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
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
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, 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
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.
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.
