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Avatar universal

Elevated Heart Rate/Dizziness

I'm a 50 y/o Male, 6' 2" 240 lbs, former high school athlete (probably still athletic for 5-7 yrs after HS), whom now is in poor aerobic shape.  My daily meds include LEVOTHYROXINE NA (SYNTHROID) 0.1MG TAB in mornings for Hypo-thyroid, SIMVASTATIN 40MG TAB in evenings for high cholesterol.  I have a difficult time consuming enough water to stay safely hydrated, a battle of mine.  My only exercise is golfing (walking) 2X weekly & bowling 1X weekly.  A few weeks back I wore a Garmin GPS HR monitor during a recent golf round, during the 6.5 mile walk, my HR cycled from a low of 90-100 bpm on the greens & prior tee shots to 140-170 bpm while pushing the cart to each shot.  I felt no real discomfort, just got winded occasionally while pushing the cart.  

Now jump to this past weekend, I was playing my normal game, but before the round I had taken (2) Excedrin Migraine caplets (combined total of 500 mg Acetaminophen/500 mg Aspirin/130 mg Caffeine), this was done as a preventative measure for occasional migraines.  Upon teeing off on this cold morning (40 degrees), I felt a slight increase in my HR while walking toward my tee shot.  I also noticed a little tunnel vision as if I may pass out (although I've never passed out, just seemed like that feeling).  I stopped & recovered enough to hit the next shot & walk to hit...slowly.  I completed that hole & teed off on the next hole, where I noticed the same discomfort/feeling as I walked to the shot.  I then decided to stop playing for the day & go to the ER.  After being driven off the golf course, I attempted to drive myself to the ER, but felt the same feeling again as walked to the car so I decided to call 911.  While in the ambulance, my HR was between 155-195, though it didn't feel like it did when I felt the 'attack'.  By the time I arrived at the ER (5-10 mins), my HR had lowered to 85-90 bpm (only oxygen was given to me via little hose in nostrils).  While being treated at the ER, they ran the standard tests I guess (Blood, EKG, X-Ray & kept monitoring my BP & oxygen level for 5 hrs).  Everything was normal, including my BP averaged about 117/69 the entire time.  Since I had definitely had an elevated HR (witnessed by EMT in ambulance), the ER Doc felt compelled to prescribe me Toprol-XL 50 mg 2X daily, to eliminate the chance of another high HR, until I meet with my PCM.

As stated, I rarely exercise & my resting HR is probably around 75-85 (before Toprol XL) & since I was able to easily reach 140-170 bpm by just walking/pushing a golf cart, I'm pretty sure that means I'm out of shape.  Could the slight increase in caffeine on that morning, along with cold weather & me pushing a golf cart, have caused my HR to escalate that high & cause me to feel lightheaded/like I was going to pass out?  Although out of shape, I've never had any problems with my heart before & with the blood tests/EKG not showing any indication of a problem after this episode, I'm concerned as to why it happened.  If the caffeine was enough, than ok, but that worries me a little.  Of course, I know I need to start working out aerobically, but this episode scares me with that regard...I may cause another High HR with any exercise.  
19 Responses
363243 tn?1331037450
I would definitely see a cardiologist and he/she will conduct tests to look at the structure of your heart and the electrical activity of your heart also (sometimes you have to see an electrophysiologist for the latter). I would wait until seeing the specialist before doing any strenuous exercise. I have to mention though that the mention of the levothyroxine really stood out for me because your thyroid and thyroid medication can directly affect your heart. Did they check your TSH, FT3 and FT4 in the ER, and if not, when was the last time you had those checked? If your TSH is too low it can cause you to have hyper symptoms like an elevated HR. I'm assuming the rest of your lab work was normal (CBC, etc.). Do you have Hashimoto's or are you hypothyroid for another reason? Hashimoto's can make you swing hypo and also hyper.
995271 tn?1463927859
Don't work out until you get clearance from your cardiologist.

I doubt this is a "deconditioning" issue, meaning out of shape.  For some reason your heart is over reacting to normal stressors with an elevated heart rate.  That can happen for all sorts of reasons.    You have to get it figured out.  You should have a stress test, ekg, and an echo.  If you have any risk factors for heart disease (family history, smoker,...) I'd go the extra step, with testing to make sure your heart's arteries are open such as a nuclear stress or a heart CAT scan.
Avatar universal
Thanks for the replies.  I will definitely await the visit to my PCM (Mar 15) & possibly a Cardiologist before beginning any exercise regimen.  I have no direct risk factors-I do not smoke & no family history.  
They did test my thyroid in the ER & indicated that all was normal, along the rest of my lab work.  Not sure why/how I am Hypo...just certain I have not been diagnosed with Hashimotos.
In the past I have noticed a fast/jumpy heartbeat when I first awaken, but it usually goes away after a minute or two.  On the morning of my episode, I also felt this way, but it lasted a little longer.
Avatar universal
I failed to mention a key thing from that day...I occasionally experience what I now know to be heart palpitations.  These usually last around a minute and are relatively mild.  On the morning of my ER visit, I felt these palpitations for a longer period of time.  I also now realize that these heart palpitations always occur shorter after I take my Levothyroxine in the morning for my hypo-thyroid.  Maybe this coupled with the increased caffeine from the Excedrin, may have triggered my heart racing.
Avatar universal
Although it feels like I am talking to myself:)  I do have another tidbit I neglected to mention.  Seems my ER Doc did provide a diagnosis during my visit (Dx in small print on my release form), PSVT.  My Primary Care Doc appt is tomorrow and I will discuss it with him, but it sounds like PSVT is being used as a 'catch-all' for my one-time, accelerated heart rate.  Does this sound correct?
Plus, can someone be vulnerable to PSVT on rare occasions...or is it normal for it start to occur late in life and I may experience more in the future?
I understand that if it is truly PSVT, then it is very treatable (yay), but just wondering whether it is being used because nothing else could be found.
Thanks for listening/reading...I will provide an update after my doc visit.
1807132 tn?1318747197
PSVT is a general term for any fast heart beat in the atria that comes and goes.  There are run of the mill psvts like avnrt and avrt, some that are a bit more bothersome like wpw.  People are generally born with these types of svts because they are characterised by an extra fiber in the heart that conducts the electrical signal allowing it to fall into a loop.  I believe that it is possible for them to simply show up later in life but I rather think most of the congenital forms show up at least sporadically by the time one is in their twenties.  There is, however, another svt, afib, that is caused by other factors like thyroid issues, heart or artery issues or for no reason at all.  Afib episodes can come and go and but need to be treated more diligently than run of the mill svts due to the risk of the person throwing a blood clot.  Blood thinners are generally prescribed but other meds are dependent on the overall health of the heart and how well the person is tolerating the episodes or how often one has episodes.  This all said, see your primary tomorrow but I would definitely push to see a cardilogist.  You really need a full workup of your heart to make sure all is in good health.  Please do keep us posted on your visits.  Take care.
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