Well, before we speak to the matter of Inappropriate Sinus Tachycardia, please state the nature of your symptoms related directly to the ISP, when they first began and what other symptoms you are experiencing.

Also, please tell me your average documented resting heart rate over the course of the problem.

Best regards,

Rutheford Rane, MD (ret.)

Okay, sorry for the delay. I do recall you from your previous postings, but I'm still trying to get a firmer understanding of precisely how your doctors and/or specialists came to the diagnosis of Inappropriate Sinus Tachycardia. There are very characteristic signs of this disorder that you make no mention of and I hesitate to list them here because it typically induces a self-fulfilling prophecy that patients suddenly find these symptoms to be present after all, if you see my point.

How often do you experience the episodes, how long do they last and what other symptoms do you experience together with sinus tachycardia? Do you experience the episodes at any particular time of the day and do they occur nocturnally and wake you from sleep? In other words, I need for you to describe the average incident for me from start to finish, what you feel just before and during the episode along with what you feel like afterwards. Please be specific and avoid general descriptions of "really bad" or similar impressions. I need to know what you are feeling  in the way of changes from normal with regard to any aspect of physiology.

To directly address your question, you need to relax and not reach so far into the future regarding the outlook at this point. It's far too premature and I would be interested to know what the electrophysiologist discovers on testing and evaluation.

The bisoprolol will induce a capitation, or limitation, on your maximum heart rate and many patients complain that they just can't seem to generate the same energy as before, with endurance being limited.

You're going to be fine. Respond to my questions when you can collect your thoughts to the specifics requested and we'll speak again. In the meantime, take a breath and relax. You're not in danger.

Best regards,

Rutheford Rane, MD (ret.)

Okay, there is nothing of your symptom patterns to warrant an ablation procedure at all and you should know that the results of such intervention are quite variable, from no effect to actual worsening of the condition in some instances. The description or test results provided do not appear to suggest the presence of a reentrant node, which is the primary reason for which ablation is warranted and even then it is based upon frequency, age and other relevant factors.

Also, and I may have asked this previously, but please list any and all medications, vitamins, supplements or any other derivative that you are now taking.

Your condition does not suggest it to be a way of life from this point forward, but more primary is the question of the underlying cause. I will be glad to discuss the circumstances further, but please bear with me with respect to time in responding. My schedule of late is quite taxing.

Best regards,

Rutheford Rane, MD (ret.)

Hi was doing really well for two months on 5mg of bisoprolol was also slowly cutting down on my anxiety meds, last week i had two days with no anxiety meds and my sinus tachycardia came back with avengance. I contacted the cardio who increased the meds to 10mg and see how i go. My question is its not really helped it stops the really fast rhythm to a degree although i still get this in the morning but i now have the forceful beat in my stomach like before. Can BB just stop working ?? the 5 helped more than the 10 two months ago, or is this my anxiety medication starting it all back up again?? I really don't know much about IST and the cardio and electrophysiololgist do not seem that bothered by it but it makes my life miserable and stops me from being able to enjoy a simple walk. Do you know much about this condition and could you shed some light on it for me ?? Kind Regards

Michelle

Okay, I've read your more recent postings. Firstly, let me begin here by sharing with you that there is no way for me to formally consult with you due to the obvious circumstances. Secondly, and more importantly here, is that I can share some professional wisdom in the context that inappropriate sinus tachycardia is entirely benign and regardless of endurance does not cause damage to your heart, nor is the phenomenon caused by it.

The fear factor is what drives many patients to seek resolution more than recurrence and most feel that they must restrict their lives in order to try and prevent incidence develop the notion that an albatross constantly circles overhead.

Long-term studies indicate an excellent prognosis with no negative sequelae as a result of the presence of IST. The rate at which you describe recurrence would, as I previously stated, not make you a very viable candidate for ablation and the procedure has highly mixed results. There are several cases in which patients with more protracted cases have underwent epicardial ablation with good results but the procedure is irreversible and can ultimately result in the need for a synthetic pacer later in life in certain instances.

I'm here to tell you that you are in no danger from the disorder and it will never cause you to suffer any type of cardiac event. I also tend to think that the onset with respect to the endometrial hyperplasia is purely coincidental and the best approach to treatment at this point is symptomatically with the drugs of choice being prescribed by your physician.

At this point, I'm afraid that even at my advanced age and tenure in the profession, I have no sacred wisdom that will suddenly shift the course of things. Again, it is indeed harmless and although certainly frightening and aggravating it will not shorten your life by even as much as one second in time. That much is medical fact.

You're going to be fine. I'd advocate working with your primary care physician and specialist to determine the best prophylaxis to prevent occurrence and realize that you can't put your life on hold hoping for the best while anticipating the worst.

Best regards,

Rutheford Rane, MD (ret.)

Frank Dysautonomia, or irregularity of the autonomic nervous system is typically  supported by clinical signs of an underlying disorder or disease.

You are in no danger and you need to refrain from attempting to over-analyze the circumstances. Your apprehension and concerns are certainly understandable, but your perception of the risk is far beyond the actual case at hand.

Best regards,

Rutheford Rane, MD (ret.)

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