How to manage sinus tachycardia?

Q: I have sinus tachycardia since 10 years. My resting pulse is 92 per minute. My ECG is normal. EKG: nothing abnormal except that ventricular efficiency is 45%. I am on Dilzem SR 90 mg a day. My BP is average 150/85. My age is 81 plus. I cannot stand beta blockers. Is there any thing to worry about? I am also a diabetic well under control, since 20 years and on insulin 32 units AM and 9 units PM.

A:Sinus tachycardia can be appropriate or inappropriate. Your sinus tachycardia could be due to many things. When there is no reason for the sinus rate to be high still it is high that is called as inappropriate sinus tachycardia. First & foremost you must ensure that your BP is not more than 120/80 mmHg & your blood sugar is stringently controlled. Then you should have a battery of tests to confirm that the condition of your heart is normal despite having both hypertension & diabetes both of which can be devastating to the heart if not appropriately controlled with existing medications. I do not understand the meaning of the term "cannot stand beta blockers" as there are many drugs with different properties & effect & clubbing them together in to a group & throwing them in to the trash bin may not be the right attitude, of course if you have known contraindications like asthma then it is different. In absence of beta blockers diltiazem is the only drug that I will recommend for your age. Drugs that are more powerful to suppress sinus rate like verapamil have side effects like constipation & they can be used if your cardiac function is normal as they in general depress heart function.