High Heart Rate: When to Seek Further Cardiac Evaluation

Heart rate of 140-150 while lying in bed?

I started noticing high heart rate notifications on my Apple Watch at the end of April.
That evening, while sitting and lying down, my heart rate was between 140-150.
Looking at the records, during the day when I was standing and walking, my heart rate was in the 90s.
However, after 5-6 PM every day, my heart rate would exceed 100, often reaching 110-120.
I went to the emergency department at Chung Rong and had two electrocardiograms (ECGs), and the doctors said everything was normal.
However, when I first arrived at the emergency department, my blood pressure readings were 180/120 and 160 (usually at home, my readings are around 120-130/80-95).
I was then referred to the cardiology outpatient clinic at Chung Rong, where I had a third ECG that also came back normal, but I frequently experience palpitations and occasionally have brief chest pain on the left side.
The doctor prescribed a one-month supply of heart medication (10 ng), but I forgot to take it today, and my heart rate shot up to 130 while walking and 140.
The doctor said this is normal.
Is there really no problem, or do I need to undergo further cardiac evaluations?

Liang Le Duo, 30~39 year old female. Ask Date: 2022/05/24

Dr. Wu Xueming reply Cardiology

Based on your symptoms, it is recommended that you maintain a regular schedule and engage in regular exercise.
If your symptoms do not improve, you may consider visiting a cardiology clinic for a 24-hour Holter monitor test.

Reply Date: 2022/05/24

More Info

Understanding a high heart rate, or tachycardia, is crucial for assessing potential underlying cardiac issues. In your case, the consistent elevation in heart rate, particularly during the evening hours, alongside episodes of palpitations and occasional chest discomfort, warrants careful evaluation. While your doctors have indicated that your ECG results are normal, there are several factors to consider when determining whether further cardiac evaluation is necessary.

When to Seek Further Cardiac Evaluation
1. Persistent Symptoms: If you experience ongoing symptoms such as palpitations, chest pain, or shortness of breath, it is essential to communicate these to your healthcare provider. Even if initial tests appear normal, persistent symptoms may indicate an underlying issue that requires further investigation.

2. Heart Rate Patterns: You mentioned that your heart rate spikes to 140-150 beats per minute while resting, which is significantly elevated. A resting heart rate above 100 beats per minute is considered tachycardia. If this pattern continues, especially if it is accompanied by symptoms, it may necessitate additional testing.

3. Blood Pressure Fluctuations: Your reported blood pressure readings of 180/120 mmHg are concerning, especially if they are significantly higher than your usual readings. Hypertension can strain the heart and may be a contributing factor to your elevated heart rate. Consistent monitoring and management of blood pressure are crucial.

4. Medication Effects: You mentioned taking a medication (心康樂) that may influence your heart rate. It’s important to discuss with your doctor how this medication affects your heart rate and whether adjustments are necessary. Missing doses can also lead to fluctuations in heart rate.

5. Holter Monitoring: If you haven’t already undergone Holter monitoring (24-hour ECG), this could provide valuable insights into your heart's rhythm over an extended period. It can help identify any arrhythmias that may not be captured during a standard ECG.

6. Stress Testing: A cardiac stress test can evaluate how your heart responds to exertion. Given your symptoms, this could help determine if there are any ischemic changes or arrhythmias that occur during physical activity.

7. Echocardiogram: An echocardiogram can assess the structure and function of your heart. It can help identify any abnormalities in heart valves, chambers, or overall heart function that might contribute to your symptoms.

8. Referral to a Cardiologist: If your symptoms persist or worsen, consider seeking a referral to a cardiologist who specializes in arrhythmias or heart rhythm disorders. They can provide a more in-depth evaluation and recommend advanced diagnostic tests if necessary.

Conclusion
While your initial evaluations have returned normal results, the combination of high heart rate, fluctuating blood pressure, and symptoms like palpitations and chest discomfort suggests that further evaluation may be warranted. It is essential to maintain open communication with your healthcare provider about your symptoms and concerns. Keeping a detailed log of your heart rate, symptoms, and any triggers can also be helpful for your doctor in determining the next steps in your evaluation and management plan. Remember, proactive management is key to maintaining heart health, especially when symptoms are present.

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