Dear Doctor: A Woman’s Rapid Heartbeat Is Ignored by Her Doctor for 10 Years

DEAR DR. ROACH: I am a 75-year-old woman who has suffered from a rapid heartbeat for at least 10 years now. However, my blood pressure remains normal. In fact, doctors are usually surprised at how good my blood pressure is since I’m borderline obese and mildly diabetic.

During this last physical, my doctor mentioned my rapid heart rate but did not recommend treatment or referral to a cardiologist. Should I insist on being referred to a cardiologist, or would that just lead to unnecessary additional tests? –M

ANSWER: I unfortunately hear of people (most often women) suffering from a potentially serious health problem that goes unaddressed for many years, and I fear this may be the case for you.

In a person with a persistently fast heart rate (greater than 100 bpm), an electrocardiogram (ECG) is an essential first step. I suspect you may have done this, but if not, it clearly needs to be done. Atrial fibrillation and some less common heart rhythms should be excluded.

It is likely that you have “sinus tachycardia”, which means that the impulse comes from the sinus node but is constantly too fast. The heart rate is supposed to be rapid if you exercise, and a rapid pulse can often occur in response to an infection or loss of fluids. But I think after 10 years you most likely have a condition called inappropriate sinus tachycardia (IST).

Since you are writing to me, I assume this bothers you. Most people with inappropriate sinus tachycardia note palpitations, but loss of endurance and decreased exercise tolerance are other common symptoms.

Before receiving treatment, it is important to ensure that there is no long-standing cause such as anemia or thyroid disease. It is also necessary to exclude the diagnosis of postural orthostatic tachycardia syndrome, which can overlap with STI and appears to be much more common now, especially after COVID infection.

I have had some success prescribing exercises to carefully selected patients with STIs. The cardiology literature recommends beta blockers or ivabradine to reduce symptoms and improve exercise capacity.

Referral to a cardiologist is appropriate given your 10 years without evaluation. Even if you decide not to seek therapy, it is very wise to make sure there are no serious problems.

DEAR DR. GARDON: I am a 61-year-old man in excellent physical health. However, out of nowhere, I started having severe anxiety attacks when driving over 60 mph on the highway. I now frequently have to exit the highway to calm down and am constantly afraid of having additional attacks while driving. Do you have any idea on how to deal with this? — Public relations

ANSWER: From my reading, some people will develop a fear of driving on the highway after an accident, but it can also come out of nowhere. Highway driving tends to be more problematic because the danger is greater due to faster speeds, but even more so due to higher perceived danger, which is sometimes disproportionate.

From what I’ve read, cognitive behavioral therapy is one treatment, while exposure treatment, sometimes using virtual reality, is another. The sooner you start treatment, the more likely it will be successful.

Since it sounds like you are having panic attacks, SSRI medications like sertraline may also be helpful, but some other panic attack medications are not suitable for people who drive.

Dr. Roach regrets not being able to respond to individual letters, but he will incorporate them into the column as much as possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu or mail to 628 Virginia Dr., Orlando, FL 32803.

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