Heart rate 210bpm for 12 minutes - diagnosis anxiety?

[Lozcdoz]

Hi all, horrid day yesterday, normal morning, pushed me toddler around his pushschair for the school run, decided to take a slightly longer route home. All fine, bit out of breath as he’s heavy and its very hilly where we are. Got home, unlocked the door and bent down to pick something off the floor and my heart rate rocketed to 210bpm. (Recorded on Apple watch) Was naturally very worried as was on my own with toddler and felt like I was going to pass out. Any way, my neighbour took me to A&E, had 2 ecgs and 2 lots of bloods to watch for troponin levels. These were high to start but then came down slowly along with my HR. I was discharged after several hours diagnosis anxiety. I was really surprised by the diagnosis, now referred back to my GP for 24 hr monitor and poss going on betablockers. I should be elated that it wasn't seen as anything more serious but I cant help feeling like an idiot and maybe a but fobbed off as it was nothing? FWIW, I have had panic attacks in the past, but years ago and have been seen for missed beats and heart palpitations before when I had my son but for the last few years have been absolutely fine with these. Just gutted, feel like I’ve taken 10 steps backwards. I’m 39, female, would say the last few months have been a little stressful but not majorly. Advice and personal experiences welcomed! Thank you!

[Hidden]

That sounds like an awful experience, hopefully you are feeling improved now. I don't think I would be particularly happy with a diagnosis of anxiety. I'm not at all certain that raised troponin levels are a symptom of anxiety. A little bit more information on troponin and the likely causes of raised levels can be found here:

medicalnewstoday.com/articl...

I think in your situation, I'd make an appointment with your GP to discuss things further, maybe take a copy of the above article.

[Lozcdoz in reply to Hidden]

Thank you so much!

[jeanjeannie50]

I think that at times we forget to breathe deeply enough. So you pushing a push chair up a hill, yes you'd have been out of breath and your heart rate would be high because of that. Then you bending down to pick up something off the floor (often when we do that we hold our breath). I think your heart was just protesting and asking for oxygen.

Over 17 years I've had lots of abnormal heart rhythms and this is what I've discovered.

Next time you walk up that hill do it a little slower and stop for a few minutes to catch your breath and deep breathe to give your heart the oxygen it needs. When I do that I pretend to be looking as something. Incidentally, I live in a very hilly area too. In fact to avoid a very steep hill I now walk home by a longer and more scenic route. The very steep hill often leaves me totally shattered for the rest of the day if I'm carrying shopping.

I'm not medically trained, but I have a lot of experience because of my own heart.

Let us know how you get on please.

Jean

[Lozcdoz in reply to jeanjeannie50]

Thank you Jean! This does make a lot of sense I think I have a deviates septum as I struggle to breath through my nose and I’m a terrible mouth breather. This is something else I can raise with my gp. Thank you so much.

[jeanjeannie50 in reply to Lozcdoz]

I once worked for a very large company and I remember two people that I knew needing an op on their nose because of difficulty breathing. It would be a good idea to bring this up with your GP. I can remember one saying how wonderful it was to breathe normally again.

Jean

[Hidden]

With the caveat I’m not medically qualified.

I would not take a diagnosis of anxiety, particularly with the situation as you described and a history of ‘missed beats’, and also because that would be an unusually high heart rate to be caused by anxiety. It can cause tachycardia, for sure, but not usually that high or sustained.

The missed beats you mention are actually early beats rather than missed, and commonly known as ectopics, but more correctly either premature atrial contractions (PACs) or premature ventricular contractions (PVCs) depending on where in the heart they originate from. They’re extremely common and unless occurring as 10% of your daily beats, or in runs of PVCs without any normal beats in between, are benign for the vast majority of people in their own right. However, they are also the trigger for the condition I have, which is supraventricular tachycardia or SVT. SVT is an unpleasant but relatively mild, non life-threatening form of arrhythmia where an ectopic beat causes the heart rate to suddenly increase and it gets ‘stuck’ there, often at rates above 180bpm. The episodes can be short and self-limiting, but some people need intervention from A&E to get the heart back down to normal rate. The reason I’m specifically mentioning this to you is that although not fully understood, there are some things medically known to be able to trigger ectopics, and one of them is bending forward if someone is prone to positional ones. I can very reliably give myself a PVC by bending down exactly in the way you describe. End result being I don’t generally do it these days.

The good news is that if it was SVT, it’s unpleasant rather than dangerous, and the first line treatment is beta blockers. The idea is to reduce the frequency of ectopics (which will show on a holter monitor) and lower the heart rate slightly to prevent future episodes. Some people (myself included) also find there are lifestyle factors that increase the ectopics we experience. I was having several hundred a day at the time of my first SVT episode in 2009, and as a result of medication and making (medically proven) changes to my lifestyle and what I eat, I’m down to around a dozen a day. I notice every one, but I haven’t had a single episode of SVT in the last 7 years since deciding to try excluding a variety of things and making sure I get enough sleep, where I’d been having two or three episodes a month, sometimes a week for the years before. These changes don’t work for everyone, but if you look at my profile, you should be able to see my recent replies about ectopics and things science has proven can be useful in reducing/managing them. Stress and anxiety are both potential factors, along with insufficient sleep.

In any event, I think you absolutely need to speak to your GP and push a bit to make sure you get a diagnosis if one is required. The sad reality is that - even as a man - past mental health history can bias medics towards incorrect diagnosis. As a woman, I’m aware from family members that mental health issues can cause even more difficulty in getting appropriate diagnoses even if years past.

[Lozcdoz in reply to Hidden]

Thank you so much Charlie_G! Your response is just what I was hoping for. I will raise this with my Gp telephone call tomorrow. I am 100% convinced that bending over triggered the high hr yesterday and I will push this with the medical professionals. Cannot thank you enough for your insight and you have made me feel more confident about trying betablockers.

[Hidden in reply to Lozcdoz]

Like I said, I’m not medically qualified in the slightest, but the events in combination and the fact that it was sustained do suggest to me that it was potentially an arrhythmia rather than anxiety. I have firsthand experience of quite serious things being inappropriately pinned on past mental health, but add that to being female and having palpitations? I’ve seen a lot of posts here from ladies over the years where they were fobbed off on the basis of their gender, never mind anything else. Also, just for additional information to go armed to the GP with, I’ve checked just now, and SVT episodes can and do cause elevated troponin. One study suggests troponin is elevated in up to 48% of all episodes. So that would also fit with the episode being SVT.

Anyway, hope your GP has their head on straight and you get some joy. If it does turn out to be SVT, other than looking into the lifestyle factors to minimise ectopics, one other piece of advice is to know when to get help for any future episodes. The rule as stated by the NHS is if it hasn’t stopped within 30 minutes, or an episode of any duration where you feel otherwise unwell with it and/or have chest pain, get yourself to A&E. If you haven’t got someone that can take you, or you feel unwell, call an ambulance. I wasn’t given this information for years and sat through bouts lasting several hours as a result, leaving me exhausted and weak for weeks afterwards. There are also some tactics you can try at home to bring an episode to an end, but like the lifestyle changes and ectopics, unfortunately these don’t work for everyone.

Good luck, and let us know how you get on if you want to or have any questions.

[Lozcdoz in reply to Hidden]

Thank you so much. I have lots of questions ready for tomorrow. That was the other thing from A&E, they basically said it was anxiety and off you go, no info of what to do should it happen again.