Q. When I stand up quickly, my heart rate jumps. How to fix it?

Answered by Dr. Muhammad M. Hanif Md. and medically reviewed by iCliniq medical review team.

 

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Hi doctor, 

I am a 26 year old healthy male. My height is 178 cm and weight is 73 kg. I do exercise regularly and I am healthy too. I have recently visited a cardiologist and done a cycloergometric test (Bruce stage 4 protocol). During the test my blood pressure remained normal but my heart rate increased very high to a level of 194. Without the ability to regulate my pace I felt as if I hit the wall. I felt very lightheaded, slight blurry vision and tingling sensation in legs. When I run the same thing happens every time, so it is not a single occurrence. My resting blood pressure was 132/80 mmHg. Sinus rhythm in ECG was 113 per minute. During the test we exceeded the maximum load of 5% and 111% maximum heart rate for the candidate's age (194bpm). Blood pressure increased to 160/60 mmHg. Base ECG at maximum load does not change much. Blood pressure was normalized in two minutes. 

When I stand up after sitting for a while, I get blurry, black out vision which is often severe. My breath is quite shallow. I feel tired most of the time and muscle fatigue. The symptoms always worsen when hot or dehydrated. I did the "standing up test" on my own. I measured my heart rate while I am sitting relaxed for several times which are 62,64,67,70 and 73. Zero to two minutes after standing up the values are 74,88,90,97 and 93. After two minutes it is 77 and after five minutes it is 84. There is an increase of around 30 bpm in the first two minutes. Quickly going from lying down to standing up heart rate jumps from 63-105. What causes this and how can I fix it? So far I tried to increase my water intake. I have tried drinking a lot still I feel dehydrated. I also tried increasing my salt intake.


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Dr. Muhammad M. Hanif Md.
MBBS
Cardiology, Critical Care Physician, General Medicine, Internal Medicine

Hi,

Welcome to icliniq.com.

I have worked through your query and understand your health issues. I assure you not to worry as you have consulted the appropriate expert physician who will take care all of your medical concerns.

  • Your body mass index looks normal for this age. Thanks for attaching your EKG (attachment removed to protect patient identity) and is totally normal after fulfilling all the criteria. Your cycloergometric cardiac stress test and case history is a bit abnormal one, showing high heart rate.
  • You seem also to have orthostatic hypotension. So, I suggest when you get up from lying or sitting posture, do it slowly and with a pause. Do not just get up so quickly. It will help you a lot. Pressure stockings will also help keep the blood pressure less pooled to lower extremities and dependant parts of body.
  • Keep yourself hydrated. Use Pedialyte instead. It is best and a balanced drink for you. Do not take extra salts from now.
  • I would request you to go for a new complete blood count with differentials, screening test for hemoglobin S, kidney function tests, liver function tests, fasting blood sugar levels and fasting lipid profile test from laboratory and follow me up by uploading the results.
  • Also do check your blood pressure three times a day and keep a record with dates and time for almost three days and upload that chart too in a detailed follow up.
  • After I get the aforementioned workup I will be in a better position to treat you based on evidences and with a correct reason in mind behind your illness.

Revert back with the laboratory reports to a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

 

Hi doctor,

I have attached the blood and urine test that covers some of the things you asked for. For all the rest of the tests, I do not have access right now. I would have to wait a few months to get my turn. Here is my three days blood pressure and heart rate respectively. Day 1:- 12:00 - 105/40 and 76 bpm, 18:00 - 110/65 and 74 bpm and 20:00 - 115/70 and 78 bpm. On day 2, 12:40 - 110/70 and 72 bpm, 18:15 - 115/80 and 80 bpm and 22:40 - 115/70 and 74 bpm. On day 3, 12:56 - 115/80 and 75 bpm, 18:53 - 115/75 and 72 bpm and 23:59 - 115/70 and 74 bpm.

 

Dr. Muhammad M. Hanif Md.
MBBS
Cardiology, Critical Care Physician, General Medicine, Internal Medicine

Hi,

Welcome back to icliniq.com.

I appreciate your efforts for taking your blood pressure regularly and making a chart of it. I have thoroughly gone through your attached reports (attachment removed to protect patient identity) and can well understand your genuine concerns.

  • Almost all of your blood work is normal. Your liver is also doing great. Lipid profile is also good. Your blood pressure and heart rate are normal and there is nothing wrong with that.
  • You have no major cardiovascular disease as far as your case suggests up to now.

Investigations to be done:

1. Echocardiogram.
2. Screening test for hemoglobin S.
Once you have received the reports check in for follow up.

Preventive measures:

1. You already have high serum electrolytes levels. So, do not take extra salt as I already mentioned in my last answer.
2. Take plenty of plain water. No added sugar, soda, coffee, tea and chocolates.
3. Regular physical activity is needed. At a healthy pace you need 10,000 steps daily at least 3 to 4 times a week. Use Fitbit, smartwatch or smartphone as a pedometer.
4. Do not get up fast from lying position. Take small steps from lying to getting up.

Regarding follow up:

Revert back with the investigation report to a cardiologist online.---> https://www.icliniq.com/ask-a-doctor-online/cardiologist

 
 
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