Morning Heart Rate Fluctuations: Anxiety or Heart Issue?

Morning heart rhythm

Hello, Doctor.
Recently, I've noticed that when I wake up in the morning, my heart rate sometimes spikes to around 140 beats per minute, but when I lie down, it drops back to 100-90-80.
Is this a typical anxiety-related heart rate? Does such rapid fluctuation in heart rate have any impact on the heart, and could it potentially trigger arrhythmias? Sometimes, even washing my hair makes me feel tightness in my chest and shortness of breath.
Is this related to heart issues or panic and anxiety? Currently, I take Yongkang Xu every morning, but it doesn't seem to have much effect on my anxiety.
Should I take it for a longer period? To avoid anxiety in the morning, if I take half a Xanax every day upon waking, will that make the situation worse or lead to dependence? Thank you, Doctor.

Niming, 20~29 year old female. Ask Date: 2023/04/13

Dr. He Dongjin reply Cardiology

Hello, that's correct.
The heartbeat associated with typical anxiety will not affect the heart; it will not lead to arrhythmias or worsen over time.
You might consider taking Xanax before bedtime to see if it helps.
If it doesn't, there's no issue with that; focus on making yourself comfortable first.
Changhua Hospital cares about you.

Reply Date: 2023/04/13

More Info

Morning heart rate fluctuations, particularly when waking up, can often be attributed to anxiety rather than an underlying heart condition. It's not uncommon for individuals to experience a rapid heartbeat upon waking, especially if they are feeling anxious or stressed. The heart rate you mentioned—rising to 140 beats per minute and then decreasing to 100-90-80 when lying down—can be a physiological response to anxiety.
When we wake up, our body transitions from a state of rest to activity, which can trigger the release of stress hormones like adrenaline. This can lead to an increased heart rate. Additionally, anxiety can cause hyperventilation, which may also contribute to feelings of breathlessness or chest tightness. These symptoms can be exacerbated by the anticipation of anxiety itself, creating a cycle of worry and physical response.

Regarding your concern about whether these fluctuations could lead to heart rhythm issues, it's important to note that while anxiety can cause temporary increases in heart rate, it typically does not lead to significant heart problems or arrhythmias in healthy individuals. Your heart appears to be functioning normally based on the tests you've undergone, including Holter monitoring and echocardiograms, which have shown no significant abnormalities.
However, if you are experiencing persistent symptoms such as chest tightness or difficulty breathing, it is advisable to consult with a healthcare professional for further evaluation. They may recommend additional tests or a referral to a cardiologist if necessary.
As for your current medication, it seems you are taking a medication for anxiety (永康緒) but are not experiencing the desired effects. Medications for anxiety can take time to build up in your system and may require adjustments in dosage or even a change in medication to find what works best for you. It is crucial to discuss any concerns about your medication with your prescribing doctor, especially if you are considering taking additional medications like 半顆贊安諾 (a benzodiazepine) for anxiety. Benzodiazepines can be effective for short-term relief of anxiety symptoms but may lead to dependence if used long-term.
In managing anxiety, consider incorporating lifestyle changes such as regular physical activity, mindfulness practices, or cognitive-behavioral therapy (CBT), which can be effective in reducing anxiety symptoms without the need for medication. Additionally, practicing relaxation techniques such as deep breathing exercises can help calm your nervous system and may alleviate some of the physical symptoms you are experiencing.

In summary, while your morning heart rate fluctuations are likely related to anxiety, it is essential to monitor your symptoms and consult with a healthcare professional if they persist or worsen. Managing anxiety through a combination of medication, therapy, and lifestyle changes can significantly improve your quality of life and reduce the impact of these symptoms on your daily activities.

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