Heart Rhythm Issues: When to Seek Medical Advice

Cardiac rhythm issues

Hello, Doctor.
Thank you for your valuable advice.
I am currently taking antiarrhythmic medication.
Sometimes my blood pressure is 104, other times it is 130.
I feel that the medication sometimes makes my heart rate stronger, causing my blood pressure to drop significantly, even to the 50s when sitting in the car.
At other times, I feel it is not strong enough, and when lying down, my heart rate is still around 80-90.
Is this normal? When walking, my heart rate sometimes reaches around 120-130; is that normal as well?
Recently, I had an echocardiogram, a 24-hour Holter monitor, X-rays, and blood tests, all of which were normal.
However, I have noticed that sometimes when lying in bed, my heart rate drops to the 60s, and when I stand up, it immediately increases to around 110.
I feel a bit short of breath when I get up.
Is this anxiety, or could there still be an issue with my heart? I have been quite concerned about my heart rate lately and often feel a sense of tightness in my chest.
Do you think I need to undergo a CT scan or any other tests?
Additionally, I would like to ask if sitting and smoking sometimes raises my heart rate to 130-140.
Is this frequent occurrence harmful to my body and abnormal? I am currently in the process of gradually quitting smoking.
I apologize for the lengthy message, and thank you for your help.
Wishing you well!

Niming, 20~29 year old female. Ask Date: 2023/07/01

Dr. He Dongjin reply Cardiology

Hello, if your echocardiogram, 24-hour Holter monitor, X-ray, and blood tests are all normal, then there is no need for a CT scan.
Quitting smoking can cause changes in your heart rate, which is normal, so there's no need to worry.
Changhua Hospital cares about you.

Reply Date: 2023/07/01

More Info

When it comes to understanding heart rhythm issues and knowing when to seek medical advice, it's essential to consider several factors, including your symptoms, medical history, and the results of any recent tests. Based on your description, it seems you have been experiencing fluctuations in your heart rate and blood pressure, which can understandably cause concern.

Firstly, the heart rate can vary significantly depending on various factors, including physical activity, body position (lying down vs. standing), and emotional state. A resting heart rate of 60-100 beats per minute is generally considered normal for adults. However, heart rates can drop below 60 BPM (bradycardia) or rise above 100 BPM (tachycardia) under certain conditions. For instance, it's not uncommon for heart rates to increase when standing up due to the body's natural response to maintain blood flow. This phenomenon is known as orthostatic tachycardia.
Your observation of heart rates fluctuating between 50s while lying down and 110s upon standing is not unusual, especially if you have been experiencing anxiety or stress. Anxiety can lead to heightened awareness of bodily sensations, which may amplify your perception of heart rate changes. It's also important to note that medications, such as those for heart rhythm issues, can influence heart rate and blood pressure. If you feel that your medication is causing significant fluctuations in your heart rate or blood pressure, it would be wise to discuss this with your healthcare provider. They may need to adjust your dosage or consider alternative treatments.

Regarding your question about whether you should undergo further testing, such as a CT scan, it largely depends on your symptoms and the clinical judgment of your healthcare provider. Since you have already undergone a comprehensive evaluation, including echocardiograms and Holter monitoring, and the results were normal, it suggests that there may not be an underlying structural heart problem. However, if your symptoms persist or worsen, or if you experience new symptoms such as chest pain, shortness of breath, or fainting, it would be prudent to seek medical attention promptly.

As for your smoking habit, it's commendable that you're working on quitting. Smoking can significantly impact cardiovascular health, leading to increased heart rate and blood pressure, among other issues. The elevated heart rates you experience while smoking (130-140 BPM) are concerning and indicate that your body is under stress. Quitting smoking can improve your overall heart health and reduce the risk of developing cardiovascular diseases.

In summary, while your symptoms may be related to anxiety or the effects of medication, it's crucial to maintain open communication with your healthcare provider. They can help you navigate these concerns and determine if further evaluation is necessary. Additionally, adopting a heart-healthy lifestyle—such as regular exercise, a balanced diet, stress management techniques, and smoking cessation—can significantly benefit your cardiovascular health. If you ever feel uncertain or if your symptoms change, do not hesitate to seek medical advice. Your health and peace of mind are paramount.

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