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What causes a high resting pulse and what should be done?

General responses to selected questions from Joel Braunstein, MD, of Johns Hopkins University and Joseph Toscano, MD.

Question:

I am asking this for my father who is 85 and lives in a different state. My father had an EKG today which appeared "normal" but his pulse is high --100+. His blood pressure seems to be "ok" 100/85, 120/90.(He has been on blood pressure med. I do not know which one.) What medical condition occurs when you have a "high pulse" Or what could be causing this and what should he be doing about this? Thank you for helping me help him.

Answer:

Short of having a pulse that exceeds 100 times per minute, your father is to be commended for having a "normal" EKG at the age of 85. The presence of your father's rapid heart rate, however, warrants some attention. Without having seen your father's EKG, I am assuming that the cause of this rapid heart rate is sinus tachycardia. Normal sinus rhythm, with a rate between 60 and 100 times per minute, implies normal cardiac electrical activity. When the sinus node begins firing electrical stimuli at a rate faster than 100 times per minute, sinus tachycardia is said present.

Sinus tachycardia typically occurs as a result of some bodily stress, which causes the heart to beat fast enough to address the body's increased energy demands. Conditions classically recognized to cause sinus tachycardia are anemia, fever or serious infection, overactive thyroid function, acute blood loss (as in hemorrhage) and dehydration, pulmonary embolism, chronic deconditioning, anxiety, and various medications. Many times, one of these conditions is easily recognized as a predisposing risk factor for sinus tachycardia. Correcting this underlying factor often resolves the sinus tachycardia. For those cases that don't resolve, an intrinsic abnormality of the sinus node may be present and require further evaluation. In this circumstance, medications may prove helpful to slow the sinus node and relieve symptoms.

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