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What Causes Tachycardia While Climbing Stairs Despite Having Normal Holter Monitor Test?

Posted on Tue, 16 Jun 2015

Question: Hi doctor I have a few questions about my heart. I have had all cardiac tests done a few months ago. This included holter 2 48 hour, 2 stress tests, 2 Echocardiogram and blood work. Everything showed a structurally normal heart and I passed both stress tests achieving 90 percent of my maximum heart rate. The holter showed 400 pacs over 48 hours and 15 pvcs. I had some bradycardia approximately 26 % of the time and 12 % of the time tachycardia. The lowest heart rate was 41 during sleep and 164 while climbing stairs and during anxiety. Average heart rate was 71. Occasionally I get episodes where my heart will start racing approximately 165-170 bpm. It will start off withe climbing the stairs and then I get nervous anticipating a fast heart rate and it happens fpr approximately 3-5 minutes. I do suffer from anxiety and I have some acid reflux and digestion issues. I'm worried because this fast heart rate has happened approximately 3 times over the past 5 days and twice tonight. I do think anxiety has something to do with it. I was just wondering if you believe anxiety is triggering this or if this is triggering anxiety. My Holter both showed sinus rhythm and no significant arythmia. I'm so confused I don't know what's going on I need some help.

I have been doing cbt and psycho therapy for 2 months now

Answered by Dr. Divakara (2 hours later)

Brief Answer:
Its due to Anxiety.

Detailed Answer:
HI

Greetings from Dr.Divakara.P
Thanks for posting your query.

Well your cardiac evaluation including Holter shows everything is normal with your heart. Tachycardia during climbing stairs or during anxiety is normal .

So its basically your Anxiety that is causing fast heart rate. You need to focus on management of anxiety and not on fast heart rate.

I advise you to take Counselling from a psychiatrist. ( I have noticed in your previous queries that you are taking CBT but I think its not helping you much , so consider changing your Psychiatrist )

Also start doing meditation and Yoga , it shall help you a great deal. You can also learn a new hobby like Music or new language which will divert your mind .

You have mentioned that your blood work was normal but I need to know was any thyroid test ( T3, T4 and TSH ) was done. Kindly let me know.

Hope this information was useful to you.
Any clarifications feel free to ask .

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Divakara (9 minutes later)

Hi doctor thank you for your reply. Yes my doctor did the thyroid tsh test and said it was at a normal level. Can anxiety cause such fast heart rate? Also my cardiologist insists that my heart is very healthy and the etopic beats I get are due to anxiety

Answered by Dr. Divakara (1 hour later)

Brief Answer:
Yes Anxiety can cause.

Detailed Answer:
HI

Thanks for the information.

Oh yes Anxiety can cause very fast rates . In some people I have seen it causing heart rate crossing 200 .

The only thing that needs management in you is Anxiety. Follow my advise ( in my previous reply ). Manage your anxiety and your heart rate will be just fine.

Take Care.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Divakara (7 hours later)

Doctor 1 more question I have for you is about the bradycardia I experience. I get times where my heart rate will be in the low 50s. I have told my cardiologist about this and he says it's normal. It just feels strange that my heart rate fluctuates so much sometimes. For example I'll be sitting down or standing and my heart will be beating at 65-70 bpm and then I'll have a few beats in the low 50s and then back up. It's so confusing to me. He says everything is normal but is this a normal feeling? Can it be caused by my acid reflux affecting the vagus nerve?

Answered by Dr. Divakara (3 hours later)

Brief Answer:
Unlikely due to Acid Reflux.

Detailed Answer:
HI

Thanks for the information .

A heart rate of 60 is normal . Any rate less than 60 when a person is awake is considered Bradycardia.

See you have been evaluated with Stress test which by itself is a very good test , also you have undergone Holter monitoring which will check for your heart the whole day and even that has not detected any significant problems.

It is very unlikely for acid reflux to cause Bradycardia. So don't bother about it.

So I say just relax , forget about your heart rate or heart -- Its fine. It is your Anxiety that is causing you these problems . Try to manage the Anxiety.

Regards.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar