What causes rapid heart rate and shortness of breath while walking upstairs?

Posted on Thu, 2 Jun 2016 in Hypertension and Heart Disease
Question: What conditions would cause a rapid increase in heart rate and shortness of breath when going up stairs or an incline? Then a rapid decrease in heart rate when lying down. Also, what does it mean when a murmur is only heard after exertion (like going up a couple flights of stairs)? I am a young, thin female that used to exercise regularly but over the past year I have become more short of breath when active. I feel fine when lying down, but my heart rate increases from 70-80 to 130+ when going up 2 flights of stairs. I often find myself taking in deep breaths when active. I do not have asthma
Answered by Dr. Ilir Sharka 2 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:

Welcome and thank you for asking on HCM!

I carefully passed through your question and would explain that it is normal to have an increased heart rate during physical activity (also called effort). It is caused by the activation of sympathetic nervous system, causing the release of a big amount of chatecholamines (adrenaline and noradrenaline) in your blood, leading to increased heart rate (which is a physiological reaction, in order to increase the blood supply to the muscles which are working).

When your body is at rest, this nervous system is disactivated and chatecholamines are metabolized withing 10 minutes by our body, causing a decrease in the heart rate. This is a normal physiological reaction too.

Regarding the heart murmurs, I would like to explain that when blood flows normally through the heart valves, it makes a two-beat “lub-lub” sound. With a murmur, the blood is not flowing normally through the heart valves, and your physician may hear through a stethoscope any of a variety of “swishing” sounds that can differ in volume, pitch, and duration.

Heart murmurs can happen in a normal (also called innocent murmurs) and in abnormal structure heart (also called pathological murmurs).

Innocent murmurs are typically heard after physical exertion, caused by the rapid flow of blood to the normal heart. They are not related to any heart disorders. They can also be heard in pregnancy, chronic anemia or thyroid dysfunction.

So relax! You have nothing to worry about!

Anxiety could also play an important role in your symptomatology.

I would recommend consulting with your attending physician for a careful physical exam and some tests to be be sure that everything is OK:

- a resting ECG and cardiac ultrasound to examine your cardiac function and structure
- an ambulatory 24-48 hours ECG monitoring to examine your heart rhythm trends during the day and investigate for possible cardiac arrhythmia
- respiratory function tests to exclude possible lung disorders that can lead to shortness of breath during physical effort.
- some blood lab tests (complete blood count for anemia, thyroid hormone levels, blood electrolytes).

You should discuss with your doctor on the above issues.

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
Follow up: Dr. Ilir Sharka 8 hours later
This has been going on for a year and gradually getting worse. My increased heart rate is with mild activity (immediately after walking up a few stairs, and soon as I start walking up an incline). Some times I have to go lay down after doing simple household chores or a hot shower. I often have to take deep breaths, it seems to take so much effort. This is not normal because I am thin and used to be very active and exercise regularly. My heart has a gallop sound when it gets really high. I had an echo and it had a minimal left to right shunt, but no right to left. This was not present on an echo the year before. Could this be a false positive? I have seen a psychiatrist twice. They cleared me for anxiety issues. Pulmonary function tests had a reduced DLCO. Normal O2 stats. Stress test showed no signs of ischemia, but a flat blood pressure response. EKG normal. Holter monitor-normal rhythm-many episodes of tachycardia with activity. CBC, TSH, Electrolytes normal. GI cleared me for GI issues. I am supposed to get an exercise right heart XXXXXXX I have been seeing a pulmonologist and she has been ordering the tests (she is wonderful! but is running out of tests to check), I am now trying to get a cardiologist. I don't know what else to do. I feel crazy because things that are simple exhaust me and they can't figure out what is wrong with me. I am asking different opinions hoping that someone could give me a different perspective.
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

Thank you for the additional information!

Regarding your last echo finding, I would explain that the fact the shunt was identified in the last but not in the previous cardiac ultrasound means that you have to do with a small communication between the right and the left heart, probably a small inter-atrial septal defect.

The clinical implication of this finding could be investigated by reviewing several cardiac ultrasound parameters such as : chamber dilation, left atrium, right atrium and ventricle, measurement of the shunt severity, presence of pulmonary hypertension and increased pulmonary vascular resistance, direct visualization of the congenital defect.

Your doctor has made the right decision to recommend you a right heart catheterization as it will provide with the most exact information on the importance of this shunt and suggesting also the most appropriate alternatives of treatment.

I would like to review all your performed tests for another professional opinion.

Hope to have clarified some of your uncertainties.


Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Ilir Sharka


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