Inappropriate sinus tachycardia palpitations

Question #22429

47 days ago

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Inappropriate sinus tachycardia palpitations - #22429

Bisma

Hello Doctor, I am an 18-year-old female seeking guidance regarding ongoing symptoms for the past 2 months. My main concern is heart palpitations and high heart rate. I have recorded a maximum HR of 150 bpm on ECG, around 110 bpm during doctor visits, and 90–100 bpm at rest normally. I have undergone 4 ECGs, all showing sinus tachycardia. I have been evaluated by two cardiologists. My echocardiography is normal, and no structural heart disease was found. Along with this, I experience full body aches, mainly in the neck, shoulders, arms, calves, and sometimes joint discomfort. I also have tingling sensations, cold hands and feet, and occasional numbness, especially with sitting or activity. Sometimes I feel a lump/tightness in the throat, with a sensation of difficulty breathing, though oxygen levels are normal. Relevant history: Had dengue fever 3 months ago These symptoms started about 2 months ago and persist Investigations done: Echocardiography: Normal Abdomen & pelvis ultrasound: Normal TSH: 1.28 CBC: WBC 11,000; Hb 13.1; RBC 5.1; Platelets 371,000 CRP: 11 ESR: 42 Vitamin D: 36 Ferritin: 46 Vitamin B12: 198 Cholesterol: 166 Evening cortisol: 10 I would like your opinion on: Whether these symptoms could be due to circulation issues, autonomic dysfunction (e.g., IST/POTS-like), post-viral effects, or anxiety-related causes Whether any further tests are needed Whether treatment or lifestyle measures should be started at this stage Thank you for your time and guidance. Kind regards, [Bisma] Cardiologistdiagnoseme with inappropriate sinus trachycardia please tell me what test are necessary to conclude and exclusion of other diseases please help

Palpitations bodyaches

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Dr. Prasannajeet Singh Shekhawat

I am a 2023 batch passout and working as a general physician right now, based in Hanumangarh, Rajasthan. Still kinda new in the bigger picture maybe, but honestly—every single day in this line teaches you more than textbooks ever could. I’ve had the chance to work under some pretty respected doctors during and after my graduation, not just for the clinical part but also to see how they handle people, real people, in pain, in panic, and sometimes just confused about their own health. General medicine covers a lot, right? Like from the smallest complaints to those random, vague symptoms that no one really understands at first—those are kinda my zone now. I don’t really rush to label things, I try to spend time actually listening. Feels weird to say it but ya, I do take that part seriously. Some patients just need someone to hear the whole story instead of jumping to prescription pads after 30 seconds. Right now, my practice includes everything from managing common infections, blood pressure issues, sugar problems to more layered cases where symptoms overlap and you gotta just... piece things together. It's not glamorous all the time, but it's real. I’ve handled a bunch of seasonal disease waves too, like dengue surges and viral fevers that hit rural belts hard—Hanumangarh doesn’t get much spotlight but there’s plenty happening out here. Also, I do rely on basics—thorough history, solid clinical exam and yeah when needed, investigations. But not over-prescribing things just cz they’re there. One thing I picked up from the senior consultants I worked with—they used to say “don’t chase labs, chase the patient’s story”... stuck with me till now. Anyway, still learning every single day tbh. But I like that. Keeps me grounded and kind of obsessed with trying to get better.

46 days ago

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

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Dr. Bharat Joshi

I’m a periodontist and academician with a strong clinical and teaching background. Over the last 4 years and 8 months, I’ve been actively involved in dental education, guiding students at multiple levels including dental hygienist, BDS, and MDS programs. Currently, I serve as a Reader at MMCDSR in Ambala, Haryana—a role that allows me to merge my academic passion with hands-on experience. Clinically, I’ve been practicing dentistry for the past 12 years. From routine procedures like scaling and root planing to more advanced cases involving grafts, biopsies, and implant surgeries. Honestly, I still find joy in doing a simple RCT when it’s needed. It’s not just about the procedure but making sure the patient feels comfortable and safe. Academically, I have 26 research publications to my credit. I’m on the editorial boards of the Archives of Dental Research and Journal of Dental Research and Oral Health, and I’ve spent a lot of time reviewing manuscripts—from case reports to meta-analyses and even book reviews. I was honored to receive the “Best Editor” award by Innovative Publications, and Athena Publications recognized me as an “excellent reviewer,” which honestly came as a bit of a surprise! In 2025, I had the opportunity to present a guest lecture in Italy on traumatic oral lesions. Sharing my work and learning from peers globally has been incredibly fulfilling. Outside academics and clinics, I’ve also worked in the pharmaceutical sector as a Drug Safety Associate for about 3 years, focusing on pharmacovigilance. That role really sharpened my attention to detail and deepened my understanding of drug interactions and adverse effects. My goal is to keep learning, and give every patient and student my absolute best.

46 days ago

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

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Dr. Nirav Jain

I am a qualified medical doctor with MBBS and DNB Diploma in Family Medicine from NBEMS, and my work has always been centered on treating patients in a complete, not just symptom based way. During my DNB training I rotated through almost every core department—Internal medicine, Pediatrics, Obstetrics & Gynecology, Surgery, Orthopedics, ENT, Dermatology, Psychiatry, Emergency medicine. That mix gave me the skill to manage acute illness, long term disease and preventive care together, something I find very important in family practice. In psychiatry I worked closely with patients who struggled with depression, anxiety, stress related problems, insomnia or substance use. I learned not just about medication but also about simple psychotherapy tools, psycho education and how to talk openly without judgement. I still use that exp in family medicine, specially when chronic disease patients also face mental health issues. My time in General surgery included assisting in minor and major procedures, managing wounds, abscess, sutures and emergencies. While I am not a surgeon, this gave me confidence to recognize surgical cases early, provide first line care and refer fast when needed, which makes a big difference in online or OPD settings. Now I work as a consultant in General medicine and Family practice, with focus on both in-person and online consultation. I treat conditions like fever, infections, gastrointestinal complaints, respiratory illness, and also manage diabetes, hypertension, thyroid disorders, and lifestyle related chronic diseases. I see women for PCOS, contraception counseling, menstrual health, and children for common pediatric issues. I also dedicate time to preventive health, lifestyle counseling and diet-sleep-exercise advice, since these small changes affect long term wellness more than we often realize. My key skills include holistic diagnosis, evidence based treatment, chronic disease management, mental health support, preventive medicine and telemedicine communiation. At the center of all this is one thing—patients should feel heard, safe, and guided with care that is both professional and personal.

40 days ago

Hello Bisma, thank you for sharing your concern. These are the further tests advised from my side - 24-hour Holter monitoring, Sr. Electrolytes, Vit-B12, CRP, ESR, Active standing test/ Tilt table test.
Take adequate fluids + salt (unless contraindicated).
Tab. Methylcobalamin 1500mcg at night × 1 month.
Gentle graded exercise (recumbent cycling, walking). Avoid caffeine, dehydration.
Consider Cardiologist opinion regarding heart medicines.
Seek urgent care if- Fainting, Chest pain with exertion, New neurological weakness, Breathlessness at rest.
Feel free to reach out again.
Regards,
Dr. Nirav Jain
MBBS, D.Fam.Medicine

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Dr. Shayeque Reza

I completed my medical degree in 2023, but honestly, my journey in healthcare started way before that. Since 2018, I’ve been actively involved in clinical practice—getting hands-on exposure across multiple departments like ENT, pediatrics, dermatology, ophthalmology, medicine, and emergency care. One of the most intense and defining phases of my training was working at a District Government Hospital for a full year during the COVID pandemic. It was chaotic, unpredictable, and exhausting—but it also grounded me in real-world medicine like no textbook ever could. Over time, I’ve worked in both OPD and IPD setups, handling everything from mild viral fevers to more stubborn, long-term conditions. These day-to-day experiences really built my base and taught me how to stay calm when things get hectic—and how to adjust fast when plans don’t go as expected. What I’ve learned most is that care isn't only about writing the right medicine. It’s about being fully there, listening properly, and making sure the person feels seen—not just treated. Alongside clinical work, I’ve also been exposed to preventive health, health education, and community outreach. These areas really matter to me because I believe real impact begins outside the hospital, with awareness and early intervention. My approach is always centered around clarity, empathy, and clinical logic—I like to make sure every patient knows exactly what’s going on and why we’re doing what we’re doing. I’ve always felt a pull towards general medicine and internal care, and honestly, I’m still learning every single day—each patient brings a new lesson. Medicine never really sits still, it keeps shifting, and I try to shift with it. Not just in terms of what I know, but also in how I listen and respond. For me, it’s always been about giving real care. Genuine, respectful, and the kind that actually helps a person heal—inside and out.

46 days ago

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.

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Dr. Arsha K Isac

I am a general dentist with 3+ years of working in real-world setups, and lemme say—every single patient teaches me something diff. It’s not just teeth honestly, it’s people… and how they feel walking into the chair. I try really hard to not make it just a “procedure thing.” I explain stuff in plain words—no confusing dental jargon, just straight talk—coz I feel like when ppl *get* what's going on, they feel safer n that makes all the difference. Worked with all ages—like, little kids who need that gentle nudge about brushing, to older folks who come in with long histories and sometimes just need someone to really sit n listen. It’s weirdly rewarding to see someone walk out lighter, not just 'coz their toothache's gone but coz they felt seen during the whole thing. A lot of ppl come in scared or just unsure, and I honestly take that seriously. I keep the vibe calm. Try to read their mood, don’t rush. I always tell myself—every smile’s got a story, even the broken ones. My thing is: comfort first, then precision. I want the outcome to last, not just look good for a week. Not tryna claim perfection or magic solutions—just consistent, clear, hands-on care where patients feel heard. I think dentistry should *fit* the person, not push them into a box. That's kinda been my philosophy from day one. And yeah, maybe sometimes I overexplain or spend a bit too long checking alignment again but hey, if it means someone eats pain-free or finally smiles wide in pics again? Worth it. Every time.

46 days ago

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

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Dr. Aarav Deshmukh

I am a general physician with 8 years of practice, mostly in urban clinics and semi-rural setups. I began working right after MBBS in a govt hospital in Kerala, and wow — first few months were chaotic, not gonna lie. Since then, I’ve seen 1000s of patients with all kinds of cases — fevers, uncontrolled diabetes, asthma, infections, you name it. I usually work with working-class patients, and that changed how I treat — people don’t always have time or money for fancy tests, so I focus on smart clinical diagnosis and practical treatment. Over time, I’ve developed an interest in preventive care — like helping young adults with early metabolic issues. I also counsel a lot on diet, sleep, and stress — more than half the problems start there anyway. I did a certification in evidence-based practice last year, and I keep learning stuff online. I’m not perfect (nobody is), but I care. I show up, I listen, I adjust when I’m wrong. Every patient needs something slightly different. That’s what keeps this work alive for me.

45 days ago

Considering your symptoms and test results, it seems quite plausible that you’re experiencing inappropriate sinus tachycardia (IST) or a related condition like postural orthostatic tachycardia syndrome (POTS), both of which can be influenced by autonomic dysfunction. It’s also quite common to have lingering symptoms after a viral infection like dengue, which might contribute to this current condition. Your symptoms like palpitations, high heart rate, and body aches are consistent with these conditions.
Further testing that might be useful includes: a tilt table test, to evaluate how your heart rate and blood pressure respond to changes in posture; a 24-hour Holter monitor could also help in tracking your heart rate over a full day to assess variability. Some autonomic function tests could be valuable, considering your symptoms like cold hands and feet, tingling, and numbness.
Regarding treatment, beta-blockers or calcium channel blockers might help manage the heart rate if IST is confirmed, but these medications should be discussed with your treating physician for proper assessment and potential side effects. Hydration and increased salt intake, when appropriately advised, can improve symptoms if POTS is a diagnosis. You might also benefit from physical therapy and exercises designed to improve vascular tone and autonomic stability, which a physiotherapist trained in autonomic disorders can guide you through. Since your Vitamin B12 is on the lower side, supplementation could be beneficial, considering its role in nerve function and energy metabolism, and ensuring adequate dietary intake of iron would help maintain levels even though your ferritin is within limits. Be mindful of stress and anxiety, which can exacerbate these conditions, and consider mindfulness techniques or counseling if needed.
It’s important to follow up with your cardiologist or a specialist in autonomic disorders to refine the diagnosis and treatment plan. Keep monitoring your symptoms, and if there’s any sudden worsening — like more severe pain, fainting, or sustained high heart rates — immediate medical review would be necessary to rule out acute complications.

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Dr. Alan Reji

I'm Dr. Alan Reji, a general dentist with a deep-rooted passion for helping people achieve lasting oral health while making dental visits feel less intimidating. I graduated from Pushpagiri College of Dental Sciences (batch of 2018), and ever since, I've been committed to offering high-quality care that balances both advanced clinical knowledge and genuine compassion for my patients. Starting Dent To Smile here in Palakkad wasn’t just about opening a clinic—it was really about creating a space where people feel relaxed the moment they walk in. Dental care can feel cold or overly clinical, and I’ve always wanted to change that. So I focused on making it warm, easygoing, and centered completely around you. I mix new-age tech with some good old-fashioned values—really listening, explaining stuff without jargon, and making sure you feel involved, not just treated. From regular cleanings to fillings or even cosmetic work, I try my best to keep things smooth and stress-free. No hidden steps. No last-minute surprises. I have a strong interest in patient education and preventive dentistry. I genuinely believe most dental issues can be caught early—or even avoided—when patients are given the right information at the right time. That’s why I take time to talk, not just treat. Helping people understand why something’s happening is as important to me as treating what’s happening. At my practice, I’ve made it a point to stay current with the latest innovations—digital diagnostics, minimally invasive techniques, and smart scheduling that respects people’s time. I also try to make my services accessible and affordable, because good dental care shouldn’t be out of reach for anyone.

44 days ago

With normal echocardiography, repeated ECGs showing sinus tachycardia, post-dengue onset, and symptoms like cold extremities and tingling, inappropriate sinus tachycardia (IST) is a reasonable diagnosis after exclusion of secondary causes. To conclusively confirm IST and rule out others, recommended tests include orthostatic vitals or tilt-table test, serum electrolytes, repeat inflammatory markers, iron studies/B12 recheck, and 24-hour Holter monitoring. Specialist consultation: continued follow-up with a cardiologist (and neurologist if sensory symptoms persist) to finalize diagnosis and guide treatment.

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