Concern for rapid morning heartbeat
DEAR DOCTOR: Every morning upon waking, I feel an even/steady pulsing of about 200 beats per minute, although my pulse is normally about 60 beats per minute. I’m 84, take no medications and have no aches and pains. What could be causing this, and should I be concerned?
DEAR READER: Yes, you should be concerned. At 84, even with extreme exertion, your pulse should not be so high.
The pulse rate can be affected by, among other things, disorders of the atria. Atrial fibrillation, a haphazard rhythm of the atria, can indeed produce pulse rates of 200, but not the even, steady pulse that you describe. Atrial flutter, a regular rapid beating of the heart that, like fibrillation, can originate from multiple parts of the atria, is possible but perhaps unlikely. Atrial tachycardia, a regular rapid beating originating from one section of the atrium, can cause rates of 200, so this is a possibility.
Disorders of the ventricles also can cause a very rapid heart rate. Ventricular fibrillation, like atrial fibrillation, is a disorganized rhythm of the heart and the
leading cause of sudden cardiac death. Due to your lack of symptoms and the regularity to your pulse rate, this seems unlikely.
Perhaps most likely is ventricular tachycardia, which has a regular rhythm with rates greater than 100 and can have rates as high as 250. Besides having a fast heart rate, those with short bursts of ventricular tachycardia may not feel any other symptoms.
We also have to consider the fact that this happens only in the morning. That takes us to our bodies’ circadian rhythm, which means the core processes of the body fluctuate depending upon the time of day. For that reason, increased blood pressure, heart rate, blood vessel constriction and clotting are greatest in the morning. Similarly, heart attacks are more frequent in the morning, as are ventricular fibrillation and tachycardia.
See your doctor, who can order a heart monitor to measure your heart rate and determine what type of rhythm is causing this.