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What Causes High Heart Rate?

Posted on Sat, 26 Jul 2014

Question: I need a question answered about exercise and my heart. I am a 50 year old female who has a lot of weight to lose. I do have type 2 diabetes, but with diet and meds my A1C level is currently 6.8. Although I take an evening walk, I will be TOTALLY honest when I say that it is more like a 45 minute stroll with friends. Losing weight is all about amping my exercise program. Here is the problem I am facing. I have a high heart rate. A walk around the block can raise my heart rate to 180 bpm. I was grocery shopping and the visiting nurses association were taking blood pressure for free. Just walking around the grocery store my pulse was 150 bpm. I recently was in XXXXXXX DC on vacation. As I was walking up the hill to the Tomb of The Unknown Soldier, I became light headed, dizzy, and short of breath. The next day I had the same problem at Mount XXXXXXX I found it very hard to catch my breath this time. Two months ago, I tried to take a beginning zumba class and had the same symptoms. The instructor said she was not comfortable with me in the class and refunded my money. If I keep my afternoon walks somewhat leisurely, I have an increased heart rate, but the other symptoms aren't there. I am at a loss of what to do. I need to lose weight, but I am unsure as to how much I can do. What advice do you have for me??

Answered by Dr. Binu Parameswaran Pillai (6 hours later)

Brief Answer:
Hello

Detailed Answer:
Hello,
Good day.
Noted your symptoms.
You symptoms seems to be exertional dyspnea which is likely to be due to excess weight. However, I must say that we have to rule out ischemic heart disease. Angina typically present like this. In a diabetic, angina usually appears like this and they may not have chest pain on exertion. This is called as angina equivalent.

Are you on any blood pressure medications? Do you smoke ? Alcohol ?
HAve you had a recent cholesterol test done?

I would strongly encourage you to avoid exertion and heavy exercise at this stage. You may please start on aspirin 75 mg once daily and please get an urgent lipid profile ( cholesterol) done. If that is abnormal, you will need aggressive cholesterol lowering pills as well. You also may need a pill called beta blocker ( atenolol etc) which can reduce heart rate and will protect the heart.

Please meet a doctor soon to arrange for a stress test ( TMT) and only after that you should embark on exercise to reduce weight.

Reduce your salt intake and carbohydrate intake.

I would appreciate if you could answer my above questions.

Regards XXXXXXX

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

Follow up: Dr. Binu Parameswaran Pillai (49 minutes later)

Here are the answers to your questions.
These are the results of my lipid panel taken 6 months ago.
Cholesterol 215
Triglycerides 167
HDL 46
LDL 136
VLDL 33
Chol/HDL Ratio 4.7

Although these are high, my numbers are trending lower.

Enalapril 5mg QD. - b.p.
Simvastatin 20mg QD. - cholesterol
Amitryptiline 100mg QD - migraine prevention
Lantus 25 units QD
Victoza 1.2 QD
Glipizide 5mg bid

I do not smoke and my alcohol is very small. I will have a drink with dinner on the weekend.

Although there is no heart disease in my immediate family, I have had 3 female first cousins die of heart disease before their 50th birthday.

If you need any other information, I will gladly provide it.

Thank you

Answered by Dr. Binu Parameswaran Pillai (21 minutes later)

Brief Answer:
Hi

Detailed Answer:
Hi,
Thank you very much.
I would consider that LDL and Tg to be high for a diabetic. We prefer to keep LDL < 80 and Tg < 150. You HDL however seems to be good.

Simvastatin is a weak statin and its use is sort of less preferred now a days. We do have better and powerful statins which not only bring down the LDL, but increase HDL as well. Apart from that, they reduce mortality. ( eg: Rosuvastatin, Atorvastatin etc).
I would advice you to be on Atorvastatin 20 mg or Rosuvastatin 10 mg instead of Simvastatin.

As we are considering angina here, I would also advice you to reduce Amitryptilline.

You are on Victoza, which helps to lose weight. But I was wondering why you are not on Metformin ? It is such a wonderful drug that it improves diabetes, protects heart and recent evidence shows that, it even protects against certain cancers.

I hope your BP is well controlled with Enalapril. Strongly recommend to add Aspirin as well.
As I mentioned earlier, we should try to get an ECG and stress test ( TMT) soon. Till then, please limit your exertion and avoid heavy exercise.

Regards
Binu

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

Follow up: Dr. Binu Parameswaran Pillai (13 minutes later)

When I was first diagnosed with diabetes in 2012, I was put on metformin and it worked wonderfully, the gastrointestinal side effects were horrible. I even tried the extended release metformin and I was still having diarrhea 2-3 times a day. As a teacher, this just was not acceptable. Metformin was ruining my life.

I will discuss all of this with my doctor at my next appointment.

Thank you!

Answered by Dr. Binu Parameswaran Pillai (3 hours later)

Brief Answer:
Hello

Detailed Answer:
Okay. Yes, metformin tend to cause gastrointestinal side effects in some people. With extended release preperation, the chances are lesser. Most of the symptoms improve over a period of 2-3 weeks. But i realise your problem with Metformin.

You are welcome to ask more questions. But if you have nothing more to ask, you may please close the query.

Wish you good health

Kind regards
Binu

Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

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