inappropriate sinus tach

Was he tested for T3 and T4?

I dont know specifically about T3 or T4 but the TSH was WNL.

Is the pt African-American? A significant portion of African-Americans do not respond to B-blockers, but respond well to calcium channel blockers.

My mom's resting HR is around 140-150 without her meds...she also has random episodes of SVT with no apparent cause. She had tried quite a few different beta blockers (including atenolol and metoprolol) and it wasn't until they put her on propranolol did she have significant results. Her resting is still 90s-100's but she experiences far less SVT episodes and overall her HR is way better controlled.

Maybe the pt needs a different beta blocker? Unfortunatly mom now has more respiratory/asthma issues likely r/t the propranolol but least her HR isn't so crazy!

No, pt is in late 20s, caucasian female.

Pt also has hx of "mild asthma" - she said she doesn't take any meds for it - inhalers cause her more tachycardia.

Accessory pathway like a WPW? Are there delta waves? Beta blockers are contraindicated in duel pathways because they slow the normal pathway and the faster one takes off.

Definitely needs cardiology consult.

what is pt's coffee/soda/tea intake? I did this to myself inadvertantly by overdoing it on coffee and coca cola, I thought my intake was "normal" since I didn't drink any during the day, even on toprol XL I stayed in the high 90's so add excessive caffiene to the mix and 120's were nothing, I didn't become symptomatic until around 140. Diet & exercise and my resting HR is comming down. I'm 5'7" 119lbs so weight wasn't a factor either.

Cardiology consult, different Beta blockers, starting a calcium channel blocker, looking into what "cardiac history" the family has, ruling out other reasons why they'd be tachy is where I would expect to start. and of course could stand to loose a few pounds.

How's her H&H? I had similar symptoms when I was anemic. After 3 months of taking 1000mg of iron a day and an endometrial ablation, I'm right as rain. Barely a PVC at all and only tachy with exertion/exercise. Overweight could also cause the tachycardia d/t the extra stress on the heart. Did she have an echo? What did that say? If none of those turn up a reason, she'd likely benefit from an EP study.