Arrhythmia: When to See a Cardiologist for Heart Issues

Arrhythmia

Hello, Director.
I have been experiencing frequent arrhythmia issues since last year (2020).
Whenever I feel uncomfortable, I check my fitness watch and notice my heart rate is relatively high (around 150 bpm, sometimes even higher).
However, I find that during intense exercise, my heart rate does not fluctuate as drastically.
At school, the school nurse also measured my blood oxygen levels, which were similarly high, peaking at 202 (while at rest).
During sleep, my heart rate drops to a low of 42-43 bpm.
I have consulted with a family physician and an ENT specialist, and during a routine checkup at the hospital, it was noted that my heart rate was too fast, prompting additional thyroid blood tests, all of which came back normal.
The ENT doctor recommended that I see a cardiologist because I previously had low blood pressure (around 70/40) at her clinic.
The family physician suggested I could wear a 24-hour Holter monitor, but I was concerned it might not capture the issue, so I did not proceed with that.
Recently, my heart rate has been fluctuating significantly, affecting my sleep quality and concentration.
Should I return to my family physician or go directly to a cardiologist? Could this also be stress-related? I have a history of asthma, but I have noticed that using my chronic asthma inhaler has not improved my condition.
Is this related to my bronchial issues, or could it also be connected to my heart?

Xiao Tian Shi, 10~19 year old female. Ask Date: 2021/04/20

Dr. He Dongjin reply Cardiology

Hello, stress and asthma can cause rapid breathing and increased heart rate, but it may not necessarily be related to the heart.
If there is uncertainty about arrhythmias, it is advisable to consult a cardiologist for a comprehensive evaluation.
Changhua Hospital cares about your well-being.

Reply Date: 2021/04/20

More Info

When it comes to understanding arrhythmias and determining when to see a cardiologist, it's essential to consider the symptoms you're experiencing and their potential implications. Based on your description, it seems you have been experiencing significant fluctuations in your heart rate, with episodes of tachycardia (rapid heart rate) during both rest and exercise, as well as bradycardia (slow heart rate) during sleep. These symptoms can be concerning and warrant further evaluation.

Arrhythmias can manifest in various forms, including sinus tachycardia, bradycardia, atrial fibrillation, and more. Each type has different underlying causes and implications for health. In your case, the fact that you have recorded heart rates as low as 42-43 beats per minute during sleep and as high as 202 beats per minute at rest is particularly noteworthy. While some degree of heart rate variability is normal, extreme fluctuations can indicate an underlying issue that needs to be addressed.

Given your history of low blood pressure (70/40 mmHg) and the recommendation from an ear, nose, and throat (ENT) specialist to consult a cardiologist, it would be prudent to follow that advice. Low blood pressure can lead to inadequate blood flow to vital organs, potentially causing symptoms such as dizziness, fainting, and fatigue. These symptoms, combined with your heart rate irregularities, suggest that a thorough cardiac evaluation is necessary.

You mentioned that you have already undergone some tests, including thyroid function tests, which returned normal results. This is a good step, as thyroid dysfunction can often lead to arrhythmias. However, it is crucial to investigate other potential causes, such as structural heart issues, electrolyte imbalances, or autonomic nervous system dysfunction. A 24-hour Holter monitor, which records your heart's electrical activity over an extended period, can provide valuable insights into your heart rhythm during daily activities and sleep. This test can help identify patterns that may not be evident during a standard ECG.

Additionally, your asthma condition could potentially contribute to your symptoms. Asthma can lead to increased heart rate during episodes of bronchospasm or when using bronchodilators. However, the heart rate fluctuations you describe seem more pronounced than what would typically be expected from asthma alone. It’s essential to discuss your asthma management with your healthcare provider to ensure that your medications are appropriate and effective.

In summary, given your symptoms of arrhythmia, low blood pressure, and the impact on your sleep and concentration, it is advisable to see a cardiologist. They can perform a comprehensive evaluation, including a detailed history, physical examination, and appropriate diagnostic tests, to determine the underlying cause of your symptoms. Early intervention can be crucial in managing any potential cardiac issues and improving your overall quality of life. Additionally, addressing any stressors in your life, whether they are physical or emotional, can also be beneficial in managing your symptoms.

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