Rapid Heartbeat: Causes, Tests, and Treatment Options

Tachycardia

Hello Dr.
He: Thank you for your response.
Following up on my previous question, you mentioned that a heart rate of 156 beats per minute could indicate an arrhythmia.
However, I have undergone several 24-hour Holter monitors, and the doctors said that the few instances of arrhythmia were mild, with a brief heart rate reaching 150 beats.
Dr.
He, what further tests should I undergo to identify the cause? Recently, for the past three months, I have experienced episodes during the night where my heart rate suddenly spikes to over 120 beats per minute, occurring every few days.
I have visited the emergency room several times, but they reported no abnormalities on the ECG.
However, over the past two to three months, I have only been sleeping for two to three hours and feel very fatigued in the morning before going to work.
What should I tell my doctor during my follow-up appointment regarding further testing to find the cause? Is this related to autonomic nervous system dysfunction? Can autonomic nervous system dysfunction cause such a rapid heart rate? The doctor has now prescribed me Concor 1.25 mg, one tablet in the morning and one in the evening.
I have felt dizzy for the past two weeks, and after measuring my blood pressure in the morning and evening for a week, my systolic pressure has been around 100, diastolic pressure around 60, and my heart rate between 56 and the 60s.
Is the dizziness a side effect of the medication, or is it due to low blood pressure? I would greatly appreciate your clarification.
Thank you!

Mr. Wang, 40~49 year old female. Ask Date: 2016/05/09

Dr. He Dongjin reply Cardiology

Hello, my heart suddenly jumps to over 120 beats per minute, and this happens every few days.
It seems related to autonomic nervous system dysfunction.
Rapid heart rate can be associated with autonomic nervous system disorders, and the side effects of the medication can cause dizziness, as well as low blood pressure leading to dizziness.
I recommend reducing the dosage to 1.25 mg of Concan before bedtime.
Changhua Hospital cares about you.

Reply Date: 2016/05/09

More Info

Understanding rapid heartbeat, or tachycardia, can be quite complex, as it may stem from various underlying causes. In your case, the episodes of your heart rate reaching 120 beats per minute during sleep, along with the history of mild arrhythmias noted in your Holter monitor, suggest that further investigation is warranted to determine the root cause of your symptoms.

Causes of Rapid Heartbeat
1. Arrhythmias: These are irregular heartbeats that can lead to episodes of tachycardia. Your previous tests indicated some minor arrhythmias, which could be contributing to your symptoms. Conditions such as atrial fibrillation or supraventricular tachycardia (SVT) could cause sudden increases in heart rate.

2. Autonomic Nervous System Dysfunction: Dysregulation of the autonomic nervous system can lead to episodes of rapid heartbeat, especially during sleep. This can be exacerbated by stress, anxiety, or other psychological factors.

3. Physiological Factors: Factors such as dehydration, electrolyte imbalances, or hormonal changes (like those seen in hyperthyroidism) can also lead to increased heart rates.

4. Medications: The medication you are currently taking, such as the beta-blocker (康肯), can have side effects that may include dizziness and changes in heart rate. If your blood pressure is dropping too low, this could also lead to symptoms of dizziness and fatigue.

Recommended Tests
Given your symptoms and history, here are some tests and evaluations you might consider discussing with your healthcare provider:
1. Extended Holter Monitor: If your current Holter monitor did not capture the episodes of tachycardia, an extended monitoring period might help correlate your symptoms with your heart rhythm.

2. Event Monitor: This device is worn for a longer period (up to 30 days) and can be activated by you when you feel symptoms, providing more data on your heart rhythm during episodes.

3. Echocardiogram: This ultrasound of the heart can assess the structure and function of your heart, helping to rule out any structural abnormalities that could be contributing to your symptoms.

4. Electrophysiological Study (EPS): If arrhythmias are suspected, an EPS can help identify the specific type of arrhythmia and guide treatment options.

5. Thyroid Function Tests: Since thyroid dysfunction can lead to tachycardia, checking your thyroid hormone levels may be beneficial.

Self-Management and Lifestyle Modifications
In addition to medical evaluations, consider the following lifestyle modifications:
- Stress Management: Techniques such as mindfulness, yoga, or cognitive behavioral therapy can help manage anxiety and stress, which may reduce episodes of tachycardia.

- Avoid Stimulants: Reducing or eliminating caffeine, nicotine, and other stimulants can help manage heart rate.

- Hydration and Nutrition: Ensure you are well-hydrated and maintain a balanced diet to support overall cardiovascular health.

Conclusion
Your symptoms of rapid heartbeat, especially during sleep, warrant further investigation to rule out any serious underlying conditions. It is essential to communicate your experiences, including the frequency and nature of your symptoms, to your healthcare provider. Discussing the possibility of additional tests, such as an extended Holter monitor or an event monitor, may provide more insight into your condition. Additionally, consider the potential side effects of your current medication and discuss any concerns with your doctor to ensure that your treatment plan is appropriate for your situation. Remember, managing stress and maintaining a healthy lifestyle can also play a significant role in your overall heart health.

Similar Q&A

Managing Rapid Heartbeat: Understanding Triggers and Solutions

Hello Doctor: I am from Hong Kong. In early June of this year, due to work and life stress, I often felt my heart racing. During one episode, I went directly to the hospital for an electrocardiogram, where my heart rate was over 120. I also had blood tests for thyroid function an...

Dr. Wu Xueming reply Cardiology
Due to your young age and lack of chronic diseases, your risk of developing heart disease is low. Many factors in daily life can contribute to this situation, such as emotions, stress, irregular sleep patterns, or excessive intake of caffeinated beverages. It is advisable to adju...

Understanding Heart Rhythm Disorders: Causes, Symptoms, and Treatments

I apologize for the lengthy message, but I would like to ask about my condition. Previously, I often felt discomfort in my heart, experiencing sudden episodes of rapid heartbeat. After frequent occurrences, I went to the hospital for a 24-hour Holter ECG, which showed the followi...

Dr. He Dongjin reply Cardiology
Hello, it seems that the symptoms you are experiencing are likely due to autonomic nervous system dysregulation and anxiety, which can lead to panic attacks. This is not indicative of a worsening heart condition, and you are not at risk of sudden death. Please do not scare yourse...

Understanding Rapid Heartbeat: Causes, Treatments, and When to Seek Help

In July, I felt that my heart was racing, often exceeding 100 beats per minute. I subsequently underwent X-rays, blood tests, an electrocardiogram, exercise testing, and 24-hour monitoring. The doctor said there were no issues with arrhythmia and prescribed me medication. Today, ...

Dr. He Dongjin reply Cardiology
Hello, Kangxin can be used for tachycardia as a long-acting medication. If the cause of the rapid heartbeat cannot be identified, it may not necessarily require an echocardiogram. It is quite possible that it is due to autonomic nervous system dysregulation. It would be advisable...

Understanding Rapid Heartbeat: When to Seek Further Medical Evaluation

A few months after being diagnosed last September, I discovered that I had a rapid heartbeat, and I also experienced severe insomnia after the diagnosis, which I had never encountered before. I underwent echocardiography and CT scans of the heart and lungs, but the cardiologist t...

Dr. Wu Xueming reply Cardiology
Many factors in daily life can contribute to this condition, such as emotions, stress, irregular sleep patterns, or excessive intake of caffeinated beverages. It is advisable to adjust your lifestyle and engage in regular exercise. However, if symptoms persist, it is recommended ...