Rapid Heartbeat: When to See a Cardiologist

Rapid heartbeat

Hello Doctor, my heart rate used to be around the 90s.
There is a significant family history of heart disease.
Since May of this year, my Apple Watch frequently alerts me that my heart rate exceeds 120 beats per minute, even though I work in an office and don’t feel particularly unwell.
I can feel my heart beating while sitting.
One day, I played badminton in the morning, and my heart rate reached about 160 during exercise.
After a nap in the afternoon, I woke up with a heart rate still at 140, which prompted me to visit a nearby clinic.
They performed an electrocardiogram (ECG) and an echocardiogram, and the doctor said it appeared to be simply a case of tachycardia.
I regularly check my Apple Watch, and it hasn’t missed any readings.
The doctor prescribed Concor 1.25 mg for me to take every morning.
When I take it, my heart rate can drop to around 100.
After finishing a week’s supply, I wanted to observe my heart rate, and it returned to 115-125 without medication.
I have tried this three times.
I would like to ask if my condition warrants a visit to a cardiologist.

Niming, 20~29 year old female. Ask Date: 2024/07/23

Dr. Wu Xueming reply Cardiology

Many factors in daily life can contribute to this condition, such as emotions, stress, irregular sleep patterns, or excessive intake of caffeinated beverages.
It is advisable to adjust your lifestyle and engage in regular exercise.
However, if symptoms persist, it is recommended to visit a hospital for an electrocardiogram (ECG) examination.

Reply Date: 2024/07/23

More Info

Based on your description, it appears that you are experiencing episodes of tachycardia, where your heart rate exceeds 120 beats per minute, particularly during physical activity and even at rest. Given your family history of heart disease and the fact that you have been monitoring your heart rate with an Apple Watch, it is understandable that you are concerned about your cardiovascular health.

First, let's break down the situation. Tachycardia can be caused by a variety of factors, including physical exertion, anxiety, caffeine intake, dehydration, or underlying medical conditions. In your case, it seems that your heart rate elevates significantly during exercise and remains elevated even after resting, which could indicate an abnormal response of your heart to stress or exertion.

The fact that you have a family history of heart disease is particularly important. Family history can increase your risk for various cardiovascular conditions, including arrhythmias, coronary artery disease, and other heart-related issues. Therefore, it is prudent to take your symptoms seriously.

You mentioned that you have undergone an electrocardiogram (ECG) and echocardiogram, which showed that your heart is structurally normal but does not address the underlying cause of your tachycardia. The medication you were prescribed, likely a beta-blocker, has helped to lower your heart rate, but it seems that once you stop taking it, your heart rate returns to the elevated levels.

Given these factors, it is advisable to consult a cardiologist for a more comprehensive evaluation. A cardiologist can perform further tests, such as a Holter monitor (a 24-hour ECG) to continuously monitor your heart rate and rhythm over an extended period. This can help identify any arrhythmias or abnormal heart rhythms that may not have been captured during your initial tests.

Additionally, the cardiologist may recommend further investigations, such as an exercise stress test, to evaluate how your heart responds to physical activity and to determine if there are any underlying issues that need to be addressed. They may also review your lifestyle factors, including your diet, exercise routine, and stress levels, which can all contribute to your symptoms.

In summary, while your initial tests may not have indicated any immediate concerns, the combination of your symptoms, family history, and the response to medication suggests that further evaluation by a cardiologist is warranted. It is better to err on the side of caution, especially when it comes to heart health. Early detection and management of any potential issues can significantly improve outcomes and provide peace of mind.

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