Rapid heartbeat appears normal on EKG

Sunday Signal
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By Keith Roach, M.D.

Signal Contributing Writer

Dear Dr. Roach  had symptoms of lightheadedness, so my doctor ordered an EKG and sent me to a cardiologist. They did a heart monitor for a week and said I have inappropriate sinus tachycardia but that I don’t need any treatment. I’m still having symptoms. What can I do?

— B.V.

Answer nappropriate sinus tachycardia is an uncommon diagnosis, most often seen in women in their 30s. The heart rate is fast (“tachycardia”), but on an EKG it appears normal, meaning it comes from the sino-atrial node, the natural pacemaker of the heart, hence “sinus.” The average heart rate must be over 90 for 24 hours. 

It’s important to be sure there isn’t another cause for the tachycardia, such as elevated thyroid levels, fever, dehydration or anemia. The symptoms may continue for months or even years. Common symptoms include the lightheadedness you felt, but may also include palpitations, shortness of breath, dizziness and decreased ability to exercise.

The diagnosis can sometimes be confused with postural orthostatic tachycardia syndrome, where the heart rate dramatically increases with changing to an upright position.

If there is no other reason for sinus tachycardia, then medication may be used to reduce symptoms. A beta blocker is the usual first choice, but there are others available.

I found some more information at https://tinyurl.com/ISTheart that may be useful for you.

Dear Dr. Roach s there such a thing as irritable male syndrome, similar to PMS in women? If it is real, does it cycle yearly or monthly? My husband is negative and blames others for things at some times more than others. Also, is there a cure or ways to manage it?

— Anon.

Answer he term “irritable male syndrome” was coined in 2002 in a review of animal behavior, among male animals with a strictly seasonal breeding pattern. After mating season in these animals, testosterone levels drop markedly, and the animals exhibited symptoms of nervousness and irrationality.

In humans, low testosterone has a set of common symptoms, including low libido and low overall energy. Psychiatric symptoms, such as depressed mood and anxiety, are less strongly tied to low testosterone levels.

Most experts do not believe that the findings in animals are analogous to what healthy men experience. While it is possible that your husband has low testosterone, and that this level may be causing a degree of irritability, it is much more likely that his behavior has a different underlying cause than loss of testosterone.

By contrast, premenstrual syndrome, where there are dramatic shifts in hormones, is clearly associated with mood swings, irritability, anxiety and depression. As the hormone changes are cyclical, so the symptoms are cyclical as well. No such cycles exist in men for testosterone.

I have certainly known many irritable males, however, and anybody can be more irritable one day compared with another. I would note that, especially in men, irritability and being easily angered can be a sign of depression, among many other possibilities.

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]. 

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