Tachycardia at rest and PVCs during exercise

[Capleton]

I am a 25 year old male, bmi of 26.  As long as I can remember, I have had a fast heart rate at various times during the day.  There is a link to stress as it is fastest in stressful situations, but also food, alcohol etc.  My cardiologist examined me with an echo and said it was normal.  I had an EKG and my HR was 100 which he said was too high.  He asked me to wear a holter monitor to see if this rate was sustained over 24 hours.  When I got these results back, minimum HR was in low 50's and maximum was 145.  He said that during the day my HR was often over 100.  My average over 24 hours was 81 beats.  He said that it was too high for someone my age.  I was surprised as I had expected my HR to be higher and I thought 81 was a good result.  My blood tests were normal but with slightly elevated TSH (4.98) but still within the normal lab range (0.3-5.0).  He says he does not know what is causing the fast heart rate.  He suggests a rigoros exercise programme for 6 months.  If my HR does not improve I have to return.

I have two questions:

1.  Why did he say that a 24 hour average of 81 was still too fast for someone my age?  I understand he is really into sport and maybe it is not an optimal HR, but it is still ok, is it not?  I think I generally have a fast heart rate as just standing will send it to 100 and walking up to 120.  

2.  On another note, I have noticed that when I begin to jog, and get up to a HRM of 160 or so, my HR will suddenly drop into the 70's or 80's.  If I stop jogging it returns to 160.  My cardio said there is something wrong with my Heart Rate Monitor.  But I am not sure because I have used two different models and this continues to happen.  Someone else suggested that these were PVC bigeminy and the HRM is only registering every second beat.  THis always happens at the start of my run and does not happen for the rest of the run.  If this is bigeminy, are such PVCs at the start of exercise dangerous? I have heard many scare stories.
Thanks so much

[Forum-M.D.-MJM]

Hello Capleton,

This is a relatively common clinic question.


1. Why did he say that a 24 hour average of 81 was still too fast for someone my age? I understand he is really into sport and maybe it is not an optimal HR, but it is still ok, is it not?

There is a range of normal heart rates, but it does not mean that there something wrong with you if your heart rate is outside those zones.  An average heart rate of 80 for a 26 year old male is a bit high, but that does not mean that something is wrong.  It also important to note that averages an be very misleading depending on the question.  For example if your heart rate is in the 40-50's during sleep for 8 hours but is in the low 100's all day averaging to 80 is very different information than someone that stays at 80 all day and night with no variation.  I would say that your heart rate is on the high side of normal but the information you provided does not concern me.  A period of observation is very appropriate.  If the heart rate bothers you I would consider adding a beta blocker.  There is not much else I would do.  We can do ablations for symptomatic sinus tachcyardia but the rates tend to be much higher.  I would not consider an ablation with the information your provide.


2. On another note, I have noticed that when I begin to jog, and get up to a HRM of 160 or so, my HR will suddenly drop into the 70's or 80's. If I stop jogging it returns to 160. My cardio said there is something wrong with my Heart Rate Monitor.

An exercise stress test or holter monitor during exercise would answer these questions.  I do not think that your heart rate drops during exercise.  Drops like this tend to cause significant symptoms.  It is a very easy question to answer wtih a monitor.

PVCs would probably be counted by a heart rate monitor and you would likely be very symptomatic.

I hope this helps.  Thanks for posting.

[tickertock]

Your story same so much like mine, a heartrate on the high resting side, low in the nights almost a abnormal exaggerated response to the least movement. Mine is very controlled with the beta blocker atenolol. An average of 81 bpm in a 24 hour period is well within the norm is my personal opinion and it shows that the rate of 100 is not sustained in a 24 hour period from what you've written it would same like a normal report even though your heartrate is on the high resting side of normal at times, just my personal opinon only, I'm not a MD.

[Capleton]

Thank-you

[Capleton]

I have been looking at studies on 24 hour holter monitors among the "normal" population and the mean appears to be 76 beats.

[prjose56]

Sorry to jump in but I just had a question for all of you.  With the high sensitivity of your heart rates, tachycardia...etc, how are you still able to go out and exercise without being worried about your heart rate skyrocketing?  I've been having the same symptoms as the both of you but I've completely avoided exercising because my heart rate goes up so quickly.  It's really frustrating because I used to be so active.  

What are your reactions to exercise?  Do any of you have panic attacks?  

Thanks for you help.  

Jose

[Capleton]

Hi Jose,

My HR jumps to about 150 almost immediately starting exercise.  Then it stays in the 170's or 180's.  Sometimes if I am running to catch a bus, it will jump to 180's just in a short sprint!  This has not really worried me before.  I am more conerned about the overall picture i.e. what my heart does over 24 hours.  I understand some people just have a different reaction to exercise.  Although I do notice that if I get up to the 180's too quickly, it takes a long time to go back down to the normal range (maybe one or two hours) and the arteries in my abdomen and neck feel like (and look like) they are pumping out of my body.  But this happens if I get my HR up too quickly.  I try to avoid that.

[prjose56]

Hi Capleton.  Thanks for the response.  Would you mind exchanging email addresses.  I have a few more questions I'd like to ask you.  Our symptoms are quite similar.  Mine is lilrican_56***@****.  

Thanks.

Jose

[mom52]

Question - my 16 year old son has tachycardia SA, due to extra electrical pathways.  He is virually asymptomatic.  No apparent damage to the heart.
My concern is long term.  I worry about the long term affect of 100+ heartbeats over the course of his life.  Ablation is an option.  Should we do that while he is young and heathy?  Any other thoughts?