Heart Rate and Blood Pressure Fluctuations: When to Seek Help

Heart rate and blood pressure issues?

I'm sorry, Director, but I accidentally had another episode and went to the emergency room...
I was worried about my heart rate and blood pressure.
While trying to sleep, I suddenly started sweating, and I couldn't tell if it was hot or cold sweat.
This scared me, and my heart rate shot up to 150-160, but it only lasted about a minute before it dropped back down.
Then I started feeling very cold and trembling.
Director, I would like to ask you, I have been taking the antiarrhythmic medication for a month now, only in the morning.
My blood pressure has been around 120/70, and my heart rate at night before falling asleep has been 70-80.
However, for the past three days, it's been strange; my blood pressure at night has dropped to around 100/55, and my heart rate while lying in bed has been just over 50.
What could be the reason for this, Director? Generally, the morning dose of the antiarrhythmic medication shouldn't have much effect at night, right? Should I see a doctor for this? Now, my morning heart rate increases to 120-130 when walking or eating, but at night, it drops to the 50s, and even when walking, it's only 70-80.
I don't understand why there's such a big difference.
I'm hesitant to take the evening dose of the antiarrhythmic medication.
Director, what could be the cause of this? Is there any danger? Which specialist should I see? I'm sorry, and thank you, Director.
Take care.

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

Dr. He Dongjin reply Cardiology

Hello, it's nothing to worry about.
Heart rates naturally fluctuate; you might be concerned when it's fast and also when it's slow.
From my perspective, these are normal variations.
A heart rate in the 50s is fine, and walking can raise it to 70-80.
It seems that if you are not anxious, your autonomic nervous system is gradually stabilizing, which is a good sign.
Relax, everything is fine.
Changhua Hospital cares about you.

Reply Date: 2023/07/07

More Info

Understanding fluctuations in heart rate and blood pressure can be quite concerning, especially when accompanied by symptoms like sweating, palpitations, and tremors. Your experience of sudden increases in heart rate to 150-160 beats per minute, followed by a rapid decrease, is indicative of potential autonomic nervous system involvement, which can be influenced by various factors including stress, anxiety, or even underlying cardiac conditions.

From your description, it seems that you are experiencing episodes of tachycardia (rapid heart rate) during stressful situations, which may be exacerbated by anxiety. The fact that your heart rate drops to the 50s at night, along with a blood pressure reading of 100/55, suggests that you may be experiencing bradycardia (slow heart rate) during rest. This fluctuation is not uncommon, as heart rate can vary significantly based on activity levels, stress, and even the time of day.
Your current medication regimen, particularly the heart rhythm medication you mentioned, may also play a role in these fluctuations. It’s important to note that medications can have different effects depending on the time they are taken, and individual responses can vary widely. If you are taking a medication that affects heart rate, it could potentially lead to bradycardia, especially if the dosage is not appropriately adjusted for your needs.

The symptoms you describe—sweating, rapid heart rate, and subsequent coldness—could be related to a panic response or an episode of autonomic dysregulation. It’s also worth considering other factors such as dehydration, electrolyte imbalances, or even thyroid function, which can influence heart rate and blood pressure.
Given that your blood pressure readings at night are lower than expected, and your heart rate is significantly reduced, it would be prudent to consult with your healthcare provider. They may want to perform a thorough evaluation, including blood tests to check for electrolyte levels and thyroid function, as well as possibly an echocardiogram or Holter monitor to assess your heart rhythm over a longer period.
In terms of when to seek help, you should definitely reach out to your doctor if you experience:
1. Persistent symptoms of tachycardia or bradycardia.

2. Dizziness, fainting, or near-fainting episodes.

3. Significant fluctuations in blood pressure that are not explained by your activity level or medication.

4. Any new or worsening symptoms that cause you concern.

It’s essential to maintain open communication with your healthcare provider about your symptoms and any changes you notice. They can help determine whether your current medication regimen is appropriate or if adjustments are needed.
In summary, while fluctuations in heart rate and blood pressure can be normal, especially in response to stress or medication, significant changes warrant further investigation. Your health and safety are paramount, so don’t hesitate to seek medical advice when you feel uncertain about your symptoms.

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