Unexplained Rapid Heartbeat: Causes and Solutions

Simple tachycardia?

Last September, I had a simple health check-up, during which my pulse was only 84 beats per minute, and there was only one abnormal result: my cholesterol level was high at 228.
However, over the past five months, my heart rate has been inexplicably increasing.
I have a smoking habit and have visited a cardiologist nearly ten times.
I have undergone multiple electrocardiograms (ECGs), all of which were normal.
Last week, while waiting for an examination at Mackay Memorial Hospital, I checked my blood pressure, and my heart rate surprisingly jumped to 162 beats per minute, with a blood pressure reading of 141/80.
At that moment, I felt like I was struggling to breathe, so I quickly got up and walked a couple of laps in the hospital corridor, which helped alleviate the feeling of breathlessness (I initially started seeing a cardiologist six months ago due to this sensation).
When it was my turn to see the doctor, he immediately asked me to undergo another ECG and requested the nursing staff to perform several additional tests.
The doctor seemed a bit surprised by the ECG results and mentioned something in English (likely indicating that the ECG was normal), then said my heart rate was simply elevated.
He prescribed me propranolol 10 mg, advising me to take it only if I felt uncomfortable.

However, I have noticed that whenever I eat or go out, my heart rate exceeds 100 beats per minute, and it becomes quite exaggerated when I am at the hospital.
Sometimes, even when I wake up and measure my heart rate, it can exceed 100.
Therefore, I now consistently take one pill in the morning and evening, and when I stay home working on the computer, my heart rate usually remains between 72 and 90 beats per minute.

I am curious why my heart rate accelerates inexplicably.
Could it be that I have an extra electrical pathway in my heart, or is it simply due to heightened sympathetic nervous system activity? Is there any danger associated with my unexplained tachycardia? Would it be necessary for me to wear a 24-hour Holter monitor? I have already undergone an echocardiogram, and the doctor said my heart function is normal, with no signs of left ventricular hypertrophy or mitral valve prolapse.
I am currently feeling anxious and tense due to this unexplained rapid heart rate and am unsure how to improve the situation.
I truly hope to recover soon.

Xu Tongxue, 20~29 year old female. Ask Date: 2016/04/03

Dr. He Dongjin reply Cardiology

Hello, there is no danger to your life, so please don't be anxious.
Your current concern about the heart rhythm issue is causing your heart rate to increase.
Please continue to take your medication as prescribed and try not to measure your heart rate constantly, as this will only increase your anxiety and tension.
Your heart rhythm will stabilize.
Changhua Hospital cares about you.

Reply Date: 2016/04/03

More Info

Understanding unexplained rapid heartbeat can be quite concerning, especially when it is accompanied by symptoms such as shortness of breath, dizziness, or anxiety. Based on your description, it seems that you have been experiencing episodes of tachycardia (rapid heartbeat) that have led you to seek medical attention multiple times. Your medical evaluations, including multiple electrocardiograms (ECGs) and an echocardiogram, have not revealed any significant abnormalities, which is reassuring.

Possible Causes of Rapid Heartbeat
1. Physiological Factors: Rapid heart rate can be a normal response to various stimuli, such as physical activity, stress, anxiety, or even caffeine intake. Given that you mentioned your heart rate spikes when you eat or go out, it could be related to the body's natural response to these activities. Eating can stimulate the vagus nerve, which can affect heart rate, while physical activity or stress can activate the sympathetic nervous system, leading to increased heart rate.

2. Autonomic Nervous System: The autonomic nervous system, which controls involuntary bodily functions, has two main branches: the sympathetic (which increases heart rate) and the parasympathetic (which decreases it). An imbalance, such as heightened sympathetic activity or reduced parasympathetic tone, can lead to episodes of tachycardia. This might explain why your heart rate increases in certain situations, such as during meals or when you are anxious.

3. Lifestyle Factors: Smoking, as you mentioned, can significantly impact cardiovascular health and may contribute to increased heart rate. Nicotine stimulates the release of adrenaline, which can lead to a faster heartbeat. Additionally, high cholesterol levels can contribute to cardiovascular issues over time, even if they are not immediately apparent.

4. Anxiety and Stress: Anxiety can manifest physically in many ways, including increased heart rate. If you are feeling anxious about your heart rate, this could create a cycle where anxiety leads to a faster heartbeat, which in turn increases anxiety.

5. Potential Arrhythmias: While your ECGs have been normal, it is still possible to have intermittent arrhythmias that may not be captured during a standard ECG. A 24-hour Holter monitor can help identify these episodes by recording your heart's electrical activity over an extended period.

Recommendations
1. Holter Monitor: Given your ongoing symptoms and the fact that your heart rate spikes in certain situations, it may be beneficial to wear a 24-hour Holter monitor. This will provide a more comprehensive view of your heart's activity throughout the day and may help identify any irregularities that occur during your episodes of rapid heartbeat.

2. Lifestyle Modifications: Consider making lifestyle changes that can help manage your heart rate. This includes reducing or eliminating smoking, managing stress through relaxation techniques (such as yoga or meditation), and maintaining a balanced diet that is low in saturated fats and high in fruits and vegetables.

3. Medication Management: You mentioned being prescribed propranolol, a beta-blocker that can help manage heart rate and reduce anxiety. It is important to follow your doctor's advice regarding medication and to communicate any side effects or concerns you may have.

4. Regular Follow-ups: Continue to have regular check-ups with your cardiologist. If your symptoms persist or worsen, further evaluation may be necessary.

5. Mental Health Support: If anxiety is a significant factor in your symptoms, consider seeking support from a mental health professional. Cognitive-behavioral therapy (CBT) can be particularly effective in managing anxiety.

Conclusion
While it is understandable to feel anxious about your symptoms, it is important to remember that many factors can contribute to a rapid heartbeat, and not all of them are indicative of a serious underlying condition. By working closely with your healthcare provider and making some lifestyle adjustments, you can take proactive steps toward managing your heart health and reducing your anxiety.

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