Heart rate.

[Garystan]

Well hear is my story. I’m forty-nine and started working out four years ago. Lots of bike riding, kick boxing and jogging. I was very out of shape and believe I’m in average shape now.

This August I was riding in 95-degree weather and maybe pushing it a little too much.  My rides were about one hour in length. I sweat a lot and on a typical ride I can drink about 30-60 oz of water. The day after a long ride I fertilized the yard. This was not that hard and took about a half hour of pushing the spreader around. However it was humid and I broke out in a little sweat. When I came in to cool down my heart rate started to rise and I was sweating even more. I sat down and my heart rate went on cruse control, about 140 if I had to guess. And I broke out in a total sweat.

After about five minutes I was in bad shape and told the wife to make the 911 call. By the time they arrived I felt a little better. They did an EKG and said I did not have a heart attack. They thought it was exhaustion. They said they saw about ten cases like mine in the last week. They recommended some Gatorade and to see my Dr. before I exercised again.

So I was off to the University on Michigan to see an internal medicine specialist. I had not been to a doctor in thirty years, yes I know… She ran her own EKG and saw nothing wrong with it. Seeing I have a heart murmur and have not been to a Dr. in a while she ordered some tests. She did total blood work and it was fine: Cholesterol=148, HDL=64, LDL=73, Triglycerides=54. She ran a stress test and it was fine. She did a heart eco before and immediately after the stress test and it was fine. She concurred with the Medics and thought it was exhaustion and recommended some sports drinks to help with my electrolytes. Which, by the way she tested and they were fine.

Well, I thought I was out of the wood until about two months later when I was up North at a hotel. I did my push ups, which take about two minutes and noticed my heart rate did not slow down. I did my best to keep it together and managed to relax and avoid the 911 call. After about five minutes my heart rate slowed down.
I called her the next day and she thought it was not exhaustion because I had not been pushing it and there was no heat involved. She told me to tighten up my stomach to help slow down my heart rate if it happened again and set me up with a Cardiologist. It did happen about two more times in the next week and the stomach exercise did work.

The Cardiologist concurred there was no damage done and put me on an event monitor. I can record an EKG if I have another problem. He was a little concerned about my blood pressure. The medics read it at 145/90 and the internal medicine specialist read it around the same or a little higher for about three readings. It was real high on the stress test. 240 over something toward the end. The Cardiologist read it at 128/72 and thought that was fine but was concerned about the other readings.

He had me where a 24-hour monitor that took readings every 20 minutes. My average was 120/69 Higher in the day and lower at night. He thought I have sensitive blood pressure. This would account for the white coat syndrome in the Dr. office. He is concerned about the high reading on the stress test and suggests we look into this after we find out about my rapid heart. He called it sensitive blood pressure. But he does not think they are related.

He said he hopes it happens when I have the monitor on so he can see what is going on. He said not to worry, it has not or is not doing any damage and it is not a mechanical problem like clogged arteries or anything with my valves. He said if I get chest pain or can’t breath call 911 and if tightening of my stomach does not work to stick my head in a bucket of ice water. It has been six weeks and no problem yet.


I seems this happens only after short period of exercise, a minute or two. Never if I stop after five minutes or an hour. It’s like my heart thinks it should keep going because of my usual exercise routine. Whenever I do a short burst of exercise I get a very strong heartbeat. I also notice some rise in heart rate and some shortness of breath even after climbing some stairs. By shortness of breath I mean very minor. If I was to start talking at the top of some stairs someone might notice it in my breath. But again, I can exercise at a high rate for an hour and not have any problem.

So my questions are:

1. Is this tachycardia? The articles I’ve read online seem to indicate it is.
2. I know there are multiple reasons for tachycardia. Does my good readings on the stress test and eco eliminate some of these reasons?
3. Could the exhaustion or over doing the exercise have caused this to occur? Or is this something I have had and it just started to show up?
4. I have had the monitor extended another month. This is up in two weeks and must go back. If nothing happens in two weeks what should be my next step?
5. Could this be related to my blood pressure?
6. I also have a slight heart murmur. Could this be related?
7. Is there anything else I should look into or any other tests I should have done.
8. This only happens after some sort of exertion. Is this a clue?

Thanks in advance.

[CCF-M.D.-MJM]

Hello,

1. Is this tachycardia? The articles I’ve read online seem to indicate it is.

by definition anything over 100 beats per minute is tachycardia.  this could be an exercise induced arrhythmia -- that is what it sounds like at least. The key is to catch it on a heart monitor.

I agree with all the treatment recommendations.  If they can't capture it on a event monitor.  the two options are an implantable loop recorder or doing an ep study.  If the symtpoms are bothersome and too frequent, I would consider the ep study with a possible ablation if they find it.

2. I know there are multiple reasons for tachycardia. Does my good readings on the stress test and eco eliminate some of these reasons?

a little bit, but even without the stress test, from the symtoms you describe it sounds like atrioventricular nodal reentrant tachycardia -- this is the most common.

3. Could the exhaustion or over doing the exercise have caused this to occur? Or is this something I have had and it just started to show up?

the over exertion on the hot day probably sparked -- but it probably would have shown its head any way.

4. I have had the monitor extended another month. This is up in two weeks and must go back. If nothing happens in two weeks what should be my next step?

implantable loop recorder or EP study.

5. Could this be related to my blood pressure?

probably not -- i can't think of reason why it could.

6. I also have a slight heart murmur. Could this be related?

not with a normal echo.

7. Is there anything else I should look into or any other tests I should have done.

if your current monitor is negative -- a loop recorder or ep study.

8. This only happens after some sort of exertion. Is this a clue?

it is probably stimulated by the adrenaline of exercise and the most likely cause of these things is AVNRT, although atrial tachycardia and atrioventricular reentrant tachycardia (AVRT) is also possible.

I hope this helps.  Good luck and thanks for posting.

[jdm]

Here's some advice from a person who has been there.....watch out for the development of a severe anxiety condition as a result of this tachycardia.  After years of heavy aerobic exercise I began ( at age 35 ) to develop sinus tach after exercise. Now 20 years later the tach has drastically altered my exercise and life style in terms of what I can do.  The greatest negative outcome , though, was the development of generalized anxiety disorder.  Now, not only will the actual organic tachycardia cause severe anxiety but also just about any little thing can set off an anxiety attack.....then the anxiety pumps up the adrenaline which loops back and increase my pulse rate.  A vicious circle.  The result is that a former mountain climber and marathoner now prefers sleep to almost any other activity-because when asleep I am generally , but not always, safe from a random anxiety attack.  I am male but don't talk about this to my few remaining friends.  Most men ( and heck come to think of it most women too ) just conclude I'm a wimp who is scared of his shadow.  So my advice  to you is watch out for anxiety as it can sneak up on you.  If you're like most men you'll try to deny it to yourself and most other people in your life won't understand it enough to "allow" you to have it and still retain their respect.  nuf said, good luck

[davidky]

I too suffer from anxiety induced tachycardia. I first encountered this when i was 25 years old. I have lost the freedom in my life from this disorder. When i went to a cardiologist the first time to have it checked i had a panic attack while taking a stress test. My heart rate was through the roof (over 200 bpm). The more i looked at the monitor the faster it got. Anyhow the doctor put me on atenenol. I have been on this medicine for some time now with no real problems. I do get lightheaded at times but it has helped with my anxiety.  I was also prescibed some xanax for the anxiety but i only take it when needed. It is more of a security blanket for me.  Just knowing i have it helps tremendously. My last refill lasted a year.  Anxiety can wreak havoc on a persons life.  I would give anything to have the freedom of mind i once had before this occured.

[fearfactor]

I have had viral gastroenteritis, with vomiting for the past couple days.  I'm finally getting over it, but the first night (Saturday) I developed severe tachycardia (well, I thought it was severe - up to about 140 bpm) after vomiting (which I have a phobia of) and probably due to my low-grade fever.  Does anyone else have tachycardia when they're sick?  My HR was up all day yesterday, up to around 108 resting but is finally back down today now that I'm better.  Anybody else experience this?

[Mel22]

I suffer from anxiety too. I exercise 4 days a week. I do about an hour of moderately strenuous cardio--fast walking on treadmill and doing the elliptical. If at then end of that hour, I get the *slightest* notion that my heart rate is getting higher than it "should" say, 155, I panic, which sends my rate to 160 and I enter the vicious cycle of a panic attack including the part where I convince myself that it really is a heart attack *this time*. Nasty stuff. After you've done all of your medical testing, you have to work through the anxiety, or you set yourself up for a lifetime of fear and frustration.

Good luck!

[fishingfool42]

My story has some similarities to the ones already mentioned.  I am a 48 year old male who had a history of heavy drinking and smoking.  Even with those two habits, I was in generally good physical condition until I finally had to give up playing basketball about 8 years ago due to various physical ailments.  A few months ago I began experiencing strange fluttering sensations in the upper left-hand side of my chest area.  These became more frequent and began to be accompanied by lightheadedness to the point of almost passing out along with what felt like a hard thump of the heart from time to time.  Like a fool, I tried to ignore all of these things "pretending" that they would go away.  It finally took one of my co-workers forcing me to go to the local hospital's ER that may have possibly saved my life.  I was having sustained and non-sustained PAC's and PVC's along with some occasional non-sustained tachycardia.  It was discovered that I had 90% blockage in one artery and 70% in another.  I had emergency angioplasty with three stents in the one that was 90% blocked with the intentions of bringing me back in a month later to have the other one done.  Immediately after the angioplasty, my heartbeat went back to normal but for only a couple of hours.  I slowly went back to having most all of the same symptoms so it was decided to do the other blockage right away the following day.  It has been 3 months almost to the day and I am still having skipped heartbeats.  I was back in the emergency room just one week after my angioplasties with messed up heart beats but by the time I got there they had ended.  Recently I have begun having extended bouts of arrhythmia's sometimes for days at a time.  My cardiologist says that since I don't have any other symptoms like chest pains or shortness of breath, he's not concerned.  I also have a panic and anxiety disorder that makes things that much worse when the heart beats get wacky.  I am on beta blockers, anti-anxiety meds along with the statins and blood thinners.  I exercise regularly doing 30 minutes a day on the treadmill at 3.5 MPH at a 6% incline along with another hour and a half of weight resistance training.  This doesn't seem to have any immediate affect on my PAC's but after about an hour of cooldown they kick in on me.  I'm resigned to the fact that I'll just have to live with them.

[Garystan]

Hey everyone, thanks for the comments. I have had bad anxiety once. I was running fast and could not tell if I was working hard or having an attack. So I stopped and my rate slowed down a little and I continued my run.
My minor anxiety is getting a little better as time goes on. My Dr. assures me it is not causing any damage and the last couple of times it has started I have managed to stop it. It has been three months sense it has happened.
So I’ll continue to exercise and where my monitor for another two weeks and see what happens. Thanks for all the comments. Nice to know I’m not alone.

[bothersome]

I definately feel right at home here. I have had severe panic attacks for years. I am on 20 mg prozac and also cerry around xanax as a security blanket. I have been able to keep my panic at bay for the past couple of years except when my heart starts skipping. I was able to deal with my skips until about a month ago when they started coming more frequently.I too am a male who was looked on as a sissy for many years until a souple of other males I know started having anxiety attacks also. I definately wouldn't wish anxiety and skipped heart beats on anyone, because as you all know it really puts a wrench in day to day life. Hope everyone had a wonderfull holiday

[prjose56]

Hi everyone.  I also suffered from anxiety induced tachycardia but have learned to control it with the help of meds and therapy.  One thing I do notice a lot more now is the changes in my heartbeat.  I tried posting this before but never really got an answer.  It's especially easy to see because I bought a heart rate monitor (the ones with a chest strap).  I notice that my heart is constantly changing.  My resting rate is anywhere from 55-70.  As soon as I move around it jumps about 20bpm.  If I stand sometimes it jumps 30bpm.  There are no other symptoms associated with it.  Just causes me to feel a bit anxious sometimes.  It was never this unsteady.  Does anyone have any input?

Happy New Year.

Jose

[kristylu]

you said it exactly, watch out for the anxiety. i now have it pretty much every day for no reason at all. i'll get panic attacks just from worrying about having one in the first place. Atleast panic attacks are what I assume I'm having. I've had all the normal tests and they say my  heart is normal but every little twitch, pain, pulse or abnormal heartbeat brings on an immediate anxiety attack.  All of a sudden I can't breathe and I feel like someone is sitting on my chest just crushing me. I get really light headed and shaky and sweaty. I found doing DEEP breathing exercises helps tremendously. Just curious, have you found any self help techniques that really work?

[bothersome]

Does anyone ever experience sharp pains in their chest when they have skips? This happened to me today for the first time. Needless to say I am very worried about this. I had an extremely stressfull day before the skips, so i'm not sure if that contributed to it or not.Usually I'll feel skips during stress , but not after i'm relaxed.

[ViewChicago]

Hey--40 year old & very cool to see myself amongst these. (Actually, not cool at all that we're dealing with this, but glad to see the similar experiences).

I'd stopped exercising regularly and began a program two years ago. 1.5 years in to increasing my exercise a gym opened near me and I joined.

My routine consisted of lifting 2x a week (upper body one day, legs another), yoga 1x a week, running 3x a week and intense spin class 1x week (where I got my heart rate up to 192 one day). OK, that adds up to 7 days, and I was averaging 5 days a week exercising (weekends away etc. accounted for most of the down time, although lazy days accounted for some of the other).

I used a heart rate monitor to understand & track my progress.

5 months into the gym membership I began taking creatine to help with my lifting (which I've now stopped). A few weeks later I began to feel dizzy while lifting and after some pretty heavy weight-lifting (we older guys need to chill, but didn't know it then).

7 months into the gym membership following one intense session (which ended with me upside down on a bench working my triceps) I was particularly dizzy. (Didn't do a cool-down, which I've now learned is important). I grabbed a sport drink and, while paying for it at the counter, noted my heart rate was not going down (after the intensity should be around 110-115 for me). In fact, it was increasing. 135 | 140 | 145. I wondered out loud "hmmm, what does it mean when your heart rate goes UP when you've finished exercising".

I sat down and rested for about 15 minutes, then stood up again planning on leaving and watched it climb to 160. I didn't like this, sat down, and rested for about 20 minutes, while my HR stayed at about 140 (darn it, for me it would be normal for it to be 100 at this point). Feeling a *little* dizzy, and fearing something was wrong (I'd never seen my HR behave like this), I had the gym phone 911 for me. I felt like a fool, but also was worried enough.

911 came, blood pressure a *little elevated*, they took a quick history (no drugs other than creatine, no heart problems in the family, no high blood pressure, resting heart rate 55 etc). They took me into the medical van, gave me oxygen, noted my blood pressure was a little higher, but heart rate below 100 now. As they were calling in to say they were releasing me, a final BP reading was 190/120--it was escalating and not good.

In the ER, my BP was up to 220/125.... ECG looked good. Follow-up with physician looked good (24 hour BP monitoring 119/79 plus my random testing of 125/83) seemed fine. No heavy pains in the chest or problems breathing during my intense exercising (and essentially stress-test when I hit 192 during spin class). Physician gave me the AOK to exercise.

It took me a couple of weeks following his OK before I got on the treadmill again. My usual treadmill = running 30 minutes between 142-153 heart beets per minute--I did this this time (although I wasn't able to run my usual distance--I'm chalking this up to de-conditioning). At about the 25 minute mark I noticed my heart rate climbing. 153 | 158 | 160 | 165 and eventually up to 179. I slowed my pace during this, then stretched (not looking at my HR to not freak myself) and, feeling dizzy/odd, returned to my condo (we have an exercise room), plopped on my bed and noted my HR wasn't returning to below 100 for about 30 minutes, instead sticking in the 110 range (not normal for what I'd seen the previous months).

My sisters insisted I phone the doctor, who wasn't at all alarmed, and agreed with me perhaps it was due to anxiety (which I told him it likely was--and should probably not have put the words into his mouth but....)

I decided to get right back on the treadmill the next day, and, this time decided just to walk to begin to de-condition myself/learn not to freak out. After about 20 minutes, I felt totally zoned and *new* this time it was an anxiety attack happening as my HR climbed high again.

I didn't exercise for another month following this (deciding that, since I was probably over-trained before, a good rest would do some good...)

Two days ago I embarked on a new program. I figured I have to learn to deal with the anxiety, which, with no other symptoms, I'm figuring is going on with me (Not a great thing to diagnose myself, on the other hand, until I have more evidence to take to the doctors, I'm sticking with this--Having only a major medical coverage with a $2,500 deductible doesn't help either).

The new program was to treadmill 5x week. First time, walk for 30 minutes. Second time, walk for 29 minutes and run one, third time walk for 28 minutes and run two et cetera until I was back on the horse.

Day one went fantastic. Heart rate averaged 115 with max 126. Day two not so good. I walked for a warm-up for 5 minutes, ran 1, then walked. About minute 27 a feeling began to take over me, I looked down, and watched my HR escalating. I didn't watch it escalate, instead decreased the already slow pace, then hopped off and stretched against the wall. After about 2 minutes my HR was back to 130 (still a little high for my exertion level but....) and I jumped back on for the last couple minutes & the cool-down.

On my way to my condo, I noted my HR was staying a little high (126) and not going down as it should. Once home, I plopped on my bed until I noted I was back into the 70's (about 30 minutes).

I wore my HR monitor last night and noted, the second day in a row, my resting HR in the a.m. was 58.

Today I was feeling edgy after not sleeping well, and watched my HR jumping all over the place this morning. Up to 120 while doing light work (but then back to low 90's then 80's and 70's while sitting) (And my usual max while doing light work around the house is about 100).

To make a short story long, I'm convinced I'd become over-conditioned which, following really pushing it with weights that last time, my heart decided it needed extra time to return to normal. This event made me nervous, which made me call 911, which kicked my BP up (*you* try sitting in a medical van with oxygen and bring your BP down) and I always have had white-coat high blood pressure.

(As an aside, I should have known sooner that I was over-trained when I noted my HR kicking up to 115 or so on the walk to the real gym, when it usually is 100-105)

Now I'm stuck with anxiety as a remnant, which I need to learn to overcome.

[Jnine]

I'm having these same symptoms. I'm 17 and ever since my symptoms I had been working out at least 6 days a week, mostly running. Latley when I'm working out my heart rate can go up to 200  in the small time spand of 2 min! I get really scared and when I stop it takes about 10 minutes for it to go down. I was wondering if this could be something other than anxiety because I have also been having chest pains with and without working out and there are tingling sensations in my left hand. This has been happenening every day for the past month and I'm really scared it might be something serious. I have had a lot of testing done last year for my heart murmer, but everything was okay. Is this somehting I should be worried about?

[jevina]

Well a few weeks ago at work I get from my desk to get something from printer
That when I felt lightheaded my nose fell stuffy, so after that I went and sit down I decide to call my doctor office  tell them what happen, so the ask me to come in that same day I went after work that afternoon I saw PA she say it sinus infection, so she give me some nasal spray and cefzil, I notice a day after I started to using medication I start to get fast heart beat,  left chest pain and burning and I start burping every few min  so I call her back tell what I was feeling so I went back to  doctor office, the did ekg it was normal,
them that same night I wake out of my sleep with my heart racing it almost felt like it wanted to jump out my chest went to er the did the chest x-ray find nothing did ekg normal. So I decide to go cardiology  he did ekg say it was slight abnormal not to worry them we did eco test it was normal ,  now I have to do regular stress test, and I am so worry, I am 27 year old female   help anyway advice ? Anxiety attack could have this trigger it because I was so stress over holiday and I have never encounter any problem like this I excise 3 day week, at work I take the stair.  also I did blood work every was good, my blood pressure was normal  , my family has a history of high blood pressure no other problem mind also normal.

[catelynnw3]

I have not read all the posts, but after browsing through them I wanted to share.  I have suffered for several years, and have learned a lot.  I realize that some people may have true cardiac problems and others have true anxiety disorders, but there are other conditions that mimic both of these.  Inappropriate Sinus Tachycardia and P.O.T.S. (Postural Orthostatic Tachycardia Syndrome)  Unfortunately many cardiologists aren't aware of these, but a good Cardiac Electrophysiologist should be able to diagnose them.

There are some excellent articles on both of these.  They also have links to dysautonomia info.  The autonomic nervous system can get out of whack and cause several unpleasant symptoms that seem to have no rhyme or reason.  I pray this will help.

http://heartdisease.about.com/cs/arrhythmias/a/IST.htm

http://www.geocities.com/inappropriatesinustachy/main.html

www.potsplace.com

On a sidenote, although it is very rare there is also something called a pheochromocytoma.  I copied some info. below from urologyhealth.org:

Pheochromocytoma is a tumor of the adrenal medulla that produces excess adrenaline. It can be a deadly tumor because of the severe elevation in blood pressure it causes. It usually is not cancerous but may be associated with cancerous tumors in other endocrine glands such as the thyroid.

The majority of patients with pheochromocytoma experience hypertension. Only 15 to 20 percent of patients have normal blood pressure. Many patients experience the classic triad of headache, profuse sweating and palpitations. In fact, hypertensive patients with this triad have more than a 90 percent chance of having a pheochromocytoma, whereas individuals with none of these characteristics have less than 1 percent incidence of pheochromocytoma. Other symptoms include anxiety, chest pain, abdominal pain, fatigue, weight loss, vision problems and seizures.

Hypertensive episodes can be sudden or long-lasting. Sudden attacks typically last less than one hour and can occur as frequently as several times a week or as rarely as a few times a year. These attacks are more commonly seen in women. Episodes can be triggered by physical, emotional or pharmacological stimuli including bending over, abdominal pressure, fear, tobacco, histamine and glucagons, as well as foods rich in tyramine (e.g., beer, wine and cheese).