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Dr. Chip
Dr. Chip, Doctor (MD)
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Experience:  Over 20 yrs of Family Practice
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Fast heart rate at rest and other issues... I've noticed for

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Fast heart rate at rest and other issues...
I've noticed for years that I seem to sometimes have a fast pounding heart rate. Almost five years ago I noticed this one day when I was laying down that my heart seemed to be pounding, so I went and had several tests done (ECGs and nuclear stress test).
These tests were to ease my mind, but I still have this issue. I was told my heart seemed fine based on these tests, but I still notice my pounding heart. Tonight, for example, I was laying down and my heart was beating somewhat fast (90-95bpm) and felt like it was pounding. This continued even as I was resting for a while. Sometimes it seems like it starts in the middle of rest when I haven't exerted myself.
(I will say here that I don't smoke, don't drink, rarely drink caffeine and am vegetarian.)
I'm still worried about my heart. I don't seem to feel skipped beats or anything terribly abnormal, just fast and pounding heart rate. I don't have chest pain or pain in my arm etc. Could this heart rate be normal for me and not harmful? (I will add here that I do suffer from anxiety problem, but generally it hasn't caused me physical symptoms that I was aware of...not sure if this could actually be from that.)
The other issue I've noticed is that I seem to feel nauseous lately. Not constantly, but it seems like every day for at least a few minutes I feel nauseous, some days for longer periods of time. I also noticed when I got up to use the bathroom the last few nights, when I strain a little to urinate, I begin to feel somewhat lightheaded.
I did start taking Trazodone to help me sleep a week or so ago, so I'm not sure this comes with that. I haven't felt nauseous enough to vomit really, nor have I felt lightheaded like I was going to actually pass out. I'm not sure what could be causing it.
Is the heart problem only when you're lying down?
Customer: replied 5 years ago.
No. I probably notice it more when I'm laying down, but I notice it sometimes during the day as well. (Often it comes after, say, eating a meal, which to me always seemed like it might be a normal reaction to eating. But when I'm laying down, it sort of surprises me. Also, at those times I can think about it, and I notice it and it makes me worry which probably bring it on worse.)
Did you ever have a Holter monitor--a continuous EKG--to capture these episodes?
Customer: replied 5 years ago.
No. I currently don't have insurance so I've had to pay out of pocket for anything I do get done. I recently went to urgent care when I was experiencing this and other than the somewhat fast heart rate (I think it was around 90) I was told my EKG was fine. And like I said, I've had several - probably a dozen at least - EKGs done in the past four years or so, and a nuclear stress test.

A cardiologist recently recommended I invest in an event monitor, which I can get for myself and record when I notice these episodes and take to a cardiologist which would be cheaper than having a holter monitor. I've ordered one but it hasn't arrived yet.
How long does an episode last?
Customer: replied 5 years ago.
It seems to depend on if I'm focusing on it or not, perhaps. When I'm laying down it can last several minutes or longer. If I notice it, say, after I've eaten a meal, it might last 15 minutes or something. Usually not sustained for that amount of time though. It's hard to say definitively because, like I said, if I'm focusing on it, I'm probably prolonging it/making it worse. But usually not more than several minutes.
Any heart problems with the nausea or light headedness?
Customer: replied 5 years ago.
Not that I can tell. I think - because I have anxiety issues - I may get myself worked up when I feel nauseaus or lightheaded, but they don't seem related.
Well, I was going to mention that--do you think the fast heart rate could be connected to anxiety?
Customer: replied 5 years ago.
I know I can make myself have a racing heartbeat if I'm anxious, and I'm pretty sure when I have a fast/pounding heartbeat I make it worse by focusing on it and getting anxious about it. My concern is that this heartbeat seems to often start when I'm not consciously anxious. So what I'm trying to say it that the heartbeat sometimes begins before I'm - at least consioucsly - feeling anxious. (Though if I notice it, I almost immediately *get* anxious, and likely prolong/worsen the fast heart rate.)

The nausea/lightheadedness - which I noticed strongly when I was going to the bathroom last night - doesn't seem to be related to anxiety at all. I don't know if it is the med I started taking at night for sleep, or something else entirely.
Well, the nausea and other symptoms could be from the trazadone, and the easiest way to determine that would be to stop it for a couple of days and see if the symptoms resolve. If not, these symptoms aren't very specific and could be from a number of causes including a virus like the flu, a vasovagal reaction with the urination, labyrinthitis, etc. As to the heart, it still could be anxiety but the best way to see if it's just sinus tachycardia and not paroxysmal atrial tachycardia would be with the event monitor. is a site I'd like you to read and then get back to me if you need to. POTS is another possibility here.
Customer: replied 5 years ago.
I will stop the Trazadone - I won't take it tonight or tomorrow and for a while - and see if that helps the way I feel. It does seem like the nausea and lightheadedness only began after I started the med, but not immediately.

I was worried the nausea and lightheadedness could be connected to a heart issue. I have never ever had chest pain of any kind in my life, nor arm pain/numbness, etc. But I get very very worried about my heart and heart-anxious, even with the EKGs, blood tests, nuclear stress test, etc.

I don't know about POTS...I don't have fatigue issues and I don't feel bad all or most of the time...the majority of the time I feel relatively fine and can go about my day normally.

I will say that due to something else entirely, the past several months I've been largely sedentary. So I don't know if that has something to do with it; the heart pounding thing has only been more recently flaring up. (Though like I said, I noticed it a few years ago, but at that time I was likely largely sedentary as well and had gained a bit of weight.) I'm not overweight, but I used to be underweight, and in the past few years have seemingly had my metabolism slow down and I've gained weight. I don't know if that and being sedentary has anything to do with it.

But my problem now is I'm so worried about my heart that I'm afraid to exert myself. I don't want to start exercising because I'm very heart-anxious now. It might actually help me but I'm too anxious to do it, so I remain sedentary.
Well, if it is just anxiety, that can become a vicious circle--your attention is focussed on your heart, the worry starts, the breathing increases, and the heart races. I don't think whatever the problem may be that you have to keep yourself sedentary--even if this were an atrial tachycardia, that isn't an impending heart attack.
Customer: replied 5 years ago.
Would I know that this isn't something serious? How would I know it isn't an impending heart attack? I'd like to believe that the dozen-plus EKGs, the blood tests, the chest x-rays , and the nuclear test would be enough, but I still notice the problem...and it terrifies me.

I neglected to add that I lost my cousin four years ago - he was 32 - to hypertrophic cardiomyopathy. He was overweight all his life, and everyone in my family directly related to him got tested for it and tested negative, so it appeared it wasn't genetic (I had had the nuclear stress test only a few months before, as well as EKGs and x-rays, so I was told I didn't need further testing/screening). But I will admit that weighs on my mind - what if I have that?

So I guess it boils down to...can I be confident that I'm not getting warning signs of something impending? Are the tests I've had mostly enough to make one relatively secure that there's not something happening? I'm sure it's possible that anxiety itself brings the heart palpitations on, and it just isn't forefront in my mind but more subconscious...but it's concerning when it seems like I notice the heartbeat and only then do I get anxious, not the other way around. I'm just scared it's a serious heart issue, which makes me afraid to exert myself, and which keeps me up at night etc. (And I can't really afford more serious heart tests out of pocket - especially if it's all in my head and I don't need more serious tests than those I've already had.)
The last time you had the tests was about five years ago? Were you told it was anxiety then?
Customer: replied 5 years ago.
In mid-2007 I began having anxiety attacks. I went to a regular doctor who wanted to see if it was something physical causing it, so she was giving me blood tests for thyroid issues, etc. She sent me to a cardiologist to get an EKG, since when I got anxious I got racing heart etc., and since I had no history of anxiety she wanted to see if it was physical. At that point I got worried about it being physical and the cardiologist offered me a nuclear stress test, which he said should rule out any issues and give me peace of mind. I did the test, and the results came back that I had, in his words, a "strong heart." He said I was fine. So after that, I went to an actual psychiatrist and they told me I had anxiety disorder, and tried to treat me accordingly. After several months, I went off any meds or treatment, and the anxiety didn't return for some years.

The difference then was the anxiety would start "in my mind," if you know what I mean, and then I'd maybe have physical symptoms. So I'd suddenly feel anxious, then I'd feel my heartbeat get fast and maybe some tingling etc. My worry now is that I feel the heartbeat first. But there's no doubt that I've got anxiety problems; I'm just used to the anxiety being in my head, and from my past counseling I can sort of "think" my way out of having mental anxiety to an extent. I'm totally caught off guard if I feel my heart racing first. Which is what has me so worried to the extent that I won't exert myself because I'm terrified. I don't have chest pain or other classic symptoms, but the heart pounding freaks me out. I don't know what to do about it. (And I suppose it's possible there's subconscious anxiety happening; it certainly doesn't take long after I feel the palpitations for anxiety to follow. It is just new to me if that's the case.)

(I'll add that I had the nuclear stress test four and a half years ago - mid-2007 - but I've had EKGs as recently as a few months ago, and I had a chest x-ray and EKGs and blood tests as recently as this spring.)
OK, and I understand. So you're worries will be less if you can be told you aren't about to have a heart attack or that you don't have hypertrophic cardiomyopathy?
Customer: replied 5 years ago.
I suppose to some extent, yes. That was why I had the stress test those years ago, and why I've gone in for EKGs and whatnot. I'm not sure what other tests I can have - except the event monitor I suppose - but when I went in and was feeling the heartbeat and got an EKG quickly, it showed up fine as far as the EKG itself goes. But yes, the combination of having had a family member pass at my current age from a heart ailment has spooked me, and the heart pounding that occassionally happens also worries me. Even being aware that I'm an anxious person, and that anxiety is focused on my heart, and that means I have an unusual/abnormal awareness of it...I'm still scared stiff by it.

(I've had other serious tests suggested - like going to get some doppler thing or one of those heart sonograms - but I don't know if that would just be overkill, especially since all the other tests seem to suggest absolutely nothing, and I wouldn't be able to pay for them without insurance anyway...those tests seem to be reserved for people who have had abnormalities or other things come up on the EKGs and whatnot...and the nuclear test was a pretty serious affair. I'm just terrified that it, I don't know, didn't show up on those tests somehow? Like something is lurking there, and that's causing the heartbeats.)
OK--do you understand that there is a big difference between a rhythm problem and coronary artery disease (the cause of heart attacks)?
Customer: replied 5 years ago.
No. I suppose I assumed a rhythm problem would be a possible symptom of some sort of underlying heart issue. I've looked up symptoms for, say, cardiomyopathy and heart attacks and whatnot, and always seen palpitations...but I've tried to also stay away from self-diagnosis because, of course, that might just make me feel worse.
Well, of course, something like ventricular tachycardia or something called torsade de points are two arrhythmias that can be dangerous, because they can segue into ventricular fibrillation. Those are highly unlikely in your case. Paroxysmal atrial tachycardia or benign sinus tachycardia are involved with the electrical system of the heart and not the coronary arteries. And, if you had cardiomyopathy, it would have shown up in the EKG's and stress test. I honestly think (just my gut medical feeling) is that this is anxiety or a relatively benign arrythmia and not a serious, life threatening heart condition.
Customer: replied 5 years ago.
It appears your message was cut off before it was finished?

I was under the impression that more invasive tests would be needed to diagnose something like cardiomyopathy. The EKGs and stress test should have shown it? Would they have shown some of these other arrhythmias/tachycardias?

I'm hoping I can at least get some peace of mind about this...and maybe not be so terrified to exert myself, etc. It's gotten to where I'm always worried about my heart, whether I'm feeling the heart pounding or not.
Sorry--I had to edit the last post. An echocardiogram and a chest x-ray would also help diagnose cardiomyopathy. As for arrhythmias, only if they're occurring at the time of an EKG could they be seen and diagnosed. With what you just said about being more and more worried about your heart, anxiety being the problem is much more likely.
Customer: replied 5 years ago.
I hope that is the case. I probably would have thought so if I felt anxious first. But sometimes the heart pounding comes when I'm laying in bed and not feeling anxious or thinking about it. Which is what sets me off to thinking I've got a problem.

I've had several chest x-rays over the past few years as well as the EKGs and stress test etc. Nothing out of the ordinary has ever been observed. (I can't really afford an echo, and with a nuclear test and all that other stuff, I wasn't sure if it would be "overkill" anyway.)

I did get to an urgent care place while I was still having my pounding heart and got an EKG which showed I had a relatively rapid pulse (about 90 or so) but the EKG itself showed fine.

How would I know it is just a benign arrhythmia/tachycardia and not somethign serious? Or would the fact that those other tests came up negative mean I need to stop freaking out about it and assume that it isn't something serious?

Like I said, I'd figure anxiety was to blame if I felt anxious first every time, but the heart pounding sensation coming on its own before I feel anxious is what has set me off recently. (And, again, it is never accompanied by any other symptoms...but of course I get to the Internet and read about "silent heart attacks" and how cardiomyopathy doesn't always have chest pain etc. and that's dangerous to self diagnose like that.)
Right on the money about Googling symptoms and possible medical problems--it's hard to separate the wheat from the chaff if you don't have medical training (not your fault). I also doubt an atrial tachycardia since those usually produce a heart rate in the over 200 range. Without an audible murmur on physical exam, you really don't need an echocardiogram. If you had a rate in the 90's on an EKG but were in sinus rhythm, that's benign sinus tachycardia and not an impending heart attack.
Customer: replied 5 years ago.
basically, even though no one has gone so far as to diagnose any actual reason behind the heart pounding - palpitations, whatever - I can be relatively certain that it isn't something life-threatening lurking there giving that symptom? My EKGs were normal every time, even when I presented with what I felt was a pounding feeling, with a heart rate in the 90s that time (which I'm told various times that it's on the high end possibly, but really until it is over 100 it isn't considered too fast). My blood pressure is always good - likely due to my eating habits - usually 110/70 or in that range.

Like I said, I worry that if I'm feeling heart pounding while I'm sitting or laying, what will happen if I exercise? But being sedentary isn't doing me any favors probably either.

It's not even just a heart attack I worry about necessarily; it's of course the idea of something like cardiomyopathy, which apparently just suddenly happened in the case of my cousin. I fear the heart pounding is some warning. But of course, I've had many tests done and it hasn't been anything showing up on them, and generally I'm told "You're fine" and sent home.
Cardiomyopathy, unless viral, doesn't just come up--it takes a long time to cause symptoms. While I can't tell you to exercise without first discussing it with a doctor who can examine you, I really don't think you're in any danger there.
Customer: replied 5 years ago.
I guess with all the evidence before me, it's likely this is something benign - if it is even originating in my body at all, and not just due to anxiety that's now beginning more with symptoms first - and if it is my heart, it's just some sort of...personal difference but not something life threatening? I suppose then with the tests I've already had done, and the impending event monitor I bought, I should assume I'm basically fine and not worry so much?

Thank you, ***** *****'ve been most helpful and thorough.
Let's put it this way--and hopefully this will help. If this were me, I wouldn't be worried that I was about to have a heart attack or something equally disastrous.
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Customer: replied 5 years ago.
I'm still having slight issues.

I stopped taking the Trazadone the other day, but I still get a little bit of the nausea. It isn't intense, but it is enough to be noticeable. I do notice that when I feel a wave of nausea, I will often then feel some gas. The nausea isn't sustained; it usually seems to come in quick waves, though this will last for several minutes to perhaps an hour.

I still notice my chest pounding, though no as much as before due to my trying to not to focus on it, which has seemed to make it at least appear to ease up. I did notice starting last night that when I was laying down, I felt a little pain in my left arm and in my chest. It's very mild, the pain doesn't seem to start in my chest and then move (or the other way around), and the pain feels like it might be muscular. However, when I feel the pain, in those locations, I of course freak out. Should I now be worried about this? (I did notice some aches and pains in other areas of my body as well; I'm sure I focus on the pain in the places like my chest and left arm because of the traditional stereotype of heart attacks.)

The bits of nausea along with the little pains have me quite worried again. None of it is severe or even all that noticable (unless you're me). I don't know whether to just try to calm myself down or to rush out once again to an ER; the last time I did that (earlier this year) I was given blood tests, EKGs and x-rays and told I was fine.
Tell me all you can about the pain.
Customer: replied 5 years ago.
The pain in my arm is sort of only when I'm laying down like I usually lay, on my side with my left arm sort of outstretched. If I move, it seems to go away. It is barely noticable (again, unless you're me looking for it). It's sort of in the upper muscle of my arm, and again, completely mild. It doesn't seem to start from anywhere or correlate to anything else.

The pain I felt in my chest just felt like it was in my chest muscle. Again it seemed to be when I was laying in bed. It wasn't quite from the center of my chest. It was entirely mild and didn't last more than a few seconds at a time.
OK--I know this sound like either a leading question or just an evasive one, but what can I tell you about this that may help here?
Customer: replied 5 years ago.
What would I need to be looking for that would actually warrant such panic and a justified trip to the ER? Everything I read seems to send me into a state of panic, which then makes me feel like I'm really in a state of emergency. I don't know if the pain or nausea or whatever that I'm feeling is something that I should be freaked out about or not.
OK. You put me between a rock and a hard place here--where I'm content to be--since there is absolutely no way over the internet I'm going to tell someone that chest and left arm pain cannot possibly be cardiac. Let's try this. Angina, or an actual heart attack is typically a crushing chest pain usually accompanied by sweating, nausea, shortness of breath, and possibly a feeling of doom. Now of course some of that falls under what you experienced. The fact that this was mild and very brief doesn't sound like a cardiac event. Add to that that your age makes a heart attack or angina very unlikely but not without some possibility. I don't know how much this helps, so, please, ask me to continue if you need me to.
Customer: replied 5 years ago.
This is certainly not crushing, nor have I experienced shortness of breath ever. The nausea and the pain don't happen at the same time; the nausea has been happening for a week or so now at least.

A feeling of doom is difficult for me to really assess because I obviously have anxiety problems; so, I do have some feelings of panic. These usually don't arise spontaneously but usually seem to come about after I've begun to focus on things and think and obsess.

I have experienced some sweating but again, it seems like it comes about after I've already begun to freak out.

It's difficult for me to know if I'm just having a panic attack or something else. I assume I'd be looking for more severe pain in my chest and whatnot if it were heart-related. I wouldn't presume to get actual diagnosis over the Internet...I just don't know if I should be rushing myself to an ER or just trying to calm myself down.
The biggest problem is, I have seen in some patients, that no matter how many tests and trips to the ER it can be nearly impossible to convince them that one particular episode is just like any other and they don't need to call 911. Again, my gut tells me from what we've talked about before that this isn't cardiac. That said, if this is something that lasts for more than seconds or the pain does become crushing, that needs prompt evaluation.
Customer: replied 5 years ago.
Thank you...that helps. I haven't felt pain in my chest area since last night. The other symptoms...I guess they could be just arising from anxiety or from some other source. I don't want to be impossible to convince; I just don't know what to make of the physical symptoms I feel and that couples with my tendency towards anxiety and hypochindria.
I fully understand. It is hard. Forgive me if this is redundant, but have you had any counseling for the anxiety problem?
Customer: replied 5 years ago.
In the past, when I had insurance, I did. I was also on meds at that time. I haven't been lately because generally that entails regular visits and that is difficult without insurance.
OK. I was going to suggest cognitive behavioral therapy which can train you in techniques for dealing with this. Short of that, learning relaxation techniques and hypnotherapy could help.
Customer: replied 5 years ago.
I would love to be able to do that, and I hope that very soon I will be able to.

In the meantime...I've got to try to tell myself that these little physical pangs and whatnot aren't a precursor to something more serious, which is hopefully the case.

I still don't know what to think of the nausea symptoms. I'm sure they too could be anxiety related, but it's strange in the way it comes on, every other day or so, usually sometimes after I've eaten.
Unfortunately, nausea is what we refer to as a very nonspecific symptom by itself. The nause of a heart attack is usually severe and not just a vague feeling.
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