Resting Heart Rate

[Eva]

Since January my heart rate has been fluctuating! Early January it was 125-130 with no other symptoms.
I was prescribed 400 mg Amiodarone. It went down to the 80s mid March. But due to its side effects, cardio asked me to drop Amiodarone from 400mg to 200 mg. After ten days, my pulse went up back to 100-125 at rest!
My Toprol was increased to 50 mg twice a day. No effect. Then back on Amiodarone 400 mg, and Toprol 75 mg twice. Pulse went down to 80s yet I was getting very short of breath and there was fluid in my lungs. Cardiologist stopped Amiodarone completely ten days ago, elevated Toprol to 100 mg twice a day. My pulse is in high 90 again and over 100 for 5 minutes twice a day while resting.
I’m very frustrated! confused, unsure what to do. I understand after my surgery in 2008, my pulse was for many months in high 90s, but it was recovering from the surgery!
Now, no one is explaining to me the reason for this elevation.
I asked my GP to check my my hsCRP… its 10.10 (high risk). I am afraid he might say it’s due to age! I always had high results and cardio wasn’t bothered with it. But never 10.10.
Could something be wrong with one of my valves? Will they tell me/reveal the truth?
I asked cardio for echocardiogram to be done by experienced technicians as I am wondering if there could be anything wrong with my valves. My cardiologist is good and caring, keeps assuring me the pulse will go down. But when??? Thinking of sending my reports to Cleveland clinic! But have to switch my insurance from HMO to PPO (if possible at this time).
Thanks for reading and thinking with me.

 

[pellicle]

Hey Eva, that sounds frustrating

Are you meaning metoprolol?

Sorry I can't offer any suggestions except to recommend more electro physiology studies of the heart (ECG).

Have you perchance had exposure to COVID?

Best Wishes

 

[Critter]

Agree with Pellicle you should go see an electrophysiologist. Get your electrical pathways mapped out and potentially have an ablation of the accessory pathway if this is the issue. Amiodarone as you know is not a great long term Med to take.

 

[Eva]

I was told ablation is recommended for patients who, in addition to high pulse, have fibrillation, high blood pressure, feel extremely tired, and severely out of breath. And
Secondly, ablation might be tricky in my situation! My left atrium is severely enlarged and my heart size is at its biggest size! So honestly, I’m scared! My guts say No.

 

[Critter]

It’s easy to control the extremely slow rhythms you can just put a pacemaker in. Not so much the fast rhythms without taking meds to try and slow down rhythms especially if one has an aberrant pacemaker and having side effects from meds. My brother had this done and he is in normal sinus rhythm with very few ectopic beats and he feels great, ymmv.

 

[Eva]

…
Have you perchance had exposure to COVID?

Best Wishes

I suspected it, but I did not have the symptoms! Always used masks all The time. I only went for knee physical therapy just before Christmas and my pulse started reacting end of December. I went twice to walk-in clinics, both doctors thought of COVID. But didn’t confirm it. So, Who knows!

 

[pellicle]

Good Morning ...

this may seem stupid, but when I've in the past had issues with irregular heart rates I have been suggested to try (and it worked):

• potassium supplements (which I took as powder mixed in with tomato juice to cover its taste)
• magnesium supplements (capsule, chelated type)

I also found (for myself) that changing which side I lay on when sleeping made a difference

I recently had an elevated liver function appear and go away again within 2 weeks which I can't explain except from an acute (single instance) stomach illness 2 days before a test. My GGt and ALT both elevated to over 5 times what my previous history was (and out of bounds for a warning flag) but resumed to normal within 2 weeks.

This coincided with a returned case of arrhythmias which I was investigating (note the non-passive I in there, not they ...). Working with my GP (which is a clinic and I may or may not see the same doctor) I take an active part in directing what we investigate (naturally in consultation with them)

I would make it a priority to engage on this with a cardiologist as soon as possible (I'm concerned that its already persisted since December)

I was told ablation is recommended for patients who, in addition to high pulse, have fibrillation, high blood pressure, feel extremely tired, and severely out of breath

I would take an ablation as a last course and pursue a wider diversity of pharmaceutical treatments before going that path. I don't like the present state of that 'art' nor the results (spread of good vs bad outcomes).

Secondly, ablation might be tricky in my situation! My left atrium is severely enlarged and my heart size is at its biggest size!

I would agree, and how long has your left atrium been in the "severely enlarged" cateogory?

I hope you get some good results soon.

My Toprol was increased to 50 mg twice a day.

so that's a higher dose, but not ludicrous ... but if a whole tablet twice a day is having no effect then I'd suggest that its not treating the cause ... BTW ... metoprolol right?

 

[Eva]

Good Morning ...Thanks, Pellicle my responses are in red!

this may seem stupid, but when I've in the past had issues with irregular heart rates I have been suggested to try (and it worked):

• potassium supplements (which I took as powder mixed in with tomato juice to cover its taste). Eating a banana a day
• magnesium supplements (capsule, chelated type). I am taking magnesium chelated since you suggested it last time!

I also found (for myself) that changing which side I lay on when sleeping made a difference. I try but mostly need to sleep on left side

I recently had an elevated liver function appear and go away again within 2 weeks which I can't explain except from an acute (single instance) stomach illness 2 days before a test. My GGt and ALT both elevated to over 5 times what my previous history was (and out of bounds for a warning flag) but resumed to normal within 2 weeks.

This coincided with a returned case of arrhythmias which I was investigating (note the non-passive I in there, not they ...). Working with my GP (which is a clinic and I may or may not see the same doctor) I take an active part in directing what we investigate (naturally in consultation with them). This is what I am exactly doing! I had to ask for CRP test, TSH, SED RATE! Three doctors I saw suspected Covid … told me an infection may cause heart pulse elevation! But didn’t specify nor followed up! Then I had a chest CT scan showed:
"Right lower lobe tree-in bud nodularity suggesting infectious or inflammatory small airway disease".
Pulmonologist response was "looks like nothing to worry about, just a little inflammation…and Antibiotics may hurt more that it may help”!!!

I would take an ablation as a last course and pursue a wider diversity of pharmaceutical treatments before going that path. I don't like the present state of that 'art' nor the results (spread of good vs bad outcomes). My exact opinion, especially if a fresh student practice on me!

I would agree, and how long has your left atrium been in the "severely enlarged" category? Three years or more, can’t remember with all this stress.

I hope you get some good results soon. Thank you very much.

so that's a higher dose, but not ludicrous ... but if a whole tablet twice a day is having no effect then I'd suggest that its not treating the cause ... BTW ... metoprolol right? Yes, Toprol is brand name for Metoprolol.
I’m suspecting something is wrong with one of my mechanical valves, mainly Aortic… wondering if it's possible to have or starting some minimal vegetation !!

 

[pellicle]

Hi

stuff which makes reply hard

my responses are in red!

Eating a banana a day

not really sufficient a banana:
Potassium (mg) 422 daily requirement: 4,700

I am taking magnesium chelated since you suggested it last time!

ok ... I have a patchy experience with it ... but when I do get serious with it its 2 capsules per meal (always with food).

I try but mostly need to sleep on left side

ok ... and if you move to RHS does it make any effect on HR? Even laying on the couch during the day?

again, just something which has worked for me, may not for you

This is what I am exactly doing! I had to ask for CRP test, TSH, SED RATE!

given that CRP is an indicator of infection I'm sort of curious whey the added, that but this seems to rule out your thyroid.

Three doctors I saw suspected Covid … told me an infection may cause heart pulse elevation!

well, only if you had a concomitant bacterial infection ...

But didn’t specify nor followed up!

grasping at straws, but no harm done ... thanks for reporting it.

Then I had a chest CT scan showed:
"Right lower lobe tree-in bud nodularity suggesting infectious or inflammatory small airway disease".
Pulmonologist response was "looks like nothing to worry about, just a little inflammation…and Antibiotics may hurt more that it may help”!!!

ok ... I'm no Dr so can't meaningfully comment there

My exact opinion, especially if a fresh student practice on me!

good to hear

Three years or more, can’t remember with all this stress.

ok, so the elevated HR may indeed by a complication of that (rather than as I was wondering, it be a result of your HR being elevated).

I think you need to really engage with a cardio, or move to a new one if not getting results

Yes, Toprol is brand name for Metoprolol.

ok, I googled it, apparently its Metoprolol succinate. This is the slow release version and I would wonder if you've had metoprolol tartrate ... it may be worth a try.

I’m suspecting something is wrong with one of my mechanical valves, mainly Aortic… wondering if it's possible to have or starting some minimal vegetation !!

I'm not sure what would be wrong with one of the valves, it could really only be an obstruction which would be apparent in an echo (or anyone with a brain and experience using a stethoscope). If you had any vegetation I would assume it would be evident in a CRP being elevated, if you were under 10 then that's really unlikely.

All this banging around would have broken anything off like that already and you'd have had a TIA or something.

What is your plan with respect to seeing a cardiologist as an urgent matter?

 

[Eva]

Hi
not really sufficient a banana:
Potassium (mg) 422 daily requirement: 4,700 even though my potassium level is ok!

ok ... I have a patchy experience with it ... but when I do get serious with it its 2 capsules per meal (always with food). I’ll try it. Tanks.

ok ... and if you move to RHS does it make any effect on HR? Even laying on the couch during the day? Maybe! As when I sleep on my left side, I feel the whole bed moving with the beats

…

given that CRP is an indicator of infection I'm sort of curious whey the added, that but this seems to rule out your thyroid. Thyroid was ruled out in January!

well, only if you had a concomitant bacterial infection ...
grasping at straws, but no harm done ... thanks for reporting it.
ok ... I'm no Dr so can't meaningfully comment there

good to hear
ok, so the elevated HR may indeed by a complication of that (rather than as I was wondering, it be a result of your HR being elevated).

I think you need to really engage with a cardio, or move to a new one if not getting results planning on it… tired of his assurances that my pulse WILL GO DOWN!


ok, I googled it, apparently its Metoprolol succinate. This is the slow release version and I would wonder if you've had metoprolol tartrate ... it may be worth a try. I’m taking metoprolol ER (extended release) Succinate.

I'm not sure what would be wrong with one of the valves, it could really only be an obstruction which would be apparent in an echo (or anyone with a brain and experience using a stethoscope). If you had any vegetation I would assume it would be evident in a CRP being elevated, if you were under 10 then that's really unlikely. hsCRP is over 10. It’s 10.10.

All this banging around would have broken anything off like that already and you'd have had a TIA or something.

What is your plan with respect to seeing a cardiologist as an urgent matter? I’m planning to call Electrophysiologist for his opinion, but not for ablation!

 

[pellicle]

10.10

isn't really an issue, depending on your age its considered background. I was >300 when I went in with my infection, remember its a marker for inflammation not specifically infection (which does trigger inflammation responses)

https://pathologytestsexplained.org.au/learning/test-index/crp
C-reactive protein (CRP) is a protein made by the liver and secreted into the blood. It is often the first evidence of inflammation or an infection in the body. Its concentration increases in the blood within a few hours after the start of infection or other inflammatory injury. The level of CRP can increase many hundred-fold in response to inflammation and then drop relatively quickly as soon as the inflammation passes, making it a valuable test to monitor effectiveness of treatment.

 

[Deepak khanka]

I was told ablation is recommended for patients who, in addition to high pulse, have fibrillation, high blood pressure, feel extremely tired, and severely out of breath. And
Secondly, ablation might be tricky in my situation! My left atrium is severely enlarged and my heart size is at its biggest size! So honestly, I’m scared! My guts say No.

Hi Eva, what is the reason for your LV to be severely dilated. My LV was severely dilated post my first surgery. My native BVA had prolapsed. This result in severe regur.

I was told ablation is recommended for patients who, in addition to high pulse, have fibrillation, high blood pressure, feel extremely tired, and severely out of breath. And
Secondly, ablation might be tricky in my situation! My left atrium is severely enlarged and my heart size is at its biggest size! So honestly, I’m scared! My guts say No.

Hi Eva, I think you need to further investigate the reason for your dilated LV. Echo would be a good start followed by a CT scan. Please raise this question with your cardiologist.Sorry! which valve do you have?

 

[Eva]

isn't really an issue, depending on your age its considered background. I was >300 when I went in with my infection, ?

https://pathologytestsexplained.org.au/learning/test-index/crp
C-reactive protein (CRP) is a protein made by the liver and secreted into the blood. It is often the first evidence of inflammation or an infection in the body. Its concentration increases in the blood within a few hours after the start of infection or other inflammatory injury. The level of CRP can increase many hundred-fold in response to inflammation and then drop relatively quickly as soon as the inflammation passes, making it a valuable test to monitor effectiveness of treatment.

Thanks again, Pellicle.
was yours CRP or hsCRP? Mine is hsCRP! My doctor normally comments two days after I automatically receive the test results. Maybe he still thinks it’s age!!
Mayo Clinic: C-reactive protein test - Mayo Clinic

Quote:
CRP is measured in milligrams per liter (mg/L). Results for a standard CRP test are usually given as follows:

• Normal: Less than 10 mg/L
• High: Equal to or greater than 10 mg/L

Note: Abnormal range values may vary depending on the laboratory doing the test. A high CRP test result is a sign of acute inflammation. It may be due to serious infection, injury or chronic disease. Your doctor will recommend other tests to determine the cause.

Results for an hs-CRP test are usually given as follows:

• Lower risk of heart disease: hs-CRP level less than 2.0 mg/L
• Higher risk of heart disease: hs-CRP level equal to or greater than 2.0 mg/L. Unquote

 

[vitdoc]

You basically have a high resting heart rate. Like most things in medicine the process should start with diagnosis. So the rate should be characterized primarily by EKG results. Do you have an unusual high sinus rhythm? Probably unlikely at that rate without a reason. Do you have A.Fib? Or some other abnormal rhythm?
Once the rhythm is properly understood then various treatment options would be considered.
So has anyone mentioned the type of rhythm to you? If not ask. If there is a inadequate response then get another opinion from someone versed in rhythm disorders probably an electrophysiologist.
Also CRP, C reactive protein is a very non specific marker of inflammation. It will go up for a myriad of reasons such as surgery, infection, rheumatic diseases etc..
So it really has in general little to do with your heart rate and probably would be very low on my list of blood tests.
So again the number one thing in medicine should be diagnosis then treatment. So get a diagnosis.

 

[mecretired]

I had a rapid heart rate for 20+ yrs. I took verapamil which lowered pulse to 90’s and metoprolol which didn’t do much. Sometime after my ohs (1 or 2 yrs) my cardiologist put me on Bystolic. My pulse dropped to normal like magic. Not recommending for you—but it’s a thought. I have also noted changes in pulse depending on whether I’m laying on my left side or right side (left side pulse is much better)

 

[Eva]

Hi Eva, what is the reason for your LV to be severely dilated. My LV was severely dilated post my first surgery. My native BVA had prolapsed. This result in severe regur.

Hi Eva, I think you need to further investigate the reason for your dilated LV. Echo would be a good start followed by a CT scan. Please raise this question with your cardiologist.Sorry! which valve do you have?

Thanks for responding. My LV is ok; and like yours, it recovered after my surgery in 2008.
It’s my Left Atrium (LA) that is severely enlarged which was revealed after an echocardiogram.
I have St. Jude’s aortic and mitral valves.
An maybe I should investigate the reason for LA enlargement! Thank you.

 

[Eva]

You basically have a high resting heart rate. Like most things in medicine the process should start with diagnosis.

When same exact thing happened in 2019, I checked myself into emergency @ 11 pm. Stayed four nights in hospital and left with diagnosis of “unspecified flutter”!!
This time, I kept asking, the response… "an infection can cause this", but where is the infection? No response! But the “After visit”/“clinical notes” say “unspecified flutter!

So the rate should be characterized primarily by EKG results. Do you have an unusual high sinus rhythm? Probably unlikely at that rate without a reason. Do you have A.Fib? Or some other abnormal rhythm?

EKG was done at my cardiologist’s office! But no remarks or recommendation other than starting me on Amiodarone!

Once the rhythm is properly understood then various treatment options would be considered.
So has anyone mentioned the type of rhythm to you? If not ask. If there is a inadequate response then get another opinion from someone versed in rhythm disorders probably an electrophysiologist.

This is what I’m planning as my patience is running out!

Also CRP, C reactive protein is a very non specific marker of inflammation. It will go up for a myriad of reasons such as surgery, infection, rheumatic diseases etc..
So it really has in general little to do with your heart rate and probably would be very low on my list of blood tests.
So again the number one thing in medicine should be diagnosis then treatment. So get a diagnosis.

I will push hard for a diagnosis or I’ll fire all my doctors!
Thanks again.

 

[Eva]

I had a rapid heart rate for 20+ yrs. I took verapamil which lowered pulse to 90’s and metoprolol which didn’t do much. Sometime after my ohs (1 or 2 yrs) my cardiologist put me on Bystolic. My pulse dropped to normal like magic. Not recommending for you—but it’s a thought. I have also noted changes in pulse depending on whether I’m laying on my left side or right side (left side pulse is much better)

Mercetired, thank you for sharing your experience. I’ll ask my cardio about those medicines.

 

[Critter]

Eva you have had 2 physicians here tell you to go see an electrophysiologist cardiotron. You need an event monitor put on to document the rhythm in order to figure out where it’s (aberrant pacemaker) coming from in the heart. I suspect it is probably in that enlarged LA. Like vitdoc said you have to know the cause in order to treat this adequately.

 

[pellicle]

Thanks again, Pellicle.
was yours CRP or hsCRP? Mine is hsCRP! My doctor normally comments two days after I automatically receive the test results. Maybe he still thinks it’s age!!

I've literally never heard of hsCRP and I suspect its just exactly what it says 'high sensitivity' - which would mean that you can rely on the numbers with a higher degree of confidence.
As CRP can also be done on fingerstick I would assume in Australia that anything done with venous draw blood would be high sensitivity, but I'll ask around.

Bottom line however is that its for what its for ... and is not a test that I can see relevance to your situation other than to confirm or disregard any possibility of vegetation on your valves.

I would still suggest more studies of both electrocardiology (looking at the waves tells you things) and echo (to confirm that the valve operation is not being impaired).

I would classify this as life endangering. The thing now is to press for actions.

Lastly I'm not sure if you picked the difference in metorprolols that I mentioned, succinate vs tartrate, I think its significant enough that you should try the tartrate.