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This rapid heartbeat appears normal on EKG


Last updated 2/16/2021 at 3:51pm | View PDF

DEAR DR. ROACH: I had symptoms of lightheadedness, so my doctor ordered an EKG and sent me to a cardiologist. They did a heart monitor for a week and said I have inappropriate sinus tachycardia but that I don’t need any treatment. I’m still having symptoms. What can I do? -- B.V.

ANSWER: Inappropriate sinus tachycardia is an uncommon diagnosis, most often seen in women in their 30s. The heart rate is fast (“tachycardia”), but on an EKG it appears normal, meaning it comes from the sino-atrial node, the natural pacemaker of the heart, hence “sinus.” The average heart rate must be over 90 for 24 hours.

It’s important to be sure there isn’t another cause for the tachycardia, such as elevated thyroid levels, fever, volume depletion (dehydration) or anemia. The symptoms may continue for months or even years. Common symptoms include the lightheadedness you felt, but may also include palpitations, shortness of breath, dizziness and decreased ability to exercise.

The diagnosis can sometimes be confused with POTS (postural orthostatic tachycardia syndrome), where the heart rate dramatically increases with changing to an upright position. A tilt-table test is the diagnostic tool for POTS.

If there is no other reason for sinus tachycardia, then medication may be used to reduce symptoms. A beta blocker is the usual first choice, but there are others available.

I found some more information at that may be useful for you.


DEAR DR. ROACH: I am a woman going crazy with hair loss. My hair has always been long and thick, but it is coming out in handfuls. I can only think it must be due to my blood pressure medicines. I’ve been taking amlodipine and lisinopril for years. I’m in good health and 90 years young. — M.

ANSWER: It is unlikely that the hair loss is due to either amlodipine or lisinopril. Neither of these are well described to provoke hair loss, and if a medicine is going to do that, it usually does within a few months.

The most common cause of hair loss in a 90-year-old woman is female pattern hair loss, in which the hair loss is mostly on the front and top of the scalp. However, there are several causes of hair loss, and a dermatologist may be helpful in determining the cause and treatment.

Please don’t stop taking your blood pressure medicine.


DEAR DR. ROACH: I have a question about undigested food. Are you getting any nutrients, other than fiber, from foods that come out looking the same as they went in? I’m thinking of foods such as corn and sunflower, flax or chia seeds. How well do they need to be chewed to get any nutrition from them? — L.W.

ANSWER: Many seeds and corn need to be chewed very well in order to be absorbed by the body. They have a large amount of undigestible fiber, which will never be absorbed. Chia seeds, unlike flax or sunflower seeds, are pretty easily digested by most people, but you can grind them and soak them ahead of time to make it easier for your body to digest.

Office test alone can’t diagnose COPD

DEAR DR. ROACH: I am a healthy 70-year-old woman. The only prescription medication I take is for dry eyes. I recently visited my new primary physician for the first time, and she had me do a breathing test, where I exhaled into a tube to measure airflow. I was told to breathe deeply and exhale completely into the tube three times in succession. It took less than a minute to complete. It is apparently a routine test she orders for new patients.

She then told me I have COPD, on the basis of that test alone. She asked if I had ever smoked or been exposed to secondhand smoke. That was her only question – coughing or shortness of breath was never mentioned. I have never smoked, but my father was a smoker when I was growing up. I actually do have a slightly productive cough most mornings. I probably walk about 10 miles a week, and I do notice some shortness of breath on long uphill sections, though I can walk briskly in level areas for miles with no problem.

She said it is not advanced enough to require an inhaler at this time. I am bothered by this very easy “diagnosis” on the basis of one simple test. I wonder if I should ask to be referred to a pulmonologist for a more thorough evaluation. – O.P.

ANSWER: The test your doctor performed is called office spirometry, and it is useful for monitoring known pulmonary diseases, especially COPD and asthma. However, by itself, it is inadequate to make the diagnosis of COPD, which I am not sure you have.

The diagnosis of COPD is made in people with persistent respiratory symptoms, usually shortness of breath or coughing. Spirometry will usually show obstruction to airflow. Formal pulmonary function testing, which is an extensive process taking an hour or so with a skilled and experienced technician, is ideal for determining severity.

The problem with getting a breathing test in someone who has no significant symptoms is that you can find someone whose test results are at or just below the lower limit of normal, and the diagnosis is unclear. The prognosis for people with mild airway obstruction but with no symptoms of COPD is much better than for people with COPD and who continue to smoke. For this reason, using spirometry as a screening test for everyone is not recommended.

Without knowing the exact results of your spirometry, I suspect you do not have COPD, given your absence of smoking and your extremely mild symptoms. A comprehensive exam by a pulmonologist would be definitive and may help you be less anxious about the results you have now.

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]

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