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elevated HR with palps in the evening (long read, but plz help)
Hello, I will try to keep this as concise as possible but it will still be a long read. I've been dealing with this for probably near a year and have no idea why it happens. There is a TL;DR at the bottom.
First off, I'm a 26 year old male. I do not smoke, I drink socially but keep it in check. I live a somewhat sedentary lifestyle (trying to change that but haven't because of the issues I am about to explain).
My routine is that I get up between 10 and 11a (I'm definitely a night owl) and go to sleep between 1 and 2a. I take nuvigil for narcolepsy/EDS(dosage has changed several times over the last year, but the problem remains), omeprazole for acid reflux and, currently, I'm taking 6.25mg of atenolol twice a day (started to come off of this medicine with the help of my doc several weeks ago because of a number of reasons, I will soon stop taking it altogether).
So, my issue is that every evening around 6pm, I start getting a pounding elevated heart rate. If I'm exerting myself it's almost as if I become severely exhausted and out of breath, so I try to take it as easy as I can during these episodes. It lasts until around 8-9pm and then I'm 100% fine. At one time it got so bad that every time it happened I was forced to stop what I was doing (usually cooking and running around the kitchen) and sit down as I felt like I was going to pass out. It's not that bad anymore but it's still definitely affects my quality of life. It doesn't matter what I'm doing, it's like clockwork. I'll even get the pounding heart rate sitting in my evening classes doing nothing but listening to lectures and taking notes.
Here's the strange part. During the day (between 12 and 4p) when I'm doing work I can check my pulse and find it as low as 64bpm. Any other time of day (before and after the episodes) my usual resting heart rate is at 80bpm, even if I am sitting down and doing the same thing I do between 12 and 4. HOWEVER, during the episodes my heart rate stays around 95-100 along with the pounding heart beat. Evening episodes aside, my general restin heart rate is higher in the evening/night than it is during the day (any ideas why?).Generally my BP is stable, though it systolic can be near 130 during the episodes.
I had a stress test, blood work and an echo done back in August. Aside from my LDL being a little high and a mild MVP, everything came back normal. The tests show my heart is functioning normally and there is no indications of ischemia or muscle damage. I have a deeply ingrained family history of heart disease (my father, my grandfather and grandmother, all of their relatives), so after having some chest pains I wanted to check it out. Funny enough, my electrolyte levels weren't tested, so that could be a possibility.
I lost 40 pounds over the summer (super proud!) and I've switched my diet to mostly whole foods that I cook from scratch. Low sodium, low saturated, higher vitamin intake, only whole grains, no added sugar. That's my general diet guidelines. I try to avoid anything out of a box (I love those whole wheat Triscuits, though!). I dropped the weight in only two months, and this was without even exercising. I stopped regularly exercising around when this started back in January or February, but I do go on walks a lot to help.
So, throughout my journey of weight loss and health checks, this is one thing that has stubbornly remained. The only variable that I don't know about is my electrolyte level. I've been taking the proton pump inhibitor(omeprazole) for a long number of years and I know those can drain your magnesium reserve. I started taking some magnesium citrate and noticed that it stopped for a couple days, so I figured this was the issue. Unfortunately, after several days it came right back despite me continuing to take the supplement.
Is there anyone out there who has experienced something similar or anyone who may hold clues or insight into what may be happening, PLEASE share it with me. I don't know if this is something I should really be concerned about but I think it may be. I apologize if this felt convoluted or was hard to follow, I worded it as best I could.
TL;DR: My heart has an elevated pulse accompanied by severe palpitations in the evening like clockwork for almost a year and no tests I've had done show why. It's remained despite several major changes in my health and weight. It may be electrolyte imbalance but personal evidence suggest that there may be something else to do with it. PLEASE HELP.
First off, I'm a 26 year old male. I do not smoke, I drink socially but keep it in check. I live a somewhat sedentary lifestyle (trying to change that but haven't because of the issues I am about to explain).
My routine is that I get up between 10 and 11a (I'm definitely a night owl) and go to sleep between 1 and 2a. I take nuvigil for narcolepsy/EDS(dosage has changed several times over the last year, but the problem remains), omeprazole for acid reflux and, currently, I'm taking 6.25mg of atenolol twice a day (started to come off of this medicine with the help of my doc several weeks ago because of a number of reasons, I will soon stop taking it altogether).
So, my issue is that every evening around 6pm, I start getting a pounding elevated heart rate. If I'm exerting myself it's almost as if I become severely exhausted and out of breath, so I try to take it as easy as I can during these episodes. It lasts until around 8-9pm and then I'm 100% fine. At one time it got so bad that every time it happened I was forced to stop what I was doing (usually cooking and running around the kitchen) and sit down as I felt like I was going to pass out. It's not that bad anymore but it's still definitely affects my quality of life. It doesn't matter what I'm doing, it's like clockwork. I'll even get the pounding heart rate sitting in my evening classes doing nothing but listening to lectures and taking notes.
Here's the strange part. During the day (between 12 and 4p) when I'm doing work I can check my pulse and find it as low as 64bpm. Any other time of day (before and after the episodes) my usual resting heart rate is at 80bpm, even if I am sitting down and doing the same thing I do between 12 and 4. HOWEVER, during the episodes my heart rate stays around 95-100 along with the pounding heart beat. Evening episodes aside, my general restin heart rate is higher in the evening/night than it is during the day (any ideas why?).Generally my BP is stable, though it systolic can be near 130 during the episodes.
I had a stress test, blood work and an echo done back in August. Aside from my LDL being a little high and a mild MVP, everything came back normal. The tests show my heart is functioning normally and there is no indications of ischemia or muscle damage. I have a deeply ingrained family history of heart disease (my father, my grandfather and grandmother, all of their relatives), so after having some chest pains I wanted to check it out. Funny enough, my electrolyte levels weren't tested, so that could be a possibility.
I lost 40 pounds over the summer (super proud!) and I've switched my diet to mostly whole foods that I cook from scratch. Low sodium, low saturated, higher vitamin intake, only whole grains, no added sugar. That's my general diet guidelines. I try to avoid anything out of a box (I love those whole wheat Triscuits, though!). I dropped the weight in only two months, and this was without even exercising. I stopped regularly exercising around when this started back in January or February, but I do go on walks a lot to help.
So, throughout my journey of weight loss and health checks, this is one thing that has stubbornly remained. The only variable that I don't know about is my electrolyte level. I've been taking the proton pump inhibitor(omeprazole) for a long number of years and I know those can drain your magnesium reserve. I started taking some magnesium citrate and noticed that it stopped for a couple days, so I figured this was the issue. Unfortunately, after several days it came right back despite me continuing to take the supplement.
Is there anyone out there who has experienced something similar or anyone who may hold clues or insight into what may be happening, PLEASE share it with me. I don't know if this is something I should really be concerned about but I think it may be. I apologize if this felt convoluted or was hard to follow, I worded it as best I could.
TL;DR: My heart has an elevated pulse accompanied by severe palpitations in the evening like clockwork for almost a year and no tests I've had done show why. It's remained despite several major changes in my health and weight. It may be electrolyte imbalance but personal evidence suggest that there may be something else to do with it. PLEASE HELP.
Best Answer
That peak plasma suggestion turned out to be right. I haven't taken the Nuvigil for two days and I haven't had any of my usual anxiety of palpitations.
I've been dealing with this garbage since February. It's so stupid, I've been taking this med since around 2008 without issue. Suddenly it pops up...I guess the atenolol was keeping it in check....
I've been dealing with this garbage since February. It's so stupid, I've been taking this med since around 2008 without issue. Suddenly it pops up...I guess the atenolol was keeping it in check....
Sooooo, I figured out what my problem is.
This whole time. This whole. Freaking. Time.
This whole time it was the nuvigil I've been taking. Apparently what I've been experiencing is a severe side effect. So, I can't function very well without it because I get so sleepy I can't think right. Don't know what I'm gonna do, but I'd rather deal with the head fatigue instead of the body fatigue every night. Overall pulse has been slightly lower since I haven't taken it in two days.
This whole time. This whole. Freaking. Time.
This whole time it was the nuvigil I've been taking. Apparently what I've been experiencing is a severe side effect. So, I can't function very well without it because I get so sleepy I can't think right. Don't know what I'm gonna do, but I'd rather deal with the head fatigue instead of the body fatigue every night. Overall pulse has been slightly lower since I haven't taken it in two days.
Sleep tips, aids:
- sleep mask (to keep even low light levels from impacting you during sleep, as those will prevent deep sleep); cheapo approach: safety pin a couple of dark socks together so they can wrap around your head to cover your eyes.
- wax earplugs, great sound blockers (maybe try cheapo foam plastic ones to see if the concept helps)
- sunglasses, wear a couple of hours before bedtime; if they seem to help, get some yellow only sunglasses for much better effect. Either block blue light (from PCs, TVs, cellphone, CFLs, fluorescents, street lights), no worries about incandescents and no sunglasses. Blue light component blocks melatonin production (our sleep hormone).
- consider investing in a Dawn Simulator, a gadget that allows an incandescent light fixture to gradually brighten to full intensity approaching wakeup time (reducing likelihood that your REM sleep is shattered by an audio alarm going off around that time)
- sleep mask (to keep even low light levels from impacting you during sleep, as those will prevent deep sleep); cheapo approach: safety pin a couple of dark socks together so they can wrap around your head to cover your eyes.
- wax earplugs, great sound blockers (maybe try cheapo foam plastic ones to see if the concept helps)
- sunglasses, wear a couple of hours before bedtime; if they seem to help, get some yellow only sunglasses for much better effect. Either block blue light (from PCs, TVs, cellphone, CFLs, fluorescents, street lights), no worries about incandescents and no sunglasses. Blue light component blocks melatonin production (our sleep hormone).
- consider investing in a Dawn Simulator, a gadget that allows an incandescent light fixture to gradually brighten to full intensity approaching wakeup time (reducing likelihood that your REM sleep is shattered by an audio alarm going off around that time)
Indeed.
I'm always wake up tired and often find it difficult to get myself going because I'm so tired. I take Nuvigil for it but it only helps a little. I've cut back from 250mg to 75mg due to extreme anxiety. That happened when I dropped the atenolol dosage for the first time. I guess the atenolol was keeping the anxiety in check.
The peak plasma levels thing is my first real lead on this problem. I'll definitely look into it. I may stop my nuvigil for a couple days to see how that affects me. Now that I have your suggestion about peak plasma times, it may be time to test that out. The side effects list a pounding heartbeat as a serious side effect, so we'll see.
Any additional input would be welcomed with open arms.
I'm always wake up tired and often find it difficult to get myself going because I'm so tired. I take Nuvigil for it but it only helps a little. I've cut back from 250mg to 75mg due to extreme anxiety. That happened when I dropped the atenolol dosage for the first time. I guess the atenolol was keeping the anxiety in check.
The peak plasma levels thing is my first real lead on this problem. I'll definitely look into it. I may stop my nuvigil for a couple days to see how that affects me. Now that I have your suggestion about peak plasma times, it may be time to test that out. The side effects list a pounding heartbeat as a serious side effect, so we'll see.
Any additional input would be welcomed with open arms.
I've done a number of experiments with this and what I eat to see if eating, say, a light tuna wrap instead of a bowl of chili would affect it.
It does not. I suspected maybe eating higher sodium meals would affect it, but I've proven this isn't the case. I've even waited to eat (until after the episode subsides) and still it remains unchanged.
As far as the beta blocker is concerned, I was originally on it for 25mg twice a day until back in February where I cut it in half to 12.5mg. Strangely enough, that is around the time it started. However, even after I "settled" into the lower dosage, it remained for 7 months almost every night. Recently I cut it again to 6.25mg and it stays the same. I'm not so sure that this the problem. Perhaps it masked it when I was still at a full dosage. I've talked to several doctor's and they say they doubt it is related to the atenolol after I specifically expressed concern over it. I originally thought it was because the half life was being used up around that time and that once I took it again it would subside (this was just coincidence).
I still think that it could totally be electrolyte issues, but I have no way of knowing unless I go get a blood test. Even, then, why is it happening around the same time every day? Do electrolytes dip during the early evening or something?
I'm just sick of it happening, I want my life back. It affects my ability to exercise, too, as when I do cardio in the early afternoon, my heart rate seems really sensitive for the rest of the day including through the episodes.
It does not. I suspected maybe eating higher sodium meals would affect it, but I've proven this isn't the case. I've even waited to eat (until after the episode subsides) and still it remains unchanged.
As far as the beta blocker is concerned, I was originally on it for 25mg twice a day until back in February where I cut it in half to 12.5mg. Strangely enough, that is around the time it started. However, even after I "settled" into the lower dosage, it remained for 7 months almost every night. Recently I cut it again to 6.25mg and it stays the same. I'm not so sure that this the problem. Perhaps it masked it when I was still at a full dosage. I've talked to several doctor's and they say they doubt it is related to the atenolol after I specifically expressed concern over it. I originally thought it was because the half life was being used up around that time and that once I took it again it would subside (this was just coincidence).
I still think that it could totally be electrolyte issues, but I have no way of knowing unless I go get a blood test. Even, then, why is it happening around the same time every day? Do electrolytes dip during the early evening or something?
I'm just sick of it happening, I want my life back. It affects my ability to exercise, too, as when I do cardio in the early afternoon, my heart rate seems really sensitive for the rest of the day including through the episodes.
P.s, it could take a while to rebuild your mag levels. Up to 6 months. You also should research this more, as you should be balancing this with other electrolytes as you supplement,in particular calcium.
we all have something called the autonomic nervous system. The ANS sends signals to the heart over nerve bundles called the sympathetic and parasympathetic nerves. These speed up, slow down, and control contraction force. When it doesn't work right it's called dysautonomia. It could be so me degree of this.
It's very normal for resting heart rate to vary throughout the day. The time you are specifying is right around dinner. Eating, especially large meals, will increase heart rate and contraction force to get blood to your gut for digestion.
Weaning off the beta blocker is probably causing a rebound effect too. This means that what it was blocking before (adrenaline) will now have a more pronounced effect than before you went on the med. this is temporary.
omeprazole will reduce your absorption of electrolytes, especially magnesium. That could be playing a role.
Being deconditioned wil also play a role. I had to recently stop running due to a knee injury and I can feel myself falling out of shape and it's awful. My palps have kicked up and my resting rate is higher. When I was running my resting rates still valiied throughout day. Ranging from high 40s to low 70s. Higher rates are in the evening especially after dinner. M
So you have a bunch of lifestyle / risk factors you could attack the problem with.
It's very normal for resting heart rate to vary throughout the day. The time you are specifying is right around dinner. Eating, especially large meals, will increase heart rate and contraction force to get blood to your gut for digestion.
Weaning off the beta blocker is probably causing a rebound effect too. This means that what it was blocking before (adrenaline) will now have a more pronounced effect than before you went on the med. this is temporary.
omeprazole will reduce your absorption of electrolytes, especially magnesium. That could be playing a role.
Being deconditioned wil also play a role. I had to recently stop running due to a knee injury and I can feel myself falling out of shape and it's awful. My palps have kicked up and my resting rate is higher. When I was running my resting rates still valiied throughout day. Ranging from high 40s to low 70s. Higher rates are in the evening especially after dinner. M
So you have a bunch of lifestyle / risk factors you could attack the problem with.
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Timing of symptoms likely relates to the plasma concentrations of your various meds (rxlist.com is a good site for giving great detail on the pharmacology of meds, such as when the active ingredient reaches peak blood plasma level).
How soundly do you sleep? Do you wake up thoroughly refreshed? (your narcolepsy suggests to me you've a sleep problem that's deeply impacting you)