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What Causes Elevated Heart Rate When Diagnosed With Ankylosing Spondylitis?
Question: My son is 25. His pulse stays around 100 and shoots up randomly to 150 maximum, more often 133. His blood pressure is around 139/90. It seems to be often lower in the morning, around 118/92. We have been charting it, and it seems to go higher as day goes on. Stress test, heart ultrasound, reportedly didn't show anything wrong with heart. EKG showed the spikes in pulse rate, as did 24 hrs heart monitor. Why does bp increase as day goes on? What other tests should be done? Won't his heart get tired and weak, and could lead to heart failure? Sometimes the highest spikes are when he stands up like to 150, and his has had occasional dizziness. He has Ankylosing spondylitis and takes Enbrel. He is not very active due to spinal degeneration and pain. He is a little overweight. His back pain is chronic, he has had it long time, had foraminectomy for Cauda Equina syndrome at 16. Really afraid to ignore the heart symptoms, and worried to exercise what he can, increasing heart rate.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully read your question and would explain that these heart rate values may be related to different metabolic disorders (thyroid gland dysfunction, adrenal gland dysfunction), inflammation (related to ankylosing spondylitis), the pain (which can lead to episodes of tachycardia, orthostatic intolerance (the heart rate increases when standing up from sitting position), etc.
Does his heart rate change when standing up from sitting or lying down position?
Could you please upload his last performed 24 hours ECG monitoring and cardiac ultrasound report for me to review and give a more professional opinion on his heart function and structure.
Enbrel, can be related to adverse effects like heart failure, but as you refer, his cardiac ultrasound has resulted normal.
I would exclude the cauda equina intervention as related to this symptoms, because it is too low in the spinal column and not related to the central control of heart rate and blood pressure.
I would recommend performing some blood lab tests :
-complete blood count for chronic anemia
-blood electrolytes: an electrolyte imbalance could lead to cardiac tachycardia
-thyroid hormone levels (thyroid gland function)
-cortisol plasma levels (the function of adrenal glands)
-inflammation tests (PCR, sedimentation rate)
Urinary levels of metanephrines may be needed to exclude possible adrenal gland dysfunction (possible pheochromocytoma), although this heart rate is not too high to raise suspicions of such disorders.
You should discuss with his doctor on the above possibilities and on the possible treatment options (a beta blocker in low doses would be helpful).
Hope to have been helpful!
Feel free to ask any other questions, whenever you need!
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully read your question and would explain that these heart rate values may be related to different metabolic disorders (thyroid gland dysfunction, adrenal gland dysfunction), inflammation (related to ankylosing spondylitis), the pain (which can lead to episodes of tachycardia, orthostatic intolerance (the heart rate increases when standing up from sitting position), etc.
Does his heart rate change when standing up from sitting or lying down position?
Could you please upload his last performed 24 hours ECG monitoring and cardiac ultrasound report for me to review and give a more professional opinion on his heart function and structure.
Enbrel, can be related to adverse effects like heart failure, but as you refer, his cardiac ultrasound has resulted normal.
I would exclude the cauda equina intervention as related to this symptoms, because it is too low in the spinal column and not related to the central control of heart rate and blood pressure.
I would recommend performing some blood lab tests :
-complete blood count for chronic anemia
-blood electrolytes: an electrolyte imbalance could lead to cardiac tachycardia
-thyroid hormone levels (thyroid gland function)
-cortisol plasma levels (the function of adrenal glands)
-inflammation tests (PCR, sedimentation rate)
Urinary levels of metanephrines may be needed to exclude possible adrenal gland dysfunction (possible pheochromocytoma), although this heart rate is not too high to raise suspicions of such disorders.
You should discuss with his doctor on the above possibilities and on the possible treatment options (a beta blocker in low doses would be helpful).
Hope to have been helpful!
Feel free to ask any other questions, whenever you need!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I will need to get the reports from the dr office to send, thus it may be a few days. The spike in pulse, high as 150, has been from a sitting position. A few times the pulse rate dropped when he stood up from sitting. A couple times, the rate when up just enough to be normal, per the Nurse. So it hasn't been consistent.
I asked for a tilt test which is scheduled for tomorrow. What do you think about that . What should we know to ask about or be sure is done to ensure correct results? It is being done at a hospital, and they said to expect to be there a while.
I asked for a tilt test which is scheduled for tomorrow. What do you think about that . What should we know to ask about or be sure is done to ensure correct results? It is being done at a hospital, and they said to expect to be there a while.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
Thank you for the additional information!
The changes in his heart rate during sitting and standing up that you refer are not compatible with orthostatic intolerance (which is by definition an increase in the heart rate more than 30bpm when standing up from sitting position).
A head up tilt tests is needed to rule out orthostatic intolerance. It is normally performed in the hospital. If it results normal, this disorder can be excluded.
Hope you will find this answer helpful!
If you have any other questions, don't hesitate to ask me!
Greetings!
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
Thank you for the additional information!
The changes in his heart rate during sitting and standing up that you refer are not compatible with orthostatic intolerance (which is by definition an increase in the heart rate more than 30bpm when standing up from sitting position).
A head up tilt tests is needed to rule out orthostatic intolerance. It is normally performed in the hospital. If it results normal, this disorder can be excluded.
Hope you will find this answer helpful!
If you have any other questions, don't hesitate to ask me!
Greetings!
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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