Heart rate goes up absurdly high in the morning, answers needed

Posted by Pri @someconfusedperson, Apr 29 6:18pm

Hi everyone,

To start with demographics, I'm a 22 y.o. female with a high-stress lifestyle (breadwinner of family, academic high-achiever, slew of trauma/emotional health issues). I was in the hospital for a month because of random bursts of sinus tachycardia, especially in the morning. It's like I would wake up and suddenly the heart monitor in the hallway would alarm and a nurse would come into my room being like, "are you okay?". I would feel strange — I wouldn't feel my heart "palpitate" (except when it gets to like 160-180, or if I stand up), but I would feel really warm and generally uncomfortable (as if I had a high fever, like I had with covid — when I went to the ER for a 104 degree fever, my HR was around 146 and I had that same exact feeling).

So in the morning, whenever I roll over, stretch, or change position without my beta blocker, my heart rate would usually climb by the 30s-50s. I remember doing this when I was discharged and one *lovely day* my heart rate soared up to 183 from 74, which prompted a visit from the paramedics and another 14-day hospital stay. I also have POTS, and my hospital journey began when I stood up and immediately passed out with a heart rate of 160 after getting out of bed in the morning.

I've associated this with "adrenaline surges" (which POTS patients sometimes get(?) but I'm not sure). I have hormonal issues (was diagnosed with hyperandrogenism) — which was pretty obvious to anyone, not even just doctors (acne, messed up periods, etc.). But the doctors were telling me that this hyperandrogenism and POTS/weird bursts of tach were unrelated (sure, lol). It's weird because I would just be calm, laying down, not really doing much, and my heart rate would flip out.

Medications: 200 mg acebutolol 1x a day (since then I've not been having much of these adrenaline surges — though I did on metoprolol –but the absurd increase in heart rate still happens in the morning), 10 mg midodrine 3x a day, Ativan 1x a day (because they injected me with that stuff every day while in the hospital to stop "seizure-like episodes" and I developed physical dependence on it — trying to wean off though). I was never on any sort of medication before all of this happened.

Test results: low-normal potassium (which I've always had), low vitamin D (always had), elevated androgens (always had), everything else normal

Other info:

– Sometimes I wake up feeling out of breath (as if my body literally lacks oxygen). This has been happening for a few years. I wasn't tested for central sleep apnea but I assume this could have a stress component to it.
– I would feel out of breath around the start or the very end of my period.
– I would get short of breath while just talking to someone (maybe because I talk fast, which my partner has observed).
– As I've mentioned previously, I had covid. I'd say it was a moderate case but the fever caused me to go to the ER. There could be some inflammation/damage from that. Maybe this POTS thing is long covid, who knows.
– I initially went to the ER the day before this crap fest happened for shaking/tremors and they gave me a beta blocker (this was my first time on a beta blocker, propranolol, and after having it, my heart rate got worse). I'm starting to think a withdrawl loop is a possibility because I wasn't able to take the full dose of the beta blocker (some of it got in my system).
– Endocrinologist felt my thyroid and found it was enlarged.

My normal resting heart rate is in the 80s. After recovering from covid, it shifted to the 90s/100s. And last month I couldn't even walk or sit up without passing out with a HR of 150 or something (sometimes I would pass out just laying down) — overall feeling awful. Answers much needed.

So I'm guessing there are multiple factors that are playing into this, but my guess is 50% physical and 50% mental (or maybe everything has a root in the overly stressed mind minus the covid). Please advise. I don't want to keep going back to the hospital.

Interested in more discussions like this? Go to the Heart Rhythm Conditions Support Group.

Long COVID? Thyroid issue? You could have a combo of things so it is hard to tease out. Your docs will need time I guess, This sounds awful! (I have episodic afib with tachycardia up to 180+ and know how it feels.)

I cannot suggest much but can only comment that you can get D3 up with supplementation (I take 3,000 a day, but you might need the mega dose to boost it). For potassium I drink low sodium V-8, which uses potassium instead of salt and is pretty high in it. This is for my heart. This may not address your problem but mentioning it anyway,


I will not repeat all I have dealt with, but it is here somewhere if anybody wants to go back and read. I really wanted to say that the feeling of adrenaline surges when I turn over in bed has been ongoing for years along with so many other symptoms. All the doctors, including all the heart tests, act like I am losing my mind. BTW I am a 77 yr old F. POTS, no way it is POTS. Heart is great. Lungs are great. Every test all good. Not Covid related. Never pass out or feel that way, but the shortness of breath has been so extreme that my lifestyle was completely changed. Mayo would not see me.


Have you looked to see if there is a Long Covid doctor group near you? Many of the university medical centers have Long Covid doctor groups. If there is a big university near you with a medical center, call them up and ask. They can help better determine if it is Long Covid related. They seem to have the most experience with all of these types of symptom clusters.


Consider a possible potassium/aldosterone dysregulation. Potassium evinces a diurnal cycle.

Here's an exhaustive & serious treatment of the subject…from the best Afib support resource in the world (not kidding): https://afibbers.org/resources/diurnal%20potassium.pdf


I get potassium from low sodium V-8 in the morning with granola bars. I am not sure if that article you linked suggested getting potassium in the evening.

Interesting that the person on that link said proton pump inhibitors help afib. I posted before about the link between upper GI and afib for me. I might pop a Pepcid tonight because my heart still feels a little wobbly. (Not afib.)

I also take magnesium. afibbers.org is a great site and where I got the low sodium V-8 idea in the first place. Now I am concerned about timing!

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