Nighttime Rapid Heartbeat: Causes and Concerns

Rapid heartbeat at midnight?

Hello Doctor, my blood pressure used to be around 90 systolic and 60 diastolic, but recently it has been around 75 systolic and 55 diastolic.
I have been experiencing headaches, dizziness during physical activity, and my hands turning pale.
Recently, one night, I woke up with my right leg twitching, followed by a slight numbness in both corners of my mouth, and a strange sensation on the right side of my body (as if blood wasn't reaching that side).
In a semi-conscious state, I felt uncomfortable and sat up, suddenly experiencing a rapid heartbeat and high blood pressure, measuring 130 systolic and 86 diastolic (which is higher than usual).
My heart rate was 106, and my face and hands turned pale, feeling cold and trembling, with a sensation of poor blood circulation.
After about 2-3 minutes, I returned to normal.
I'm not sure what happened.
Thank you, Doctor.

Jia, 30~39 year old female. Ask Date: 2012/09/28

Dr. He Dongjin reply Cardiology

Hello, your symptoms seem to be primarily caused by autonomic nervous system dysfunction.
It is advisable to seek assistance from a psychiatrist.
The treatment outcomes are generally better.
Changhua Hospital cares about you and has attached a list of autonomic nervous system symptoms for your reference.

Reply Date: 2012/09/28

More Info

Understanding nighttime rapid heartbeat can be concerning, especially when accompanied by symptoms such as headache, dizziness, and unusual sensations in the body. Based on your description, it seems you have experienced a range of symptoms that could be indicative of several underlying issues.
Firstly, the rapid heartbeat you experienced during the night, especially when you woke up feeling uncomfortable, can be attributed to various factors. One common cause is anxiety or panic attacks, which can lead to an increased heart rate (tachycardia) and feelings of discomfort. Stress and anxiety can trigger the body's "fight or flight" response, leading to the release of adrenaline, which can increase heart rate and blood pressure.

Additionally, your history of low blood pressure (90/60) and recent readings (75/55) suggest that your body may be experiencing fluctuations in blood pressure, which can lead to symptoms like dizziness and faintness, particularly upon standing or during physical exertion. When blood pressure drops, it can result in inadequate blood flow to the brain and other organs, causing symptoms like lightheadedness and weakness.

The episode you described, where you felt your right leg twitching and experienced tingling sensations in your face, could indicate a transient neurological event. While it is essential to consider the possibility of a stroke or transient ischemic attack (TIA), these symptoms can also be related to anxiety or hyperventilation, especially if they occur during periods of stress or panic.

The fact that your heart rate increased to 106 beats per minute and your blood pressure rose to 130/86 during this episode is significant. It suggests that your body was reacting to a stressor, whether physical or emotional. The coldness and trembling you experienced could be a result of your body's response to stress, which can cause peripheral vasoconstriction (narrowing of blood vessels), leading to a feeling of coldness in the extremities.

Given these symptoms, it is crucial to consider a few potential underlying conditions:
1. Anxiety Disorders: As mentioned, anxiety can lead to physical symptoms, including rapid heartbeat, dizziness, and tingling sensations. Cognitive-behavioral therapy (CBT) and relaxation techniques can be beneficial in managing anxiety.

2. Autonomic Nervous System Dysregulation: Conditions such as dysautonomia can cause symptoms like those you described, where the autonomic nervous system does not regulate heart rate and blood pressure effectively.

3. Cardiovascular Issues: While your previous blood pressure readings were low, the sudden increase during your episode warrants further investigation. Conditions like arrhythmias or structural heart issues could lead to episodes of tachycardia and should be evaluated by a healthcare professional.

4. Neurological Concerns: The twitching and tingling sensations could suggest a neurological issue, and it would be advisable to consult a neurologist if these symptoms persist.

In conclusion, while some of your symptoms may be related to anxiety or stress, the combination of rapid heartbeat, changes in blood pressure, and neurological sensations should not be ignored. It is essential to seek medical attention for a thorough evaluation, including a physical examination, blood tests, and possibly imaging studies or an electrocardiogram (ECG) to rule out any serious underlying conditions. Keeping a symptom diary, noting when these episodes occur and any associated triggers, can also be helpful for your healthcare provider in determining the best course of action.

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