Rapid Heart Rate: Causes and Concerns for Patients

Rapid heartbeat

Hello Doctor, I have mild mitral and aortic valve regurgitation, and I also experience some autonomic nervous system dysfunction.
My resting heart rate is usually elevated (around 85-90 bpm).
Yesterday evening, I engaged in physical activity for about 4 hours, during which my heart rate ranged between 120-140 bpm.
Before going to bed, I noticed my heart rate was still elevated.
Upon waking up the next day, I checked my smartwatch and saw that my heart rate during sleep was between 75-80 bpm (usually it's around 65 bpm).
Could you please explain what might be causing this situation? Could it be due to fatigue, or could there be other underlying conditions? Thank you, Doctor.

Niming, 10~19 year old female. Ask Date: 2021/08/26

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 adjust your lifestyle and engage in regular exercise.
However, if symptoms persist, it is still recommended to visit a hospital for an electrocardiogram (ECG) examination.

Reply Date: 2021/08/26

More Info

Understanding rapid heart rate, or tachycardia, can be complex, especially for individuals with pre-existing conditions such as mild mitral and aortic valve regurgitation, as well as autonomic nervous system dysregulation. Your reported resting heart rate of 85-90 beats per minute (bpm) is already on the higher side of normal, and the increase to 120-140 bpm during prolonged physical activity, such as walking for four hours, is not uncommon. However, it is essential to consider various factors that could contribute to these fluctuations in heart rate.

Possible Causes of Rapid Heart Rate
1. Physical Activity: Engaging in prolonged exercise naturally elevates heart rate as the body requires more oxygen and nutrients to fuel the muscles. A heart rate of 120-140 bpm during such activity is generally expected, especially if the exercise is sustained over several hours.

2. Fatigue: Fatigue can significantly impact heart rate. When the body is tired, the heart may work harder to maintain adequate blood flow, leading to an increased heart rate. If you were particularly fatigued after your long walk, this could explain the elevated heart rate both during and after the activity.

3. Autonomic Nervous System Dysregulation: Your mention of autonomic nervous system issues suggests that your body may not regulate heart rate as effectively as it should. This dysregulation can lead to episodes of increased heart rate, especially in response to stress, anxiety, or physical exertion.

4. Underlying Heart Conditions: While your mild valve regurgitation is a consideration, it is essential to note that many individuals with similar conditions live normal, active lives without significant issues. However, if there are changes in symptoms or if you experience new or worsening symptoms, further evaluation may be warranted.

5. Dehydration or Electrolyte Imbalance: Prolonged exercise can lead to dehydration or an imbalance in electrolytes, both of which can affect heart rate. Ensuring adequate hydration and nutrition before, during, and after exercise is crucial.

6. Caffeine or Stimulants: If you consume caffeine or other stimulants, these can also lead to an increased heart rate. Monitoring your intake may help in understanding your heart rate patterns.

Concerns and Recommendations
Given your situation, it is essential to monitor your heart rate and any accompanying symptoms closely. If you experience symptoms such as chest pain, shortness of breath, dizziness, or palpitations that feel different from your usual experience, it is crucial to seek medical attention promptly.

1. Regular Monitoring: Continue to use your smartwatch or a heart rate monitor to keep track of your heart rate throughout the day, especially during and after exercise. This data can be helpful for your healthcare provider.

2. Consultation with a Cardiologist: If your heart rate remains consistently elevated or if you have concerns about your symptoms, consider scheduling an appointment with a cardiologist. They may recommend further testing, such as an echocardiogram or a stress test, to evaluate your heart's function and response to exercise.

3. Lifestyle Modifications: Incorporate stress-reducing techniques such as mindfulness, yoga, or deep-breathing exercises. These can help manage autonomic nervous system dysregulation and may contribute to a more stable heart rate.

4. Gradual Increase in Activity: If you are concerned about your heart rate during exercise, consider gradually increasing your activity level. This approach allows your body to adapt without overwhelming your cardiovascular system.

5. Hydration and Nutrition: Ensure you are well-hydrated and consuming a balanced diet rich in electrolytes, especially if you engage in prolonged physical activity.

In conclusion, while your experiences with elevated heart rates during and after exercise can be concerning, they may be attributed to a combination of physical exertion, fatigue, and autonomic nervous system factors. Regular monitoring and consultation with healthcare professionals will help ensure that you manage your heart health effectively.

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