Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Elevated Pulse Rate When Diagnosed With Atrial Fibrillation?
Question: Merry Christmas Dr.Llir Sharka can you shed some light on why my husband's pressure can be 117/66 and pulse 132 did not take pills as he got up late..now 20mins later 118/63 pulse 114....even though when taking his meds his pulse is up in the 100's plus......his last evaluation dd25/10/2016 ecg non sinusrhythm/140x'/---/0.08"/+30o/0.36": Atrial fibrillation with high ventricular response..Laboratory (25/10/2016):Hb: 15.7 Ht:47%,WBC 10.800xmm3,Linf:59%,RBS:107mg% Cr:1.0mg%, PT: 10.7" (-0.9"); PTT: 34.9" (+3.8"). Transthoracic echocardiogram (28/10/2015) Left ventricule of increased diameters and volumes (LVDd: 68mm,LVDs:44mm), and increased thickness (IVSd:14mm,PVWDd:13mm), Hypokinesia in basal inferoseptum segment, with preserved systolic function (EF:56%, Motility Index: 1.06). Peri operative risk: Gupta: 0.13%(*), Lee: 6.6% (#), ASA2, Goldman II...he did have surgery 3/11/2016 he had an umbilical hernia and a 8in. incision was done two weeks later stitches were removed but the lower section below the navel opened and is in the process of healing slowly...any opinion.....I forgot to tell you that he is on 20mgs. Xeralto.....25mgs CoregX2.....Laxic 40mgs.x2...Atacan 16mgs a day......his pulse is still in the 100's+......what are your thoughts on this matter.........
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello dear XXXX!
Welcome back on HCM!
Regarding your husband's heart rate (pulse), I would explain that an increased value could result due to several reasons:
1) If the heart rhythm is non sinus rhythm, such as the previous ECG (25/10.2016) shows, and atrial fibrillation is present, then it is quite understandable this transient pulse increase. Atrial fibrillation is considered an irregularly irregular rhythm, that is, it may change the heart rate irregularly from one instant to the other. And you can't fix a steady pulse value even when using a modern pulse oxymeter or monitor.
Also, measuring the arterial pulse by checking the wrist artery (radial artery) could not yield an exact value, as atrial fibrillation is characterized by what is called pulse deficit (not all left ventricular contractions could produce an efficient stroke volume to open the aortic valve and be transmitted through the arteries up to the radial artery and yield a touchable pulse wave. So, more heart contractions than wrist pulsasions may be present in atrial fibrillation.
Furthermore, a ventricular heart response of up to around 100 bpm is not a real concern in atrial fibrillation.
2) An important issue that affects directly the heart rate is an abrupt withdrawal or delay of therapy, more specifically the beta-blocker (Coreg).
Coreg is an effective drug in controlling heart rate and improving hemadynamic stability in heart failure.
But if it is not administered in the usual schedule, it may be associated with rebound effect (return of increased heart rates due to uninhibited beta-1 receptors), as all the beta-blockers do. The best thing to do is to take the delayed drug dose (Coreg) as soon as possible and continue the scheduled scheme.
3) Am inflammatory status (with or without fever) may lead to increased heart rate. In such casem controlling the responsible cause (inflammation/infection) would resolve also the increased pulse issue.
Measuring some laboratory inflammatory markers like PCR, ESR would be helpful to guide the underlying therapy.
4) As your husband is suffering from heart failure (dilated cardiomyopathy) with atrial fibrillation, needing diuretics (Lasix), beta-blockers (Coreg), anticoagulation (Xarelto), vessel dilators (Atacand), etc., variations in heart rate (pulse value) are going to be a common finding.
You should not worry about that!
Only if the increased heart rate (greated than 110/min) persists, coupled with underlying symptomatology (shortness of breath, palpitations, chest discomfort, excessive weakness, low blood pressure, etc.), it would be necessary to consider a direct medical consultation by asking prompt medical assistance to the nearest ER service at your living area or contacting your preferred doctor.
The best stategy to follow in a heart failure patient with heart rhythm disturbances (atrial fibrillation), such as your husband appears to be, is periodically check his cardiovascular status by careful physical exam, cardiac echo and optimize appropriately his ongoing therapy.
Hope to have been helpful to you!
In case of any further uncertaitnies, feel free to ask me again.
Wishing to you a Merry Christmas!
Best regards,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello dear XXXX!
Welcome back on HCM!
Regarding your husband's heart rate (pulse), I would explain that an increased value could result due to several reasons:
1) If the heart rhythm is non sinus rhythm, such as the previous ECG (25/10.2016) shows, and atrial fibrillation is present, then it is quite understandable this transient pulse increase. Atrial fibrillation is considered an irregularly irregular rhythm, that is, it may change the heart rate irregularly from one instant to the other. And you can't fix a steady pulse value even when using a modern pulse oxymeter or monitor.
Also, measuring the arterial pulse by checking the wrist artery (radial artery) could not yield an exact value, as atrial fibrillation is characterized by what is called pulse deficit (not all left ventricular contractions could produce an efficient stroke volume to open the aortic valve and be transmitted through the arteries up to the radial artery and yield a touchable pulse wave. So, more heart contractions than wrist pulsasions may be present in atrial fibrillation.
Furthermore, a ventricular heart response of up to around 100 bpm is not a real concern in atrial fibrillation.
2) An important issue that affects directly the heart rate is an abrupt withdrawal or delay of therapy, more specifically the beta-blocker (Coreg).
Coreg is an effective drug in controlling heart rate and improving hemadynamic stability in heart failure.
But if it is not administered in the usual schedule, it may be associated with rebound effect (return of increased heart rates due to uninhibited beta-1 receptors), as all the beta-blockers do. The best thing to do is to take the delayed drug dose (Coreg) as soon as possible and continue the scheduled scheme.
3) Am inflammatory status (with or without fever) may lead to increased heart rate. In such casem controlling the responsible cause (inflammation/infection) would resolve also the increased pulse issue.
Measuring some laboratory inflammatory markers like PCR, ESR would be helpful to guide the underlying therapy.
4) As your husband is suffering from heart failure (dilated cardiomyopathy) with atrial fibrillation, needing diuretics (Lasix), beta-blockers (Coreg), anticoagulation (Xarelto), vessel dilators (Atacand), etc., variations in heart rate (pulse value) are going to be a common finding.
You should not worry about that!
Only if the increased heart rate (greated than 110/min) persists, coupled with underlying symptomatology (shortness of breath, palpitations, chest discomfort, excessive weakness, low blood pressure, etc.), it would be necessary to consider a direct medical consultation by asking prompt medical assistance to the nearest ER service at your living area or contacting your preferred doctor.
The best stategy to follow in a heart failure patient with heart rhythm disturbances (atrial fibrillation), such as your husband appears to be, is periodically check his cardiovascular status by careful physical exam, cardiac echo and optimize appropriately his ongoing therapy.
Hope to have been helpful to you!
In case of any further uncertaitnies, feel free to ask me again.
Wishing to you a Merry Christmas!
Best regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
We check pressure on the upper arm.....we are also trying to keep his meds to a certain time each day .....he do have an enlarge aorta so do not over worry if his pulse is 100+ at times.....his pressure today was 124/67/103...your views have been very helpful with in debt explanations I can understand...thanks once again and our best wishes to you and yours over this Christmas Season......God Bless.
Brief Answer:
I remain at your disposal for further discussions!
Detailed Answer:
Hello again!
I am glad to have been helpful to you!
As an enlarged aorta is present, I advise to carefully check frequently blood pressure values and properly keep it under strict controlled ranges, because in such way would be avoided an increased stress over the aorta walls and further aortic enlargement progression.
In this regard, a regular beta blocker (Coreg) therapy coupled with other vessel dilators (such as Atancand) would be beneficial.
Wishing you a pleasant weekend!
I remain at your disposal for further discussions!
Regards,
Dr. Iliri
I remain at your disposal for further discussions!
Detailed Answer:
Hello again!
I am glad to have been helpful to you!
As an enlarged aorta is present, I advise to carefully check frequently blood pressure values and properly keep it under strict controlled ranges, because in such way would be avoided an increased stress over the aorta walls and further aortic enlargement progression.
In this regard, a regular beta blocker (Coreg) therapy coupled with other vessel dilators (such as Atancand) would be beneficial.
Wishing you a pleasant weekend!
I remain at your disposal for further discussions!
Regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
