Managing Rapid Heartbeat: Insights on Propranolol and Hypertension

Tachycardia

Hello, doctor.
I have been experiencing symptoms of rapid heartbeat since the end of March this year.
I have a history of hypertension and am currently taking antihypertensive medication.
My heart rate is consistently around 80 to 90 beats per minute in the morning, and it tends to rise to around 100 during the noon to evening hours, sometimes even reaching 110.
Before bed, it occasionally drops to the 70s.
I underwent a cardiac ultrasound, blood tests, and a 24-hour Holter monitor at a major hospital.
During my follow-up appointment, the doctor mentioned that I have symptoms of premature contractions (with infrequent occurrences throughout the day and no significant heart issues), so no medication was prescribed.
The doctor advised me to avoid staying up late, reduce coffee intake, and exercise regularly, suggesting that my condition would improve naturally.
However, I still felt unwell and visited a nearby family medicine doctor, who prescribed me a small pink tablet to take alongside my antihypertensive medication.
The name of the medication is propranolol.
I would like to ask the doctor if I still need to take this pink tablet if my heart rate remains like this.
I just took one tablet on the day I am asking this question.

AAE, 20~29 year old female. Ask Date: 2019/04/16

Dr. Bai Xiyan reply Cardiology

Thank you for your inquiry.

1.
The causes of tachycardia include hyperthyroidism, anemia, dehydration, fever, anxiety, and other issues.
It can also be influenced by autonomic nervous system disorders, certain medications, caffeine, and tea.
To manage palpitations, it is essential to rule out these factors before using the beta-blocker Propranolol for adjustment.
An ideal resting heart rate is between 60-70 beats per minute.
2.
Antihypertensive medications have different mechanisms of action and are often used in combination based on individual circumstances.
It is advisable to record your blood pressure and heart rate daily for discussion with your cardiologist.
The Cardiology Department at Chiayi Hospital is happy to assist you.

Reply Date: 2019/04/16

More Info

Managing a rapid heartbeat, especially in the context of hypertension, can be a complex issue that requires careful consideration of various factors. Based on your description, it appears that you have been experiencing episodes of increased heart rate (tachycardia) since March, with your heart rate fluctuating throughout the day. You mentioned that your resting heart rate can be in the 80s upon waking, rising to around 100 or even 110 during the day, and dropping to the 70s at night.
You have already undergone several diagnostic tests, including echocardiograms and 24-hour Holter monitoring, which have indicated that while you have occasional premature contractions (PVCs), there are no significant underlying heart issues. This is reassuring, as it suggests that your heart is structurally normal and that the tachycardia may be more related to other factors, such as anxiety, lifestyle, or possibly the effects of medications.

Propranolol, the medication you have been prescribed, is a beta-blocker that is commonly used to manage hypertension and control heart rate. It works by blocking the effects of adrenaline on the heart, which can help reduce heart rate and lower blood pressure. Given your situation, propranolol may be beneficial in managing your symptoms, particularly if you are experiencing anxiety or stress that exacerbates your heart rate.

It's important to consider the following points regarding your use of propranolol and your overall management plan:
1. Dosage and Administration: If you have just started taking propranolol, it may take some time for your body to adjust to the medication. The initial dose is often low, and your doctor may adjust it based on your response. If you find that your heart rate remains elevated or if you experience side effects, it is essential to communicate this with your healthcare provider.

2. Lifestyle Modifications: As your previous doctor advised, lifestyle changes can significantly impact your heart rate and overall cardiovascular health. Reducing caffeine intake, managing stress through relaxation techniques, ensuring adequate sleep, and engaging in regular physical activity can all contribute to better heart health.
3. Monitoring: Keeping a log of your heart rate, blood pressure, and any symptoms you experience can be very helpful for your healthcare provider. This information can guide treatment decisions and help determine if adjustments to your medication are necessary.

4. Follow-Up Care: Regular follow-up appointments with your healthcare provider are crucial. They can help monitor your condition, adjust medications as needed, and ensure that any underlying issues are addressed. If your symptoms persist or worsen, further evaluation may be warranted.

5. Potential Side Effects: While propranolol is generally well-tolerated, it can cause side effects such as fatigue, dizziness, or gastrointestinal issues. If you experience any concerning symptoms, it’s important to discuss them with your doctor.

In summary, propranolol can be an effective part of your treatment plan for managing rapid heartbeat and hypertension, especially if lifestyle modifications alone are insufficient. However, it is crucial to maintain open communication with your healthcare provider regarding your symptoms and any side effects you may experience. Regular monitoring and follow-up care will help ensure that you are on the right track toward managing your heart health effectively.

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