Is anxiety or heart problem a reason for increased heart rate?

Question

Hello doctor,

I am a 37-year-old female who has recently been having episodes of a very fast heart rate; this has been happening on and off for the past few weeks. It comes on very suddenly when it happens, and my heart rate goes up to 165 bpm; it is very frightening.

I have been to my doctor twice, but he thinks it is anxiety, and he gave me Propranolol 80 mg modified-release capsules to take every day. My heart rate is fine when I take them, and I feel calm. However, I am scared in case it is not anxiety, and there is something very seriously wrong with my heart.

I had two echocardiograms last year, and they were normal; the cardiologist said there was nothing wrong with my heart and not to worry. However, I am very anxious, and I have been upset lately; it has gotten more severe. I do not know if this fast heart rate is anxiety or if something is seriously wrong with me.

Would the echos last year pick up if something wrong caused a fast heart rate?

I was going out of my mind with worry and scared to live my life.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Sudden onset of fast heart rate and sudden normalization can occur in a few conditions.

I am giving you some details.

SVT is one of the most common causes. The pulse rate is regular and fast, at around 160 to 200 beats per minute. Usually, there is no other symptom apart from palpitations. Sometimes there is dizziness.

Atrial fibrillation and paroxysmal atrial fibrillation are also common causes. This pulse rate is irregular and fast, ranging from 120 to 180. Sometimes, the heart rate is normal but irregular. May accompany dizziness.

Ventricular tachycardia is very uncommon in structurally normal hearts, but it does occur. It may only cause palpitations and, on the other extreme, cardiac arrest.

Anxiety may be a normal heart rate, and only feelings of palpitations or rapidness. Tachycardia episodes occur during sudden anxiety but subside when anxiety or fear is gone. This is a diagnosis of exclusion.

Other causes of persistent tachycardia include atrial fibrillation, sinus tachycardia due to anemia, thyrotoxicosis, or inappropriate sinus tachycardia. You are advised to get an ECG (electrocardiogram) done when you have a tachycardia episode. Alternatively, you can have Holter monitoring done.

Are you currently taking any medicine in the long term?
Are ECGs done?
What other workup has been done to date?

I hope it helps.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I can understand your concern and feel your anxiety from your words.

Taking undue stress and overthinking trivial issues will make us sicker. It is not going to solve the problems. It is better to get an ECG done and exclude physical causes. Once the rhythm issue is excluded, your anxiety will decrease. If you have any issues that are causing you to get anxious, do share with me. I know mental stress is one of the main culprits that adversely affects our hearts and health. If any workup is done, please share it with me.

I hope it helps.

Thank you.