Inappropriate sinus tachycardia palpitations - #22429

Based on your history, test results, and symptoms, there is no evidence of a serious heart disease. Multiple ECGs show only sinus tachycardia, and your echocardiogram is normal, which is very reassuring.

What is most likely going on

Your symptoms are most consistent with a post-viral autonomic disturbance (after dengue), possibly combined with anxiety and nervous system hypersensitivity. This can cause:

Fast heart rate and palpitations

Whole-body pulsations

Cold hands and feet

Tingling, numbness, body aches

Throat tightness / lump sensation (called globus sensation) What to do now

Start Vitamin B12 supplements

Good hydration + electrolytes

Adequate salt intake (if BP allows)

Gentle daily walking and stretching

Reduce caffeine, stress, and screen over-checking heart rate

Treat sore throat symptomatically (warm fluids, gargles, paracetamol)

Visit a doctor in person.

Hello Bisma Thank you for sharing all these details—your symptoms and the tests you’ve had help paint a clear picture. Here’s a summary and what it means for you:

What’s Going On? - Heart palpitations and high heart rate: Your ECGs show sinus tachycardia (a fast but regular heart rhythm from the heart’s natural pacemaker), and your echo is normal. This means your heart structure is healthy. - Body aches, tingling, cold hands/feet, numbness, lump in throat, and breathing sensations: These symptoms are common in conditions like post-viral syndromes (especially after dengue), anxiety, or sometimes autonomic nervous system imbalance (like inappropriate sinus tachycardia or POTS). - Oxygen levels are normal: This is reassuring and means your lungs and heart are working well.

What Else Should Be Checked? Since your heart structure is normal and you’ve had dengue recently, the following tests can help rule out other causes: - Electrolytes (sodium, potassium, calcium, magnesium): Imbalances can affect heart rhythm and nerves. - Blood sugar (fasting and postprandial): To rule out diabetes or hypoglycemia. - ESR/CRP: To check for ongoing inflammation. - Holter monitoring (24–48 hours): If not already done, this can track your heart rhythm over a longer period.

Inappropriate sinus tachycardia (IST) is a condition where the heart rate is elevated without an obvious cause. To confirm this diagnosis and rule out other potential issues, several tests may be recommended: 1. Electrocardiogram (ECG): This test records the electrical activity of your heart and can help identify abnormal heart rhythms. 2. Holter Monitor: A portable ECG device worn for 24-48 hours to monitor your heart rate and rhythm during daily activities. 3. Echocardiogram: An ultrasound of the heart to assess its structure and function, ruling out any underlying heart conditions. 4. Exercise Stress Test: This test evaluates how your heart responds to physical stress and can help identify any exercise-induced arrhythmias. 5. Blood Tests: These may include thyroid function tests, electrolyte levels, and other markers to rule out metabolic or hormonal causes of tachycardia. 6. Tilt Table Test: This test assesses how your heart rate and blood pressure respond to changes in position, which can help identify autonomic dysfunction. 7. Electrophysiological Study (EPS): In some cases, a more invasive test may be performed to study the electrical pathways of the heart.

What Does This Mean? - Most likely, your symptoms are due to a combination of post-viral effects (common after dengue), possible anxiety, and maybe mild autonomic dysfunction. - The fact that your heart structure is normal is very reassuring. - These symptoms often improve with time, hydration, gentle exercise, and stress management.

What Should You Do Next? - Discuss the above tests with your doctor if not already done. - Focus on hydration, regular meals, gentle physical activity, and good sleep. - If symptoms worsen (fainting, chest pain, severe breathlessness), seek medical help immediately.

Thank you and get well soon

Hello

Bisma, Inappropriate Sinus Tachycardia (IST) is a diagnosis of exclusion. Based on what you’ve already done, most serious causes are already excluded.

Tests needed to CONFIRM IST & EXCLUDE others

If not done yet, these are enough:

24-hour Holter monitor Confirms high average HR (>90) and sinus rhythm only

Orthostatic vitals / Active standing test To rule out POTS (HR rise ≥30 bpm on standing)

Basic blood work (mostly already done): CBC ✔ TSH ✔ Electrolytes (Na, K, Mg) Vitamin B12 (low → needs treatment) Iron studies ✔

Inflammation follow-up Repeat CRP / ESR (post-viral inflammation common after dengue)

No need for CT scan, angiography, stress test, or EP study unless new red-flag symptoms appear.

What is MOST likely causing this

Post-viral autonomic dysfunction (after dengue) IST ± anxiety overlay Nutritional factors (low B12)

Is this dangerous?

No heart damage No rhythm disorder No circulation blockage Benign but uncomfortable

What to start now Hydration + adequate salt Gentle daily walking Vitamin B12 supplementation Avoid caffeine Beta-blocker only if cardiologist advises

When to worry

Only if: fainting, chest pain, persistent HR >160, or oxygen drop.

Your tests already support IST, and nothing serious is being missed. This condition improves over months, especially post-viral.

Thank you

Hello dear See as per clinical history it seems post autonomic viral symptoms only. The reason behind is that the stimulation of autonomic nervous system even on doing mild physical work Iam suggesting some medication and precautions. Precautions you can follow for improvement but some medication have to be recommended by cardiologist only Change of posture Avoid long standing Do mild physical exercise Avoid over lifting start with smallest weight to increase endurance In addition you may be given Atenolol 25 mg Clonidine Midodrine Please get these medicines only after recommendation from cardiologist or concerned physician Please donot take any medication without consulting the concerned physician Hopefully you recover soon Regards