Is this a thing, or am I just being pointlessly obsessional?

August 23, 2013 4:06 PM

I don't seem to have a single "resting heart rate" - it keeps changing each time I try to measure it! Is this more-likely-than-not bad, or a crapshoot, or...? And, more to the point, does it have a name?

My psychiatrist was worried because each of my last few visits (every 2-3 weeks) has seen my heart rate between 100 and 110. She asked me to start checking my heart rate every day while not in the office (because I have anxiety every time I enter a medical facility, and I'm always in a rush because I'm late to everything all the time.)

Anyway, I've measured it at rest (sitting in a chair for 10+ minutes) at various times over the last few days, and the rate is dramatically different at each time. I've had everything from 68 to 110. This is from the cute little electronic device, which almost perfectly matches the one at the doctor's office (all three of my doctors' offices, actually, all of a sudden - it's apparently the gizmo of the moment.)

In the interests of providing details now so that I don't have to answer questioners:

1. I've been experiencing moderate-to-extreme vertigo and nausea a lot in the last few weeks, and was in the ER the other day; the triage nurse was worried about me having an "irregular pulse" but they didn't do any heart testing at the time.
2. The reason Doctor A gave when she asked me to do this was because of the like twelve CNS-affecting medications I'm on (everything from Adderall to Vyvanse, plus several anti-depressants and anti-convulsants and other stuff in between them alphabetically; I just started on Dramamine to combat the vertigo, plus Zofran - hey, all the way to the end of the alphabet, neat - for the nausea.)
3. I had an ECG at Doctor B's office in May because I nearly fainted twice in a week with no obvious reason. It was apparently normal enough, as, again, no further testing took place. Doctor B is my primary care physician, and I will be meeting with her on Wednesday to discuss this - I'm trying to be prepared for that discussion.
4. My sister and my mom both have "heart flutters," in my mom's words. Meanwhile, I have had multiple ECGs over the course of my lifetime and have easily spent a good 10 or 15 hours total with a human being trying to listen to either my lungs or my heart, and no one has ever given me any kind of a cardiac type diagnosis (the medical establishment is free and easy with giving me diagnoses, so I feel this is relevant.)

So, again, my question is: what do you call it when your heart seems to just, you know, never exactly stabilize at any one rate? And, is it possibly bad or almost certainly really bad or maybe just one of those things like "nausea" that hardly tells anyone anything at all (and no, I don't expect precision here)?

Note: the word "arrhythmia" isn't quite enough for this, because the trouble I have is figuring out the specific term for this random oscillation between different days, different times in the same day, etc., as opposed to the rhythm potentially being clearly irregular in a Morse code kind of way. I don't think this device is good enough to tell me whether or not my heart is doing anything super-erratic, though it does in fact jump up and down a lot - the oxygen level by 1 or 2%, the heart rate by up to 15 beats. I'm more concerned about the extremely large range I'm seeing over the course of multiple days.

Oh, and also, I typically see a very noticeable and near-immediate drop of easily 10 beats if I breathe slowly, which suggests to me that the device really is responding to actual changes in my body as opposed to it just being broken.

posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! to Health & Fitness (14 answers total)

24 hour Holter monitor is the only thing that's going to produce any answers here. Pulse oximeters are used because that's a separate billing code. It's basically worthless in your case. Sounds like you have a hereditary something that could be affected by your meds. I would speculate on what that something might be but it wouldn't serve any purpose.

I was originally going to discount this question as overreacting to normal variations in your heart beat, but there's enough grey area here to where a 24 hour monitor should be a cheap test and would tell the full story.

Most doctors have no idea what they're doing with EKGs, even for cardiologists it's the number one reason for failing their board exams, so it's not unusual you're having problems getting this diagnosed, especially with psych meds involved. Good luck.
posted by hobo gitano de queretaro at 4:19 PM on August 23, 2013 [3 favorites]

Best answer: Forgive me for not addressing some of the other points in your question, but if you are truly interested in your resting heart rate, you should be testing immediately upon waking naturally from sleep (i.e. not woken up by an alarm, another person, a nightmare, a cat breaking a glass, etc.).

That device looks good because you could keep it on your nightstand, slip it on as soon as you wake, and get a reading. You don't want to fiddle with anything complicated, and definitely don't sit up, stand, or walk around before testing. Do it a bunch of days in a row and see what happens.

What you're getting now is your ambient heart rate, which is extremely variable. Sitting in a chair, after being awake for any period of time, is not your resting heart rate, if that matters to you.
posted by peep at 5:11 PM on August 23, 2013

Have you kept track of when your heart rate is getting high? I would expect it's getting higher after ingesting the amphetamines you're taking. My uncle had a heart attack after taking Dexedrine for four years. Take this seriously because it seems like you are also at risk!
posted by oceanjesse at 5:50 PM on August 23, 2013 [1 favorite]

Response by poster: Have you kept track of when your heart rate is getting high?

That was the original point of this exercise, but it appears to have no particular relationship with when I take either medication (take them at 9am, it's 75bpm at 10am and then 94 at 1:45pm and then 80 at 3pm and then 95 at 10pm...) I skip the ADHD meds on most weekend days, so tomorrow and Sunday will be a huge help in figuring this out. The only med-to-BPM relationship I've found is that the Dramamine really lowers it for a while; it is significantly more effective than breathing slowly, though it doesn't seem to start right away.

(This is a big part of why I was concerned, actually: I expected the answer to be "it's higher about an hour after the meds than at any other time.")
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 5:57 PM on August 23, 2013

You may have what is called a sinus arrhythmia.
posted by tenaciousmoon at 6:51 PM on August 23, 2013 [1 favorite]

Respiratory sinus arrhythmia (RSA) is a naturally occurring variation in heart rate that occurs during a breathing cycle. Heart rate increases during inspiration and decreases during expiration. cite

IANAD, this is common, particularly in females.
posted by JujuB at 8:24 PM on August 23, 2013

Not to be a party pooper, but sinus arrythmia does not account for a sustained increased heart rate, only for minor variation between inspiration and expiration.
posted by SLC Mom at 9:24 PM on August 23, 2013 [1 favorite]

I used to have a Timex Ironman heart rate monitor, and I'd set it to audibly beep while resting. My lowest rates were when I had woken up peacefully from a nap, and was just laying there, drowsy and looking at the monitor. Any amount of movement is going to increase heart rate.

Also, there are heart rate monitors that do an assessment of your fitness by measuring the resting heart rate.
posted by SillyShepherd at 2:21 AM on August 24, 2013

Also, there are apps that record your heart rate. Some cardiologists recommend their use by patients who have arrhythmias.
posted by SillyShepherd at 2:24 AM on August 24, 2013

This is your HEART. Try taking ithe reading every morning at the same time and also, more urgently, find *another doctor* who takes your concerns seriously and will put you on a 24-hour wearable monitor. Do it now! (she says without meaning to have a nasty tone) It could be nothing, the kind of thing that is amenable to DIY home solutions, or it could be very serious.
posted by skbw at 7:30 AM on August 24, 2013

Yes, seek medical advice. Really.
But while you do, don't panic.

68 to 110 is not necessarily crazy variation. Coffee, telling a joke, tying your shoes or just being nervous that your heart rate might be high can raise your heart rate.

To reiterate what those before me said:
Resting heart rate needs to be tested consistently. Same time each morning, before you hardly move. It's useful for tracking training and over training. That number by itself doesn't indicate fitness or lack thereof. Changes in that number matter.

Just testing throughout the day isn't really providing you information that is interpretable by you.

So, again, what skbw said above
posted by cccorlew at 8:05 AM on August 24, 2013

Best answer: It is normal for your heart rate to vary over the course of the day. It is not an arrhythmia. Your heart is designed to go faster and slower based on various signals it's getting from your body - how hydrated you are, what your body temperature is, what time of day it is (various hormonal levels change throughout the day), and your medications, etc. This is how your body adjusts and ensures you are getting enough blood/oxygen to the right places at the right times.

Like blood pressure, when you're anxious, your heart rate goes up. And the more often you check it, the more likely it is to get higher and higher as you go into an anxiety spiral. I see patients doing this all the time.

I'm not saying there may not be something else going on here, I can't say anything about your specific case, but I do notice that you say that you get anxious every time you go into a medical facility and that you seem very anxious in this question. And that could theoretically affect why your "resting" heart rate is running high - you're not relaxed.

I will add that the most common other reason I see for tachycardia (fast heart rate, which is above 90 bpm) in a person who's otherwise well, is caffeine intake. Is that an issue for you?

All this said, with the stimulants you're taking, it's important to get this fully vetted, which you will when you talk to Dr. B this coming week. In the meantime, I'd honestly suggest not checking your pulse at all if it is making you more anxious to do so.
posted by treehorn+bunny at 2:34 PM on August 24, 2013

Best answer: I'm being tested now for a bunch of things including possible arrythmias. 15 points is well within the range for normal. If you've been checked and they haven't said something is up, you can always ask, but me and my kid who has also gone through the heart work-ups for a condition were told when we were all clear and when they saw issues immediately.

My heartrate fluctuates up to 50 points within an hour, complete with fainting and unpleasant stuff, and I've been told not to go to ER unless I go below 30bpm or have other stroke symptoms. They've given me a 24 hours halter test, ultrasounded my heart and done a lot of blood tests for blood disorders. I have been warded twice now for possible mini-strokes and I'm on a blood thinner. My cardiology appointments are easily 2-8 weeks apart because I'm a chronic case and not a critical case, so that's pretty normal for them to backburner you unless you present with something more serious - each time I go to the ER, my tests and appointments get more frequent.

Your heartrate is probably absolutely fine - it's super normal to fluctuate with anxiety, and 15 points is truly okay and a normal amount. It's quite common to have a slightly wonky rhythm too like benign murmurs, that feel fluttery and weird, but unless they are causing symptoms, they're just normal variations. Cardiologists see really weird hearts all the time, and if they say you're within normal range, don't worry about it.
posted by viggorlijah at 5:24 AM on August 25, 2013

Response by poster: Thanks, all.

Morning readings have been consistently between 58 (!) and 80, but unfortunately due to my trouble waking up and the need to find glasses before I can find anything else, it's been challenging to get a reliable "definitely resting, no sudden movements" reading. I stopped taking them so often after three days per the "your anxiety is probably making it higher" advice, which is probably the most accurate thing ever said to me.

Dr. B says they took tons of notes and things while I was in the ER, and also she had me do some squatting and other things while she listened to me, and it all seems OK to her. She also agrees that if I have another fainting spell or vertigo episode we'll do the tilt table thing and maybe the Holter monitor (she says I'll definitely hate wearing it.)

She also says it looks like the two stimulants together are adding about 5-10 bpm to my baseline (she's been seeing me since before I started taking them.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 7:05 PM on September 2, 2013