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A friend of mine, female, 85 has had a resting heart rate averaging around 140 for 3 weeks. She takes her blood pressure 3 times per day and keeps a journal including her heart rate. So the history is well documented. She is on medicine for high blood pressure.
She wasn't concerned because she feels great. No dizziness, sleep problems, or anything else. But after 3 weeks she thought it was wise to see her doctor. When she tried
to to book the appointment they (Kaiser) told her to go immediately to the ER, which she did.
The ER was concerned about her heart rate and did a bunch of tests. EKG, blood, etc and couldn't find anything wrong with her other than her heart is beating too fast. They gave her two different drugs in the ER and neither one lowered her heart rate. Because she wasn't having any symptoms like dizziness they sent her home with instructions to follow up with a cardiologist and to get an ultrasound of her heart. They also put her on beta blockers and blood thinners to lower risk of stroke until she can be seen by a cardiologist. They also changed her blood pressure medication.
Kaiser was trying to schedule her cardiologist and ultrasound appointments 6 weeks out. She kept calling and pestering them "I could be dead by then" until they finally agreed to give her appointments at clinics that were outside her area that were sooner. But it's still going to be a week for the ultrasound and two weeks for the cardiologist.
Since this started, her blood pressure is low, like 90/60. They switched her blood pressure medication, but she doesn't understand why she is on medication to lower her BP when it isn't high, and said she is going to cut her dosage in half. I suggested she only change medication under medical supervision, but then she reminded me that the only way she can do that without waiting weeks for an appointment is go to the ER, and they were the ones that gave the dosage.
She is a good advocate for herself and is continuing to try to get sooner appointments and will go back to the ER if necessary, so the normal responses I read over and over on this forum "she needs to see a doctor" will not be useful. I was just curious if anybody else has been down this road before and has anything useful to share.
We used to have Kaiser and they did great for the sniffles and day to day physical issues. But my wife had serious female problems that they refused to address, and she was in a living hell for a year. I switched to conventional insurance and her problem was solved with a 30 minute non-invasive minor surgery. Kaiser is very bad usually for serious ailments. It's like Kaoser physicians are being paid on the amount of patients that didn't get serious, expensive procedures.
My wife had a racing pulse a year ago and her blood pressure was "54 over dead". Her heart was fluttering, and they shocked her heart back into rhythm the next day. Then a few months later she had a heart ablation which was where they laser the inside of the heart to where a scar forms and electrical impulses don't go across scars.
Your friend needs to return to the emergency room if the cardiologist cannot see her immediately. She could croak on you very easily. If her cardiologist cannot fit her into his schedule the emergency room will have one on call.
90/60 is acceptable BP. The beta blockers should lower her pulse a bit.
I occasionally had episodes of PSVT (look it up) for about 20 years, where my pulse would get "stuck on high idle" around 140 bpm or so. The EKG would rule out this condition though. It would also rule out any other abnormal rhythm such as the poster above has mentioned.
Even with a "normal" heart rate of 140, it would be very difficult to relax I would think. No fun at all. Hopefully she will be seen by someone competent there on the Big Island.
90/60 is acceptable BP. The beta blockers should lower her pulse a bit.
I occasionally had episodes of PSVT (look it up) for about 20 years, where my pulse would get "stuck on high idle" around 140 bpm or so. The EKG would rule out this condition though. It would also rule out any other abnormal rhythm such as the poster above has mentioned.
Even with a "normal" heart rate of 140, it would be very difficult to relax I would think. No fun at all. Hopefully she will be seen by someone competent there on the Big Island.
As far as BP I had a a
a period where my PC couldn't control BP,it was on very high side,my cardioligist added 40mg of furosimide a diuretic which quickly brought brought it down and had to change it to 20mg.
For awhile it was 80/40 then 90/40,very light headed and shortness of breath,took awhile to get it to 100 and now at 128/55-60 for a long time now,I did this for the most part on my own.I am 90 with triple bypass. Furosimide was like magic,the diuretic part doesn't bother me any more.
Amazingly, the normal BP of all mammals is 120/80 (giraffes are an exception-- bp right at the heart is 220/180, but that reduces to 110/70 by the time it gets to the brain. Amazing set of mutations they've evolved to avoid the fibrosis usally caused by high BP)....
...We consider bp < 90/60 too low to adequately supply organs with oxygen and nutrients, and we call that "shock." Very slim people may normally have bp down around 90/60 and do well, but even a slight fall below that and they get dizzy too....
Some older folks need slightly higher BP than normal to get enough blood to their brains thru hardened, narrowed arteries. We need to compromise in treating them-- allowing BPs up to 160/90 to maintain mentation at the expense of slightly higher risks of strokes, kidney damage, etc.
Older folks are also very susceptible to the BP effects of diuretics. Kidneys get wrinkles too, so to speak. We retain salt & water more easily and when given a diuretic, we don't compensate for the dehydration as quickly, so diuretics are very effective.
One-Size-Fits-All is a lousy way to practice medicine.
BTW- back to the OP and the lady with a sustained 140 HR....Always a problem that needs immediate atttention. HR 150 is almost always PAT. Hers it's a little less,, so more than likely PAT with block., which could deteriorate into a fib and the high risk of stroke.
This is usually due to accessory pathways and may need ablation. Randomly trying drugs to slow the rate may have an unpredictable, paradoxical effect and is not a good idea except while the pt is monitored on a cardiac unit in hospital.
My heart rate suddenly went to 168 three years ago. They stopped and restarted my heart, but that did not fix it. They finally gave me some meds and I am now on a low dose of amiodarone and it usually stays in the low 60s. A cardiologist told me that heart rate is not usually dangerous until it gets over 150. they were concerned with me because my resting rate has always been around 53. It sure is uncomfortable for me when it is above 90.
It's a crime how BO-Care changed the practice of medicine. Docs are almost exclusively on salary now, so no incentive to see more pts, PLUS reimbursement is based on time spent with the pt-- the corp is paid just as much for seeing one pt for 60 minutes as six pts for 10 minutes.
Luckily (so far) this pt's case hasn't deteriorated into an unsustainable, fatal tachycardia or compromised coronary circulation and induced an MI or if actually not a regular rhythm (hard to tell on an EKG with rate this fast), thrown off an embolus.
Unlikely that a pulm embolism is the cause after this long, or that something like an AV fistula has first shown itself now. Maybe "apatheitc" hyperthyroidism (not uncommon in the elderly)? If her BP hasn't always been this low, maybe just simple dehydration or other cause of hypotension?..She needs a good work-up.
My heart rate suddenly went to 168 three years ago. They stopped and restarted my heart, but that did not fix it. They finally gave me some meds and I am now on a low dose of amiodarone and it usually stays in the low 60s. A cardiologist told me that heart rate is not usually dangerous until it gets over 150. they were concerned with me because my resting rate has always been around 53. It sure is uncomfortable for me when it is above 90.
Did you get a name from the cardiologist to describe your tachycardia?
If PAT, now more commonly known as PSVT, then there is a procedure that can be done to "fix" this so you wouldn't need to take medication.
The woman OP describes does not have this condition. EKG ruled it out.
My BP, according to home monitor, frequently falls below 90/60. First thing in AM and after going for a run. I rarely feel faint at these times, but also don't feel real lively either. Age 64.
Last edited by Arktikos; 04-29-2023 at 09:36 AM..
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