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Heart rate goes down while lying and up when taking stairs. Stress, EKG and blood work normal. Cause?

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Im female, 40 years old. I have weird symptoms. My heart rate while laying in bed goes as low as 45bpm and when im up walking upstairs it goes to 136bpm. Sitting at the kitchen table i get dizzy sometimes. Im dizzy alot through the day.

Ive had 2 normal stress tests, normal chest cta, normal ekg and blood work and normal echo. What causes this. I heard its not good. My blood pressure is good. 115/60.

Posted Fri, 4 Oct 2013 in Heart Rate and Rhythm Disorders
 
 
Answered by Dr. Sukhvinder Singh 5 days later
Brief Answer:
please see details

Detailed Answer:
Respected ma'm
1. An abrupt increase in heart rate on assuming upright posture to more than 120 beats/minute or more than 30 beats/ minute than the basal rate is characteristic of Dizziness is a predominant symptom in this condition. This condition may be associated with fall in blood pressure on standing. Ideally symptoms of patient should be present for more than 6 months for this condition to be diagnosed. However in all patients anemia (low hemoglobin), dehydration and effect of medicines should be ruled out.
2. You must get evaluated for same by your physician including postural hypotension (significant fall in BP on standing).
3. There are certain general measures which help these patients. These include increase intake of water, increasing salt in diet, frequent but small meals, and supervised exercise regimen.
4. Certain drugs have beneficial role in this condition but they require prior assessment by your physician.
5. There can be other causes for dizziness but can be ascertained only after examination.
Hope this provides some insight.
Feel free to discuss further.
Sincerely
Above answer was peer-reviewed by
 
Follow-up: Heart rate goes down while lying and up when taking stairs. Stress, EKG and blood work normal. Cause? 27 hours later
Is this a normal ecg?
 
 
Answered by Dr. Sukhvinder Singh 35 minutes later
Brief Answer:
please see details.

Detailed Answer:
Respected Ma'm
(The quality of picture is not very good.)
The ECG shows normal sinus rhythm with "poor progression of R wave in precordial leads"; same has been labelled as "late transition" by your cardiologist. Commonest causes for late transition are inappropriate lead placement by technician and clockwise rotation of heart. Both are benign phenomenon. There can be other causes for the same, However as you had a normal ECHO, they are already ruled out.
Other parameters seems to be within normal limits.
Hope this helps.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Heart rate goes down while lying and up when taking stairs. Stress, EKG and blood work normal. Cause? 2 minutes later
Echo doppler showed impaired left ventricular relaxation though. Are you sure?
 
 
Answered by Dr. Sukhvinder Singh 14 minutes later
Brief Answer:
please see details.

Detailed Answer:
Respected ma'm
1. Interpretation of ECG is always done in light of clinical information. It is not absolute in itself. Neither the information provided by it is absolute.
2. If your technician has applied the leads at correct position then it is indeed late transition. The various possibilities could be a clockwise rotation of heart, an old heart attack, lung disorders, left anterior fascicular block, predominantly right sided heart, WPW syndrome etc.
3. Your ECG do not show WPW syndrome & left anterior fascicular block. Other features of a predominantly right sided heart and old heart attack are absent. You do not give any history suggestive of serious lung disorder.
4. Had it been an old heart attack or right sided heart or a serious lung disorder, the ECHO would have shown some changes. Impaired left ventricular relaxation alone do not indicate heart attack. It means that there is some degree of loss of relaxation which has many causes. It is again not a very serious issue.
Hope that provides more clarification.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
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