Fast Heart Rate: Is It Just Normal or a Cause for Concern?

Response to simple tachycardia?

Thank you very much, Dr.
He.
I haven't been paying much attention to my heart rate, and since I stopped checking my pulse regularly, it has really become more stable.
I have also stopped taking the propranolol 10 mg that Dr.
Ma prescribed for me for 4 days now.
I used to take it twice a day for about a week.
Is it okay for me to stop the medication on my own? Dr.
Ma told me to take it only if I feel uncomfortable, so I decided to stop.

I would also like to ask Dr.
He what it means when an electrocardiogram (ECG) is normal but the heart rate is simply fast.
Does this mean there is no arrhythmia? I am very worried that I might have an extra electrical pathway in my heart, which could cause my heart rate to suddenly increase.
Whenever I wake up and stand up quickly, especially if I smoke, my heart rate can exceed 150 to 180 beats per minute, and I don't understand why this happens.
I don't recall feeling this way before, and I wonder if it has something to do with my mindset.
If I do have an extra electrical pathway in my heart, can a resting ECG detect it? I have had nearly 10 resting ECGs, all of which were normal, and the doctors said my heart rate is just faster.
My echocardiogram was also normal, so I am inquiring about this.

Xu Tongxue, 20~29 year old female. Ask Date: 2016/04/12

Dr. He Dongjin reply Cardiology

Hello, currently there is no evidence of an additional circuit, so we will observe for now.
You can continue with the current treatment plan.
If an additional circuit is discovered in the future, we will address it at that time.
There's no need to worry; even if there is one, it does not pose a life-threatening risk.
With current medical technology, there is almost a 100% chance of a cure.
Changhua Hospital cares about you.

Reply Date: 2016/04/12

More Info

Understanding fast heart rates can be complex, and it’s essential to consider various factors that contribute to this phenomenon. Based on your description, it seems you have experienced episodes of tachycardia (rapid heart rate) that have caused you concern, particularly when you wake up and stand up quickly. You also mentioned that you have been prescribed propranolol, a beta-blocker that can help manage heart rate and reduce anxiety-related symptoms.

Firstly, it’s important to clarify what is meant by a "normal" electrocardiogram (ECG) despite experiencing a fast heart rate. An ECG can show a normal sinus rhythm, which indicates that the heart's electrical activity is functioning correctly. However, it can still record episodes of tachycardia, where the heart rate exceeds the normal resting range (60-100 beats per minute). In your case, the ECG results indicate that while your heart rate can spike, there are no significant arrhythmias or abnormalities detected, which is reassuring.

The episodes of rapid heart rate you experience, particularly upon standing, could be attributed to several factors. One common cause is orthostatic hypotension, where blood pressure drops upon standing, leading to a compensatory increase in heart rate. This can be exacerbated by dehydration, certain medications, or even anxiety. Additionally, your mention of smoking could also play a role, as nicotine can stimulate the heart and lead to increased heart rates.

Regarding your concern about having an extra electrical pathway in your heart (a condition known as Wolff-Parkinson-White syndrome), it is typically diagnosed through specific tests, including an electrophysiological study, which is more definitive than a standard ECG. Since you have had multiple normal ECGs and echocardiograms, the likelihood of having such a condition is low, but if you continue to have concerns, discussing further testing with your healthcare provider may be warranted.

As for stopping propranolol, it’s crucial to follow your doctor’s advice. If your physician instructed you to take the medication only when you feel unwell, it may be acceptable to pause it when you feel stable. However, it’s always best to consult your doctor before making changes to your medication regimen, especially if you have been taking it regularly. Abruptly stopping beta-blockers can sometimes lead to rebound effects, including increased heart rate or blood pressure.

In terms of lifestyle modifications, managing stress and anxiety can significantly impact your heart rate. Techniques such as mindfulness, yoga, and regular physical activity can help. Additionally, avoiding stimulants like caffeine and nicotine can also contribute to a more stable heart rate.

In summary, while your episodes of fast heart rate can be concerning, the absence of significant findings on your ECG and echocardiogram is reassuring. It’s essential to maintain open communication with your healthcare provider about your symptoms and any changes in your medication. If you continue to experience rapid heart rates or have new symptoms, further evaluation may be necessary to ensure your heart health remains stable.

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