What Causes Fast Heart Rate Despite Having Normal Stress Test And ECG?

Posted on Mon, 25 May 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 25 May 2015 Answered on

Thu, 11 Jun 2015 Last reviewed on

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. Ilir Sharka (5 hours later)

Brief Answer:
Your symptoms are probably caused by anxiety

Detailed Answer:
Hello!

Thank you for your question on HCM!

Regarding your concern, I think that your symptoms are caused by anxiety. As you refer all the cardiac tests you have performed during this period are within the normal limit for a healthy person.

I would like to know if you have had any psychological or physical stress during the last days.

It is normal to have tachycardia in this values during physical activity and anxiety. During activity and psychological stress adrenaline is released from the body causing increase of the heart rate and also some PACS and PVCS.

The bradycardia during sleep is normal, due to the predominant function of the vagal nerve during sleep.

The number of PACS and PVCS in your Holter is within the normal limits .

So I think that there is nothing to worry about in your situation! Just relax and take it easy!

Hope to have been of help!

Feel free to ask any questions whenever you need! I am at your disposal whenever you need.

Greetings! Dr. Iliri

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

Follow up: Dr. Ilir Sharka (5 hours later)

Hi doctor thank you for answering. Im just worried because it seems like every time i exert myself to go up the stairs now my heart starts racing. Last night after climbing up the stairs my heart rate stayed that high for approximately 5 minutes. Could it be that now im always thinking that my heart will start racing when i go up the stairs? So my anxiety can be causing it to happen. I do have the tendency to check my pulse after climbing the stairs. I know my tests were in normal limits i just cant figure out why i have these scary symptoms. Also is it safe to have a heart rate like this for 5 to 10 minutes? Does it do damage to the heart?
Also I have been under stress lately as I have a lot of issues to solve such as moving out of my house, losing my job etc... I would like to ask can stress be a cause for tachycardia and bradycardia and I am starting a meditation course. Do you think this will help

Answered by Dr. Ilir Sharka (18 hours later)

Brief Answer:
It is normal for tachycardia to last up to 10 minutes.

Detailed Answer:
Hello again!

It is normal to have tachycardia for up to 10 minutes after physical activity or a panic attack, because the levels of the adrenaline released during the physical activity are still high. It takes up to 10 minutes to our body to metabolize the amount of adrenaline. This happens in every healthy person. It doesn't damage your heart.

I also think that anxiety is making these episodes of tachycardia more frequent, because it increases the amount of adrenaline in your body.

So I think that a meditation course would be very helpful to you to control your anxiety.

I would also recommend to try to relax. Everything seems to be OK with you. There is nothing to worry about.

Hope to have been of help!

I am at your disposal for any other questions!

Greetings! Dr. Iiri

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Ilir Sharka (15 hours later)

I get episodes where my heart starts racing around 170bpm especially after doing minimal exertion. For example climbing the stairs. This worries me the most.

Today I did a lot of walking to get some physical activity and I felt great. However, after I went in my car and drove to my parents house I started getting fast heart rate when I got out of the car and started walking again. Could it be anxiety causing these palpitations. I've had so many tests done on my heart and everything seems to be normal. I don't understand why I would get palpitations after exercising and resting

Answered by Dr. Ilir Sharka (14 hours later)

Brief Answer:
This is a normal reaction of the body to anxiety and physical activity

Detailed Answer:
Hello again!

I think that these episodes of tachycardia are caused by anxiety. Anxiety like physical activity raises the amount of adrenaline produced by the body during this situation. This can cause an increase in your heart rate in these values.

This happens in all normal persons. So this is not happening only to you. You are just more attentive than other persons to what is happening to your body all the time.

I assure you that there is nothing to worry about.

I recommend you to relax and try not to pay attention to these things.

Hope to have been helpful!

Feel free to ask any other questions whenever you need!

Greetings! Dr. Iliri

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Ilir Sharka (36 minutes later)

Doctor 1 last question and then I will close the discussion as I am leaving for a three day holiday tomorrow. I was just wondering why on certain days I will have more bradycardia than others and if this bradycardia is normal. For example I will have a slow heart rate some days even while standing it feels very light and slow. Then on other days it's more pronounced. My tests don't show anything significant but is this normal? Also will the bradycardia get worse? Thank you for your time

Answered by Dr. Ilir Sharka (33 minutes later)

Brief Answer:
I wish you a pleasant holiday!

Detailed Answer:
Hi dear XXXX!

I would like to let you know, that you are going to have normal sinus tachycardia, as well as bradycardia time after time, during your life. And this is going to happen again and again, because that is the way a normal heart reacts in different situations, and a normal body is functioning.

This is all normal behavior.

I don't believe bradycardia will get worse, at the point it is going to produce clinicallly important complains. So relax!

Wish you a good health! Dr. Iliri

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Ilir Sharka (26 minutes later)

Thanks so much doctor.

Answered by Dr. Ilir Sharka (3 minutes later)

Brief Answer:
You are welcome!

Detailed Answer:
You are welcome!

Above answer was peer-reviewed by : Dr. Neel Kudchadkar