Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

173 Doctors Online
Doctor Image
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

What causes rapid pulse rate in the middle of night?

Answered by
Dr. Karen Steinberg

Internal Medicine Specialist

Practicing since :1981

Answered : 824 Questions

Posted on Mon, 4 Aug 2014 in Heart Rate and Rhythm Disorders
Question: I have been waking up with a rapid pulse in the middle of the night in excess of 160+ bpm. I have mitral valve syndrome that was diagnosed some 30 years ago and have had often bouts of PVS's and tachycardia with chest pain in the past. The rapid pulse lasts approximately 4-6 minutes and then brakes on it's own. I am 61 y/o with no other history. I am on atenelol 25mg for PVC's which I have had since the age of 18 y/o. I don't seem to wake up from the tachycardia but from something else, noise, first aid pager, door slamming etc., then the attack seems to come on. I have seen my cardiologist and have had a holter and event monitor on for approximately a month and did not experience an attack within this time. I guess I am worried because an an EMT I know if a rapid pulse continues for an extended amount of time and does not break on it's own, I could have a heart attack or arrest. I am not self diagnosing but am concerned that it might be SVT. I have no symptoms during the attack, chest pain, SOB, fainting and am not diorphoretic. I do notice that if I sit down and compose myself the attack is of shorter duration, rather then getting myself in a panic and increasing the rate more. I never get these attacks during the day. I am a very slender active, non-smoker, with a hot-wired nervous system as they call it. have no problem during sports, kayaking, hiking etc. My last echo and stress test was approximately three years ago, and during that time I was having these night episodes of tachycardia. The test results were "equiviable", but my doc stated to me that he is not really worried about heart disease, and unless we can document these episodes, it is difficult to see what kind of arryth. I am experiencing. He further states that if I should experience prelonged episodes or symptoms attached to the episodes, dizziness, chest pain, fainting etc., to be transported to the hospital for evaluation.
Answered by Dr. Karen Steinberg 5 hours later
Brief Answer:
Rhythm needs documentation

Detailed Answer:

Thank you for using Healthcare Magic.

It sounds like you have had a thorough evaluation by your cardiologist. Unfortunately the rhythm has not been caught on EKG so no definite recommendation can be made about it. It certainly could be an SVT, including atrial fibrillation. It is reassuring that you do not have associated symptoms with it. Certainly if you do you need immediate transportation to the ER as your doctor said. If you can get to the hospital while you are having the rapid heartbeat, they might be able to catch it that way. I'd also suggest that you discuss with your cardiologist doing another event monitor until the rhythm is actually seen, so you know what you are dealing with. If it's something like paroxysmal atrial fibrillation, particular treatment might be needed.

I think what the EMT is referring to is if the rapid rhythm does not stop over a very long period of time, eventually blood flow to the heart might be compromised and a heart attack may result. Your own doctor does not seem to be concerned about this possibility based on your previous studies, but does mention your need to be seen immediately if you experience certain symptoms with the rapid pulse, which I agree with. Again, if you can get in during an episode even if you're not having symptoms, they might be able to catch the rhythm.

I find it interesting that this only occurs at night and you don't know it unless you are awakened by something and then it starts. Is it possible you have sleep apnea, and when your oxygen level drops too low, you awaken then and then experience the rapid pulse? Sleep apnea is commonly associated with atrial fibrillation. And sleep apnea does not always occur in obese people. (I am a perfect example of that- I am your age and slender, and have moderate sleep apnea.)

These are the steps I would have you take if you were my patient:
1) Get an event monitor until the rhythm is documented
2) Try to get into the ER as soon as the rapid pulse starts, if possible, so the rhythm can be documented
3) Talk to your cardiologist about electrophysiologic studies that might be able to diagnose the arrhythmia if it can't be caught on a EKG
4) Strongly consider a sleep study to see if there is any evidence of hypoxia occurring during sleep that might set off an arrhythmia if it got severe enough.

The key thing is to determine what the arrhythmia is and what might be setting it off. Since it's been 3 years since your last studies and it's still occurring, I think it's a good idea to repeat them in any case.

Hope this answers your query. If you have further questions, I would be happy to answer them.

Above answer was peer-reviewed by : Dr. Raju A.T

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,   ,   ,   ,   ,  
Lab Tests

Recent questions on  Stress test

doctor1 MD

Merry Christmas! Sharka knows most my symptoms with bigeminy noe blood pressure and sudden onset of periodically high heartrate up towards 180-200 bpm from nowhere which is never caught on ecg or holter amd ectracystoles that get worse DURING...

doctor1 MD

Hi dr xxxxxxxx as requested I had blood panel done and they came back normal no signs of heart attack or enzymes I have a stress test set up tomorrow the ecg that was uploaded already I will ask him to take a look my question is I quit smoking 9...

doctor1 MD

I am male 93 years young currently under treatment for bladder cancer cancerous material removed and now I am thru thte second of the six shot weekly program. my problem now is shortness of breath . my heart dr. just completed a neucular stress...

doctor1 MD

Hi, may I answer your health queries right now ? Please type your query here...Hi: I had a routine physical & EKG which I failed. I took another and passed; then a stress test & nuclear stress test with a Cardiac MD, who recommended angioplasty. A second opinion from another cardiologist (D.O.) reviewed the tests & said I don't need this. The 2nd D.O. put me on niacin, sterols, and a multivitamin. I am 70, in great physical shape, bmi of 27, have no symptoms, and did the stress tests to the max, obtaining a heart rate of 150 in 11 minutes. Who is right? 1/2 my family belives the MD, etc. Jerry

doctor1 MD

I have been having chest discomfort for two months, I saw my dr. he did an ekg and it was abnormal (PVC's) I had an echo stress test today and my dr. says all looks normal. He sent me home with a holter for a month and beta blockers. My resting heartrate is between 80 and 100, and in the first three minutes of stress test , hr was 160. Family hist. is father as well as 12 of his male siblings all have has massive heart attacks without any positive stress test warnings....I am a 40 year old wowan no drinker, non smoker. Should I be concerned?

doctor1 MD

persistant intermittant episodes of chest spasms and trembling sensations around left lower pectorial region and upper rib cage....sometimes a week or 2 go by without symptons...then out of nowhere re-appear again...latest episode lasted 24 hours....had stress test 2 months ago and passed with flying history of heart problems ,am not over-weight and excercise regularly...I m 65 years old

doctor1 MD

My mother is of age 58 and she does not smoke, has never suffered a heart attack, never complained of chest pain but her stress test is positive. We are advised of Thallium Stress Test. Can you please advise what is the difference between Thallium Stress Test and Coronory angiography? Also, should I go for these tests since my mother is reluctant to do those since she is fit and fine right now? Bhavesh Mehta.