered beta blockers and declined.) However, two weeks ago, I suspect something similar happened, but I didn't measure HR or BP at the time to confirm. And the symptoms (dizziness) were a bit different and I was doing strenuous yard work.

The night prior to this most recent tachycardia, I did not wear my cpap, not sure if that has anything to do with it or not - I tend to think not, but who knows. I also have had a recent high iron reading which I will repeat labs for again soon to make sure it was not a lab error. It was not a ridiculously high iron, though. I did have an A1c which put me in the pre-diabetic range for the first time, about 2 weeks ago, and will likely repeat that. No oral anti-diabetics.

I know there's a strong correlation of POTS (postural orthostatic tachycardia syndrome) and celiac disease. But in my case, I'm not sure 1) I meet the exact diagnostic criteria (I think it's just heart rate, not high HR and low BP, necessarily); and 2) if this is a chronic enough problem to be dx'ed with POTS, since it's happened (that I can recall) no more than 3 or 4 times, max. It was just bothersome, worrisome, and even a bit uncomfortable.

Have you had similar episodes? Have you been diagnosed with POTS?

Thanks.

Plumbago

[trents]

May I ask, what is your age? 

I'm 68 and often I feel a little faint when standing up after doing a task requiring some exertion in the bent bent over position. I do not sense any syncopation or tachycardia at these times or any other. I just attribute it to postural LBP. I'm sure the pump and the entire vascular system are not what they used to be even though there are at this time no particular cardiac issues. So I am assuming that the exertion diverts more blood flow to the muscles and the brain gets less. 

Sounds like you have developed some borderline cardiac arrhythmia issues that are transient at this point and you know how to control them. You have also communicated with your physician what is going on so all that is good. If it becomes more frequent and/or you find you can't control it with the vagal maneuvers I would certainly see the doc again. 

I assume you are not connecting this with celiac disease or gluten exposure as you mention nothing about that except it occurred after eating toast. I assume that was gluten-free toast.

[Mycaringkidsmom]

1 hour ago, plumbago said:

Hi all,

Yesterday morning after eating toast, the last of my breakfast, and while standing doing this and that in the kitchen, I felt my heart strongly in my chest. My rate was increasing, so I sat down and put a pulse oximeter on my finger and my HR was 155. I had to do a couple of vagal maneuvers to get it down (cough, hold breath and bear down). I knew it would go away and it did. After a bit, I took my BP and while it was within the normal range, it was a low normal (96/66). It's likely or at least conceivable it was even lower than that at the height of the tachycardia. On a second BP reading, it came up about 10 points both systolic and diastolic. I did not feel dizzy at any point.

The last time something like this happened was in 2015. (At that time, I saw a cardiologist and more or less got the all clear, just a bit of mitral valve leakage. Got another echo in 2017 and nothing new found at that time. So structurally, I seem to have checked out. I do have PVCs which are very common, and which for me happen at some times more than others, was offered beta blockers and declined.) However, two weeks ago, I suspect something similar happened, but I didn't measure HR or BP at the time to confirm. And the symptoms (dizziness) were a bit different and I was doing strenuous yard work.

The night prior to this most recent tachycardia, I did not wear my cpap, not sure if that has anything to do with it or not - I tend to think not, but who knows. I also have had a recent high iron reading which I will repeat labs for again soon to make sure it was not a lab error. It was not a ridiculously high iron, though. I did have an A1c which put me in the pre-diabetic range for the first time, about 2 weeks ago, and will likely repeat that. No oral anti-diabetics.

I know there's a strong correlation of POTS (postural orthostatic tachycardia syndrome) and celiac disease. But in my case, I'm not sure 1) I meet the exact diagnostic criteria (I think it's just heart rate, not high HR and low BP, necessarily); and 2) if this is a chronic enough problem to be dx'ed with POTS, since it's happened (that I can recall) no more than 3 or 4 times, max. It was just bothersome, worrisome, and even a bit uncomfortable.

Have you had similar episodes? Have you been diagnosed with POTS?

Thanks.

Plumbago

Hi Plumbago,

my daughter was diagnosed with POTS in 2016. A year later diagnosed with Celiac. (Incidentally, Mayo Clinic completely missed the Celiac diagnosis & testing; her Celiac happened to be diagnosed by the allergist who ordered a blood screening.) 

She’s now a junior in college managing well, but had a very bad glutening over the weekend causing severe POTS symptoms. In her experience, there’s definitely a connection between Celiac and POTS! 

[plumbago]

32 minutes ago, trents said:

May I ask, what is your age? 

I'm 68 and often I feel a little faint when standing up after doing a task requiring some exertion in the bent bent over position. I do not sense any syncopation or tachycardia at these times or any other. I just attribute it to postural LBP. I'm sure the pump and the entire vascular system are not what they used to be even though there are at this time no particular cardiac issues. So I am assuming that the exertion diverts more blood flow to the muscles and the brain gets less. 

Sounds like you have developed some borderline cardiac arrhythmia issues that are transient at this point and you know how to control them. You have also communicated with your physician what is going on so all that is good. If it becomes more frequent and/or you find you can't control it with the vagal maneuvers I would certainly see the doc again. 

I assume you are not connecting this with celiac disease or gluten exposure as you mention nothing about that except it occurred after eating toast. I assume that was gluten-free toast.

Hi, and thanks for responding! Let's just say I was born (like a baby as relative once said) in the 1960s! What you're describing in the first paragraph is orthostatic hypotension, if I'm not mistaken. I don't think it's that, and the reason I say that is I had been standing already, for a while. What's "a while?" A few minutes at least. In other words, it wasn't like I just bounded up from a sitting position after a meal. I was pottering around, eating, doing tasks, and mostly standing up. And then my heart raced. The main feature was the heart rate. 155 is absurdly fast, almost dangerously so, if it goes on. The BP was still normal when I measured it, low normal but within range, and I never felt dizzy. Just uncomfortable. But there may indeed be some connection to eating, with the diversion of blood, as you mention. The bread was gluten free, yes.

To some extent, I do connect it to celiac disease. POTS - if it is POTS, big if - does have a strong correlation via nerve damage with celiac disease. Also, I was recently re-scoped, and celiac disease in almost complete remission.

Plumbago

[plumbago]

On 10/29/2019 at 10:31 AM, Mycaringkidsmom said:

Hi Plumbago,

my daughter was diagnosed with POTS in 2016. A year later diagnosed with Celiac. (Incidentally, Mayo Clinic completely missed the Celiac diagnosis & testing; her Celiac happened to be diagnosed by the allergist who ordered a blood screening.) 

She’s now a junior in college managing well, but had a very bad glutening over the weekend causing severe POTS symptoms. In her experience, there’s definitely a connection between Celiac and POTS! 

Thank you. Can I ask a couple of questions?
What is your and her understanding of how a bad glutening triggers POTS? Second, how was the POTS diagnosed, and what special precautions, if any, does she take?
Thank you.