Rapid Pulse in Elderly with Heart and Kidney Issues

The pulse is increasingly rapid?

My grandmother has hypertrophy of the heart, hypertension, diabetes, and anemia.
In March of this year, she was hospitalized due to kidney failure, with her kidney function at 6.0, close to the point of needing dialysis.
However, recently her blood pressure has been over 180, with lows in the 70s.
She returned to the hospital for examination, and both the echocardiogram and X-ray showed no issues, indicating that the problems are related to her kidneys.
She was prescribed antihypertensive medication, and after returning home, her blood pressure has been around 140 to 150, with lows in the 70s to 80s.
However, her pulse, which was around 70 on the first day back, has increased to over 90 after four days, and today it measured around 100, all taken in the morning between 6 and 7 AM right after waking up.
The pulse rate is increasing day by day.
Is this abnormal or normal? My grandmother is in her 80s.

A Yu, 20~29 year old female. Ask Date: 2016/09/02

Dr. He Dongjin reply Cardiology

Hello, if there is simply tachycardia without arrhythmia, observation should suffice.
It is advisable to first check the pulse; if irregular beats are detected, it is recommended to visit a cardiology clinic for evaluation.
This is because, in cases of anemia, the heart must pump more vigorously to meet the body's required cardiac output, which can result in a faster heart rate.
As long as there is no irregularity in the rhythm, monitoring is reasonable.
Changhua Hospital cares about you.

Reply Date: 2016/09/02

More Info

Understanding the rapid pulse in elderly patients, particularly those with underlying heart and kidney issues, requires a comprehensive approach that considers multiple factors. In your grandmother's case, her medical history includes heart hypertrophy, hypertension, diabetes, anemia, and recent acute kidney failure, which complicates her overall health status.

Firstly, it's important to recognize that a rapid pulse, or tachycardia, can be influenced by various physiological and pathological factors. In elderly patients, especially those with chronic conditions, the heart's response to stressors can be exaggerated. The heart may pump faster to compensate for decreased efficiency or to maintain adequate blood flow, particularly if the kidneys are not filtering blood effectively. In your grandmother's situation, her kidney function is compromised, which can lead to fluid overload and increased blood pressure, further straining the heart.

The medications prescribed to manage her hypertension can also play a role in her heart rate. Some antihypertensive medications can cause reflex tachycardia as the body attempts to maintain blood pressure. If her blood pressure was initially very high (180/70), and then managed to a more stable range (140-150/70-80), the body may still be adjusting to these changes, leading to fluctuations in heart rate.

Additionally, dehydration or electrolyte imbalances, which are common in patients with kidney issues, can also contribute to an increased heart rate. The kidneys play a crucial role in maintaining electrolyte balance, and any disturbance can affect heart rhythm and rate. Anemia, which your grandmother also has, can lead to increased heart rate as the body tries to compensate for reduced oxygen-carrying capacity.

It's also worth noting that the time of day when you measure her pulse can affect the readings. Morning tachycardia may be related to the body's natural circadian rhythms, which can influence heart rate and blood pressure. Stress, anxiety, or even pain can also elevate heart rate, particularly in elderly patients who may be more sensitive to these factors.

Given that her pulse has been consistently rising to around 100 beats per minute, it is essential to monitor this closely. While a resting heart rate of 70-90 beats per minute can be considered normal for many individuals, a sustained heart rate above 100 beats per minute warrants further investigation, especially in the context of her existing health issues.

In conclusion, while a rapid pulse in an elderly patient with heart and kidney problems can be concerning, it is essential to consider the broader clinical picture. Regular monitoring of her heart rate, blood pressure, and overall symptoms is crucial. It would be advisable to discuss these findings with her healthcare provider, who may consider further evaluation or adjustments to her medication regimen. Continuous communication with her medical team will help ensure that her condition is managed effectively and that any potential complications are addressed promptly.

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