Hello all!
I just found this forum, and just reading through all the posts I find it immensely informative and helpful. Would love some input on my situation:

First, I'll admit right here and now that I've recently gotten over (or getting over I guess) some hypochondria issues. About last August or so I started waking up feeling shaky and fatigued and feeling like I had the flu, and then the heart palpitations started, and haven't really let up since. I went through a long period of er visits/hospital stays getting cardiac work done to see if there was a problem. Now, while I readily admit that during all this I had major health anxiety, I was never really the type to be unsatisfied with tests and blood work and such. I trust my doctors when they tell me nothing is wrong with me (which so far is the case, thank god), my only issues are the physical somatic symptoms that I'm still coping with, though much better these days than before I am thankful to say.

Anyways, I do get frequent palpitations but having had several EKGs, a Holter Monitor, and an Echo, along with extensive blood work testing like CBCs, thyroid function, and a bunch of other stuff I can't remember (D-dimer, does that sound right? I refuse to google these things anymore haha), it all came back completely normal. The Holter I was told was "normal" but I don't know what that really means, like was it normal just because they didn't find any arrythmias, or was it just perfect all around? Anyway, not a concern. I'm certain that my palpitations are ectopic beats, but they bother me less and less, and go figure the less I let them bother me the less frequently they occur (though sometimes, as many of you know, it's unavoidable).

Anyways, just wanted to include a little backstory. My question is actually about resting heart rate, and I'm more just curious than anything. I get episodes of what feels like to me very fast heart rate (and having taken my pulse during them it goes into the 140s-150s, which comparatively I know is on the low end for tachycardias, but it's still scary), and I've had ekgs done during them, though never at the apex (didn't have one on the Holter sadly) and it's always been a normal sinus rhythm. When I'm totally relaxed and calm my resting heart rate is 85-100, which is normal I'm told, but some days it's never below 105 or so, and like I said I have these episodes where it skyrockets and I'm not particularly anxious during them. My doctor is hooking me up with an event monitor now, just to make sure we aren't missing something, but I have a feeling that it's going to show all normal sinus rhythms.

These episodes don't causes me any pain or discomfort per se. My blood pressure also usually skyrockets during these episodes as well (which just from 11th grade anatomy and bio, wouldn't you expect the opposite?), and sometimes I get a feeling like I can't take a deep enough breath, but I hear that can be pretty common among people who've had anxiety. The reason I'm posting is just out of curiosity really, is this the kind of thing that could be doing me harm? Is there anything suspicious here, or not really? My doctor's don't seem that concerned, especially since they haven't found an arrhythmia. They happen sometimes as soon as I wake up from bed, or when I'm doing housework or simple stuff, never during exercise or anything like that. I only even notice them because 1) I start getting palpitations or 2) the remnants of my constant pulse checking, which was an ocd feature of my hypochondria I've almost completely eliminated, come back and haunt me, and sometimes I give in and notice my fast pulse. Of course, having googled in the past I've heard of Inappropriate Sinus Tachycardia, but tend to think what symptoms I have are somatic rather than cardiac. But I'm really curious for input! My guess is that this kind of thing is normal, but I just don't know. That said, I could name probably 20 life threatening conditions it "could" be because I have a cracker jack memory and haven't forgotten all the stuff I used to google, but that would be useless of course. Also, I tend to ramble when I write so if anything wasn't clear just ask.

Okay, I've read your posting and concerns.

First of all, it's very important to realize that as physicians, we don't need to "catch" the events troubling you in order to determine whether they constitute anything problematic. What we look for on the ECG and other definitive tests is more about what's not there rather than what is, if you see my point. For patients to be experiencing true cardiac arrhythmias, it is the cause of those patterns which is evident to us rather than the subsequent ECG patterns themselves. The rhythm is incidental to the cause. It is only the patient who needs us to "see" and confirm the events as benign in order for them to become reassured. The point here is to not be sad or disappointed that the events did not arise, which incidentally is clinically significant since true pathology is incapable of evading detection upon examination, whereas anxiety-induced palpitation events rarely occur under exam because they driven by functional, or non-organic, causes.

Resting heart rate certainly varies between individuals and a constant resting rate in the 150 range can arise from a variety of factors, even circumstances as simply as dehydration. If thyroid values are all normal, then increased sympathetic tone as a consequence of anxiety, fear and stress can certainly sustain such a rate in the absence of exertion. Sedentary lifestyle can also contribute to a higher resting rate.

To address your concerns, simple sinus tachycardia cannot wear out your heart prematurely and does not induce late effects such that you will be compromised later in life.


Best regards,

Rutheford Rane, MD (ret.)