Can Elevated Heart Rate Cause Rigidity In The Arms?

Posted on Thu, 27 Jul 2023

Question: My 92 year old aunt was given Risperdal to counter delusional reaction to Adivant in the hospital. It worked and she only took it 3 weeks. Now she is in deep a fib and her arms go into rigid state when her heart rate goes above 100. Are these connected? Will this go away? She take some Metropolol .25 mg

Answered by Dr. Sagar Makode (15 minutes later)

Brief Answer:
Unlikely to be related to a fib

Detailed Answer:

Hello,

Rigidity in arms does not occur with afib. If heart rate increases too much say in 130s then she may get shortness of breath, dizziness or Chest pain etc, but to have rigidity in the arm is unlikely.

However, it's possible that rigidity is a primary problem, and may occur with risperidone, and due to this heart rate is increasing.

Now, if her rate is continuously staying in a higher range and rising above 100 then the dose of Metoprolol should be increased. She should additionally have 12.5 mg at Evening 8 pm as well (in addition to morning 25 mg) which can further be increased depending upon the response. Also, she should be on a blood thinner like xalreto to prevent the risk of stroke. So you need to discuss these issues with the local doctor and get the medicines prescribed. So we can additionally see the response of controlling heart rate in relation to her current symptoms.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Sagar Makode, Cardiologist

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sagar Makode (1 hour later)

Thank you -
If the arm rigidity is caused by Risperdal then how long could we expect it to still be in her system and causing it? She weighs about 100 lbs and has been off the Risperdal for 3 weeks

She was on 1 mg of Risperdal

Answered by Dr. Sagar Makode (8 minutes later)

Brief Answer:
So unlikely to be caused by risperidone

Detailed Answer:

Hi,

So 3 weeks is sufficient time for drug elimination. So it's unlikely to be caused by risperidone, but the possibility of withdrawal may be there, or other causes for these abnormal movements have to be found. You ll have to seek neurologist opinion on this. However, it's unlikely to be related to afib, and discuss regarding blood thinners and dose escalation of Metoprolol.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Sagar Makode, Cardiologist

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sagar Makode (20 hours later)

I’ve read of the side effect of Risperdal - NMS she has the rigidity symptom, no fever but elevated heart rate. her seizures were stronger the first week off the (1mg) of Respirdal and less bad last week. She has been off the meds for 15 days now. Can this go away by itself or does she need to be hospitalized? She did not have an episode at all yesterday and is having one now where her arms are extended out and she feels sore and has the sensation of falling. Her bp is normal 120/80 and heart rate around 103. Can this get better on its own or does she need to be hospitalized?

Answered by Dr. Sagar Makode (25 minutes later)

Brief Answer:
Likely to be rebound dystonias

Detailed Answer:

Hi,

These are likely to be rebound dystonias which follows withdrawal of the medicine. Unlikely to be neuroleptic malignant syndrome. These usually persists for few weeks and resolves later. I don't think, admission is must but it's better to get her evaluated and get medicine prescribed to antagonise dystonias.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Sagar Makode, Cardiologist

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sagar Makode (2 hours later)

Thank you! This sounds much more likely. Reading treatments I’ve read Benedryl listed as one. Could this be prescribed if other meds with more side effects are detrimental? Also - would you still agree that the Metropolol should be increaed with the additional dosage? In other words is the Dystonia actually what triggers the increased heart rate (up from the normal 70s range yesterday to 103-107 today) and treating that would be better than increasing the Metropolol or would both be good to do?

Answered by Dr. Sagar Makode (11 minutes later)

Brief Answer:
Certainly, she can have Benadryl

Detailed Answer:

Hi,

She may have Benadryl 25 mg three to four times a day if not developed any side effects and till this resolves.

Dystonias or any abnormal movements for that matter may increase the heart rate, but this will be limited to the period of movement only. Once it's settled then heart rate should come down. But, the sustained elevated heart rate just indicates the inadequacy of dose.

So if she is having heart rate more than 100 throughout the day then its better to escalate Metoprolol gradually in order to keep her heart rate in the range of 65-80. So it's better to escalate Metoprolol.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Sagar Makode, Cardiologist

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Sagar Makode (4 hours later)

Thank you.
Doctor ordered Benedryl so she took 25mg at 1:30 and will take a dose around 6 and then tonight. While yesterday was perfect (normal vitals and no rigid episodes) she has had the rigid state all day and heart rate consistently between 95 and 104. Will the doses of Benedryl have any building effect? The 1st dose 3 hours ago has only lessened the rigidity a little so far. Dr wants to wait to increase Metropolol to see if the Benedryl helps relax the muscles. My aunt can’t tolerate stronger muscle relaxers now so do you think the Benedryl will start to help?

Answered by Dr. Sagar Makode (4 hours later)

Brief Answer:
Yes, Benadryl effect will come gradually

Detailed Answer:

Hi,

Ok, so we can wait here for Benadryls full effect come, it sometimes may take a week or two. If she doesn't develop any significant side effect, we'll increase the frequency and dose until her tolerance. You can give it four times a day from the next day. If your doctor wants to wait, it's fine. There is no emergency in that. Also, discussion of the need for blood thinners.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Sagar Makode, Cardiologist

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Sagar Makode (7 hours later)

When the arms and legs are in this state for minutes or hours - is it helpful to try to gently manipulate the limbs to help keep them flexible? Does it help the muscles even if there is initial discomfort for the patient?

Answered by Dr. Sagar Makode (1 hour later)

Brief Answer:
It can be done, but may not help significantly

Detailed Answer:

Hi,

Manipulation may be done, but take care to avoid excessive force in order to reduce chances of trauma. So gently, you may manipulate. But, such manipulation may not help significantly to reduce the intensity of dystonias.

Hope I have answered your query.

Regards,
Dr. Sagar Makode, Cardiologist

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Above answer was peer-reviewed by : Dr. Remy Koshy