Inappropriate Sinus Tachycardia

A little back history: I am a 26 yeard old male 6' 255 pounds (at the time) woke up on Sept 23rd with crushing chest pain in the middle of the night. I made my way to the bathroom and my heart rate was through the roof. I woke up my girlfriend and told her what I was feeling. She calmed me down which took over an hour and we ruled it a panic attack. Later that week this happened again after taking a test at school and on my walk back to the car I got SOB, got back girlfriend calmed me down and went to sleep. The next morning while at work I got a panic feeling and went for a walk and I decided to go to an urgent care where they did an EKG and said they saw an abnormality and sent me by ambulance to the hospital. The tests performed while I was their was an EKG, Chest X-Ray, D-Dimer, Troponin, CBC blood work which all came back fine. The doctor came in and laughed at me for coming in and said the EKG was fine but I was just a little tachy and couldn't believe the urgent care sent me over this. He recommended me a GP who I followed up with and the GP did another EKG and prescribed me xanax on as needed basis and ruled it as anxiety. Well we are now in October and on my way to work I get another crushing chest pain and I decide to drive myself to the ER again. They do the same tests and chalk it up to anxiety. My GP sees I am not happy and tells me to calm my thoughts I should see a cardio to convince myself I am fine. I see the Cardio he does EKG/Echo/7 Day Holter/Stress test and diagnoses me with Inappropriate Sinus Tachycardia and places me on 25mg of Toprol XL. This has seemed to help but I still get pain and sob from time to time and I do feel palpitations as well. During the Course of these 2 and a half months I changed my diet and have lost near 30 pounds.With everything I have been through can I thoroughly say I am fine? I get a myriad of symptoms that come and go and I am working on my anxiety issues through counseling. This whole process has been really hard on me and I can really just use some reassurance or guidance. I don't want to be on medication forever, why does Inappropriate Sinus Tachycardia happen out of no where? Could the doctor be mistaken and this just all be anxiety? I have already had my thryoid checked out... Any suggestions would be helpful, Thank you!

Hi Michael,
I cannot judge whether the diagnosis of Inappropriate Sinus Tachycardia (IST) is correct: several other diseases can be confused with it. Assuming however, the diagnosis is correct, it may mean you are hypersensitive to adrenaline, which can be caused by exertion etc.

Thus far all your tests (Holter monitor yet to come) have come back negative, and if proven you have a normal heart otherwise, remember that many patients with IST can tolerate their symptoms once assured  they do not have a life-threatening arrhythmia.

In the meantime, Beta Blockers often help, as seems to be the case with you. If all treatments fail, sometimes an ablation is recommended.
Hope this helps,
Dr T


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