How to manage sinus tachycardia?

Question

Hi doctor,

I was diagnosed with inappropriate sinus tachycardia nearly two years ago. I experience dizziness, chest pain, shortness of breath, an inability to exercise, and anxiety. I am currently managing my symptoms with Ivabradine 5 mg once a day, but my quality of life is very poor, which has led to depression and anxiety disorders. Sometimes I feel better and can manage without the medication, but whenever I attempt strenuous exercises, all the symptoms return. Please forgive my words, but I can not even masturbate. My questions are:

Should I consider ablation? If so, what are the risks and success rates?
If I need to undergo pacemaker implantation, what are the possible complications and success rates? Will I be able to perform strenuous exercises with a pacemaker?
Should I consider getting a pacemaker at 21 years old?
Lastly, should I continue with medication, or is there a possibility of spontaneous recovery in the future?

Please suggest.

Answer 1

Hi,

Welcome to icliniq.com.

Firstly, do not get discouraged, sinus tachycardia is not a life-threatening condition, and it may resolve over time. The symptoms may be troublesome for a while. What are your resting and maximum heart rates? You should consider seeing a psychiatrist for anxiety and depression, which I believe are contributing to your poor quality of life. I assume other potential causes, like thyroid issues, low hemoglobin, and postural orthostatic tachycardia syndrome, have been ruled out. I also assume your echocardiogram is normal.

As for treatment, it is better to continue with medications, as the results of ablation are not very promising and it could lead to the need for a permanent pacemaker. A pacemaker is not an ideal option for someone your age, as it would limit strenuous activities and intense sports. Additionally, the regular surgeries required to replace the batteries could be inconvenient. So, I suggest you continue with medication. Beta-blockers like Metoprolol 25 mg once a day or Propranolol 20 mg once a day should be considered instead of Ivabradine. Consult your specialist, discuss these options, and start the medication after their approval.

I hope this helps, and feel free to reach out if you have any further questions.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

One can engage in moderate activities. However, with heavy activities and competitive sports, there is a risk of injury to the pacemaker, which could result in a fracture or dislodgement. Additionally, the heart rate may not increase adequately during intense exercise. Therefore, there are risks involved, and it is better for patients with pacemakers to avoid heavy activities.

Thanks and regards.