I know I rant about this topic often but it really does make me mad when I am told by medics that a fast heart rate isn't a feature of an asthma attack. I'm sure all of us in the community know that it is and sadly have experienced it (all my attacks have started with a high heart rate). I hunted out the following info from BTS, AUK and the info from the actual NHS webpage (all reputable sources) I've printed it out to show to my GP next time I'm there (hopefully it's not after an attack!). If any one wants to do like wise I've included the links below
Thanks Junglechicken for hunting these down and posting them! It still annoys me that this isn't just part of general knowledge about asthma for those who ought to know, as it really isn't an obscure sign at all (I can forgive them not knowing the more obscure stuff like the finer points of asthma subtypes, but if you work in A&E you would think the HR sign should be well known - especially as they seem able to remember that nebs can do it).
Hopefully these may help next time someone encounters this. For those who often encounter the other big 'asthma myth' ie 'asthma needs a wheeze', p4 and others of the BTS quick reference guideline state that you just need 'more than one of cough, wheeze, shortness of breath, tight chest'. The text on this page in general may be useful if encountering anyone who thinks that diagnosing asthma consists of looking for one thing and saying you can't have asthma if you don't have it:
Central to all definitions is the presence of symptoms (more than one of wheeze, breathlessness, chest tightness, cough) and of variable airflow obstruction.
• There is no single diagnostic test for asthma
• Diagnosis is based on clinical assessment supported by objective tests that seek to demonstrate variable airflow obstruction or the presence of airway inflammation
• Both the clinical assessment of symptoms and signs, and objective tests have significant false positive and false negative rates
• Tests influence the probability of asthma but do not prove a diagnosis
• Asthma status and the outcome of diagnostic tests for asthma vary over time
Just really frightens me that if I have an attack in the future that I can’t control at home, I go to A and E they won’t treat me as my stats are usually good. My GP couldn’t understand why my heart rate was so high when I am wheezing. Of course it’s salbutamol even though I’ve had none, oh it’s a panic attack then as your stats are fine.
If it helps, I also have the high heart rate good sats no wheeze pattern and most of the time A&E do actually treat me ok despite that and are mostly able to grasp it's not all wheeze and sats.
I mean there are certainly exceptions I have ranted about and there are some things which do get on my nerves (such as the whole failure to understand HR can be asthma-related, and the wheeze thing), but generally I find they can manage to treat the patient in front of them.
I have way more trouble with consultants because they don't see me when I'm bad and they often seem less accepting of more unusual clinical presentations. I feel like A&E doctors are on the whole more able to get that someone looks ill/is ill even if it isn't textbook. I'll admit I still get nervous going in case this is the time they're not, but the last two times I have had drs who made me wince with the stuff they came out with, really did NOT seem to understand asthma very well, but still managed to treat me with the correct cocktail of drugs.
Thanks Lysistrata, it is good to know that your presentation is similar to mine although I will have a wheeze on both the in and out breath. However it seems to be that it’s only in the worse attacks that it can be heard by others. Funny story actually. I was struggling with a wheeze and said to dad “listen” the wheeze was very obvious to my mum but dad said “sounds fine to me” what? Yes, it’s perfectly fine to sound like an old bellows! 😂
You’re so right about all of the above. You know you’re in a bizarre quandary when you have one of the most common diseases on the planet, are in the middle of a bad attack, and having to explain to a doctor or nurse that it’s common to not to wheeze even with severe persistent asthma...
My heart rate goes way up and stays up both when I’m in a bad attack and recovering from a flare.
I’m sorry to hear your and e focuses on oxygen levels. Our bodies have multiple ways to support oxygenation. Oxygen is the last thing to drop and by the time it does, one is in dire circumstances.
I would add, paramedics can’t make sure hose distinctions. They have tried to tell me I had anxiety (I don’t, ever). But when they called to the hospital, they only repeated observable symptoms, not their diagnosis. Ti was always admitted, twice to intensive care. It wasn’t anxiety!
I have SVT (supraventricular tachycardia), ie a well-known form of heart arrhythmia; *and* asthma. Have never had the two simultaneously, which isn't to say it can't happen - everyone's different! something some in the medical profession seem hard to accept - perhaps at least partly because the fewer "tickbox" diagnoses there are, the more time-consuming and expensive things become!
I tend to get Tachycardia with an asthma attack. A year ago I had the flu and ended up in hospital. It was my high heart rate that they picked up mostly on. They kept doing ECG's and the cardiologist finally said, her heart is fine! But the last time I was in hospital, they took me off the bisoprolol that was given me for the heart rate and then wondered why my heart rate was creeping up again! I still don't know at what rate to worry because the GP says it's just due to the asthma medication. I keep track but my heart rate has settled somewhat after the bad episode related to the flu.
I’ve been checked out by numerous doctors, had ECGs done and have found nothing unusual cardio wise. Interesting that you said that your heart rate has settled now you are recovering from your flu. My heart rate has settled big time since my asthma meds were stepped up, strange that if it’s not related to asthma🤔
I think it is related to asthma. It depends on the doctor though as to what they think. When I had flu, for months after, my heart rate was high, but the bisoprolol brought it down. Now they are saying the bisoprolol triggers the asthma (I am not convinced). I've dropped it anyway and will keep track on my heart rate. At the moment, it's between 100-120. It was up to 140-150 after the flu so at least it's a bit better.
Thanks. I do a lot of exercise so that has given me a slower heart rate (usually!). Everything is stable at the moment and I’ve not had any attacks since end of June. Been feeling wheezy and tight over the weekend and today but still in the green, PF wise.
Even with a history of asthma, several heart conditions can mimic it. An ECG helps the doctor be confident that one does have asthma and not something else.
My biggest bugbear is when I’m told I’m tachy due to the asthma drugs 🙄🙄. So then they don’t give nebs, HR increases. Finally persuade them to give neb and HR goes down (much to their confusion 🙄🙄). Aged 27 and I’ve had countless ECGs (all sinus tachy) now I just refuse the ECG. I tell them I’m sinus tachy due to asthma attack, and that I have a resp arrhythmia (HR dramatically goes up then down when breathing in then out). I freak them out with that cause HR range can be 100-150 in seconds 😅 (its a compensation of long term poor control apparently)
Yep! High heart rate must be asthma drugs, even if you’ve had none!. I know for certain that once that salbutamol gets going, my heat rate will come down. Often the problem is I think is the asthma patients that arrive at A and E will in most cases, have tried several shots of blue at home so the medics put it down to that. They don’t see the attack in its “raw form” from the beginning (my heart races before the wheeze, sometimes hours before)
Sure. If the neb gives significant relief the lungs work better. Then the heart doesn’t have to work so hard to oxygenate, and heart rate goes down. My heart rate doesn’t rise significantly from breathing treatments.
Thank you for this. I did mention to my GP last time my asthma symptoms are fast pulse no wheeze SOB....... I just wish they would log this on my records
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