Rapid Heartbeat in Adolescents: Causes and Solutions

Rapid heartbeat

Hello, doctor.
My daughter is in the ninth grade this year.
According to her, the first time she experienced a forceful and rapid heartbeat was in the first grade, and the second time was in the fourth grade.
Since then, these episodes have occurred intermittently, with intervals ranging from a week to several months.
When we visited the doctor, there were no episodes occurring, so the cause could not be determined.

Once, she had an episode at school, and the school nurse measured her heart rate at a maximum of 225 beats per minute.
I took her to the emergency room half an hour later, and her heart rate was around 150-160 beats per minute.
The doctor conducted blood tests and an X-ray, all of which were normal, but did not perform an electrocardiogram.

A couple of days ago, she had another episode.
She mentioned that it happened while she was squatting down to put on her shoes, which may have compressed her heart.
About 20 minutes later, when she got home, her heart rate was 182 beats per minute.
It gradually decreased to 161 beats per minute over the next 20 minutes, but then unexpectedly dropped rapidly to 99 beats per minute in just one minute.
About half a minute later, it further decreased to 88, and then to 83 beats per minute.
Throughout this entire process, she was quietly standing in the living room with a pulse oximeter (I took photos to document the time).
This is the first time I have recorded the complete process.
I always thought the heart rate would decrease slowly, but I didn't expect it to drop so quickly.

Doctor, could you please explain what this situation might be? Is there a solution? Thank you for your response.

Jenna, 40~49 year old female. Ask Date: 2022/12/02

Dr. He Dongjin reply Cardiology

Hello, it sounds like you may be experiencing paroxysmal arrhythmia.
I recommend that you go to the emergency department as soon as possible during an episode to get an electrocardiogram (ECG) so that we can understand what is happening and determine the appropriate follow-up care.
Changhua Hospital cares about your well-being.

Reply Date: 2022/12/02

More Info

Understanding rapid heartbeat, or tachycardia, in adolescents can be a complex issue, especially when it presents intermittently and without clear triggers. Your daughter's experience, which includes episodes of rapid heart rate reaching as high as 225 beats per minute, is concerning and warrants careful consideration.

Firstly, it's important to understand that tachycardia can be caused by a variety of factors, including physiological, psychological, and pathological conditions. In adolescents, common causes may include:
1. Anxiety and Stress: Adolescents often experience heightened anxiety, which can lead to episodes of rapid heartbeat. This is particularly relevant if your daughter has a history of anxiety or if she feels stressed during certain situations, such as at school or during physical activities.

2. Physical Activity: While you mentioned that some episodes occurred while she was simply bending down to put on shoes, it's worth noting that even minor physical exertion can trigger a rapid heartbeat in some individuals, especially if they are not accustomed to regular exercise.

3. Caffeine and Stimulants: Consumption of caffeine or other stimulants can lead to increased heart rates. It's essential to monitor her intake of caffeinated beverages, energy drinks, or even certain medications that may contain stimulants.

4. Hormonal Changes: Adolescence is a time of significant hormonal changes, which can affect heart rate and rhythm. This is particularly true for girls who may experience fluctuations related to their menstrual cycle.

5. Underlying Medical Conditions: While your daughter's previous tests (blood work, X-rays) did not reveal any issues, it is still possible that there could be an underlying heart condition, such as arrhythmias or structural heart issues, that may not have been detected. Conditions like supraventricular tachycardia (SVT) can cause episodes of rapid heart rate and may require specialized tests, such as an electrocardiogram (ECG) or a Holter monitor, to diagnose.

Given the nature of her symptoms, it is crucial to consult with a pediatric cardiologist. They may recommend further testing, including:
- Electrocardiogram (ECG): This test measures the electrical activity of the heart and can help identify any abnormal rhythms.

- Holter Monitor: This portable device records the heart's activity over 24-48 hours, capturing any episodes of tachycardia that may occur during daily activities.

- Echocardiogram: An ultrasound of the heart can help visualize its structure and function, ruling out any anatomical issues.

In the meantime, there are several strategies that may help manage her symptoms:
- Relaxation Techniques: Encourage her to practice deep breathing, meditation, or yoga, which can help reduce anxiety and potentially lower heart rate during episodes.

- Regular Exercise: Engaging in regular physical activity can improve cardiovascular fitness and may help regulate heart rate over time.

- Healthy Diet: A balanced diet low in caffeine and high in fruits, vegetables, and whole grains can support overall heart health.

- Hydration: Ensuring she stays well-hydrated can also help maintain normal heart function.

Lastly, it’s essential to keep a detailed record of her episodes, including the duration, heart rate, any associated symptoms (like dizziness or chest pain), and potential triggers. This information can be invaluable for her healthcare provider in determining the best course of action.

In conclusion, while occasional rapid heartbeats can be benign, the frequency and intensity of your daughter's episodes suggest that further evaluation is warranted. A thorough assessment by a specialist will help determine the underlying cause and appropriate management strategies to ensure her heart health and overall well-being.

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