Strange medical question that is annoying me as I can see both sides

[JetTail]

It's probably a very straightforward answer but I am not thinking straight tonight and the nurse has confused me, though that could be because I have had very little sleep in the past week or because I am exceptionally thick.

My Dm was started on a new medication 2 weeks ago while in hospital and she seemed to react badly to it so they had to take her off it. The medication sent her blood pressure and pulse very high. It settled down when they took her off the medication the next day. I think her blood pressure was 149/90 and her heart rate or pulse was 140 at its highest. They waited until they were sure those measurements were normal before discharging her. They specifically wanted the pulse rate under 100.

This afternoon we had to bring her to A&E again as she seemed very faint and unwell. This time her blood pressure was normal but her pulse rate was 117. Having been examined, and blood tests taken they have sent her home.

I asked the nurse was it ok to send her home when her pulse (or heart rate or whatever it should be called) was very high. The nurse said that it wasn't very high at all. I said that they wouldn't let her home 2 weeks ago until it fell below 100, so why were they sending her home now when it is 117. The nurse said that it was an issue the first time as it was due to medication, but that it's not an issue now as it has nothing to do with medication. I tried very badly to ask why it could be dangerous 2 weeks ago and not dangerous now. She just kept telling me that it's not that high.

I am trying really hard to understand this. I don't have any medical knowledge so I am probably just not grasping something simple. What I can't understand is why her pulse had to be below 100 to be discharged 2 weeks ago but today it was 117 and she was not admitted at all.

I'm trying to see how the high heart rate is a problem one week but not the next. Could somebody explain it to me? I would have thought that it's an indication of something (the pulse rate). I suppose I'm thinking about it as a symptom rather than a thing. Gosh I can't even try to explain why it seems to me to be the same thing.

To me, it's a value, so it either is or is not a concern. But in trying to understand the nurse, I think she was sort of saying that the cause of it is the important thing. Maybe like if you have a really bad headache and it is caused by dehydration and the next week you have a really bad headache but this time it is caused by something serious like a brain hemorrhage or something.

They don't know why her heart rate is so high again but I really don't understand why it's not an issue this week when it was 2 weeks ago?

I have no idea whether I'm even making sense right now as the nurse got frustrated with me earlier because I just couldn't understand her explanation of a high pulse not being an issue when caused by one thing, but it's an issue when it's caused by a different thing.

LOL. I'm not even making sense to myself right now so if anyone can understand what I'm asking I would be grateful.

I think I have repeated myself about 10 times in my post. Apologies.

I can sort of understand why they'd want it to go right down after medication had induced high blood pressure - to cover their backs more than anything else, but possibly to ascetain it was the result of the medication.
I20 is higher than normal, but as it's not the result of an adverse reaction to medication, they seem to have decided that it's not concerining enough to admit her.
given high blood pressure can be caused by stress, and still presumably concerns about covid, they probably feel that she is better off in her own home - it's a shame that they didn't have time to discuss it properly with you or your mother.

2 weeks ago her high blood pressure and high heart rate was caused by the medication. They wanted the heart rate below 100 as proof that the medication was out of her system and she was no longer suffering from the reaction she had to the medication. A heart rate of 117 is raised but could be anxiety or if she has a fever or just age related because she isn't fit so any exertion will cause it to rise. The heart rate is raised for a different reason than it was 2 weeks ago. If they have done tests and there is nothing that needs treatment then they will discharge her

So a high heart rate in and of itself is not dangerous? I suppose I am thinking of it like a high temperature. There's a normal range and then there's a fever. If there's a fever, you need to find out why so that you can treat it. Is a high heart rate similar or entirely different?

I really should go to bed I think lol because I think a professor could come and try to explain it to me right now and I would not understand

I think you've explained it well yourself OP. The heart rate itself isn't concerning, you could make your own heart rate go up that high by going for a run or whatever it won't harm you. 2 weeks ago they were using the heart rate to find out whether the medication was still affecting her or not.

117 is only a small raise in rate. Without knowing your mum's general health it's hard to speculate on whether it's concerning. The doctors will take everything into consideration. Your heart rate varies all the time depending on stress, level of activity etc

Ok I think I understand. So having a high heart rate isn't a problem necessarily? I think I really was just trying to compare it to temperatures where you have a normal range and then values outside of that range which damage the body. I guess I have to just accept that the heart rate being high is not going to be damaging her or indicating that damage is being done. My brain is hurting trying to understand this. I'm sure it's fine and I will stop trying to understand things I know nothing about.

Have you checked your mum's heart rate again since being discharged? If it is consistently high (over 100 bpm), even at rest, then yes, I would be inclined to get her seen again. But if it's under 100 (after sitting for about 5 to 10 minutes), then there's probably nothing to worry about. As others have mentioned, HR will also vary depending on activity, position, etc. Hope she's OK, OP!

It depends on everything else too.
What medication was it? I can’t seem to think of any any medicine that will cause a high heart rate and blood pressure.
I’m a doctor, and I’m not sure if I’d ignore a heart rate of 117. Especially if it was causing her to feel faint. Was the rhythm normal? Was it irregular? Was her blood pressure and rate of breathing normal? How is she in her self otherwise?
I can’t think of many circumstances where I would have discharged home someone with a heart rate of 117 - there’s a reason we check observations (as they indicate something going on), and I think your questions to the nurses were absolutely correct.

If you have any concerns about your mother’s health, seek help or advice again. Options, depending on how she is: ring her GP in the morning, 111 overnight, or if really unwell take to A&E.

117 isn't a concerning heart rate.

They wanted it below 100 as it was due to medication, and needed to be sure it left her system.

*117 isn't a concerning heart rate with no other factors. However if it was consistently that high, I'd get her seen again. It's very likely the environment could cause it to be higher, or the general feeling of unwell.
If it's consistently that or higher when resting, call 111 or back to a and e.

I deleted half of my first post by mistake, I do apologise- hopefully both posts together make sense!

@JetTail you are absolutely correct in how you have understood and explained things.

A normal pulse is between about 60 and 80 ....when someone is resting/sitting still, well hydrated and not under any stress etc. But our pulse is really easily affected by so many things...including just standing up or sitting down, feeling anxious or stressed, being too hot or cold etc etc.

On the first hospital visit, the doctors needed to be certain that the medication was not still causing side effects, before they could let your mum go home. So to be sure, they wanted to see it less than 100. If it never went below 100 at all that would be a bit concerning. And the doctors might be worried that the medication was continuing to adversely affect your mum. I assume they thought that if the pulse got to below 100 , which is a much more normal pulse, then they are happy the bad effects of the medication have stopped.

On the second admission, taking everything into account, including any blood tests or examinations, or the general circumstances of the hospital attendance, how your mum was feeling at the time, if she was hungry/tired/stressed etc ...a pulse of 117 could be okay to go home with. Yes it is higher than normal, but they would have ruled out any dangerous causes, and would most likely have concluded that the slightly high pulse was due to a non sinister factor (as above).

I can understand why that would be worrying for you. I don't think it was very helpful that the nurse just said that it's fine and didn't explain it (not a criticism...I fully accept she was probably super busy and under a lot of pressure).

If you have a pulse oximiter or a Fitbit type watch, you can monitor your own (or your mums) pulse through the day and see how it constantly goes up and down depending on what you are doing.

If you are still worried, definitely phone 111 or your mums gp. I do think it all sounds okay though.

@Kroot

It depends on everything else too. What medication was it? I can’t seem to think of any any medicine that will cause a high heart rate and blood pressure. I’m a doctor, and I’m not sure if I’d ignore a heart rate of 117. Especially if it was causing her to feel faint. Was the rhythm normal? Was it irregular? Was her blood pressure and rate of breathing normal? How is she in her self otherwise? I can’t think of many circumstances where I would have discharged home someone with a heart rate of 117 - there’s a reason we check observations (as they indicate something going on), and I think your questions to the nurses were absolutely correct.

If you have any concerns about your mother’s health, seek help or advice again. Options, depending on how she is: ring her GP in the morning, 111 overnight, or if really unwell take to A&E.

The medication was one she was put on for nausea. I have no idea whether there was a normal rhythm or an irregular one. I actually don't understand what either of those things are. They were not concerned about her ecg and they seemed relieved when her pulse came down so I presumed it was an important thing to be normal but now of course they've said 117 is fine so who knows, This time her blood pressure was fine. I have no idea about rate of breathing either time,.

I suppose it is a bit like temperature. If you are being treated for an infection, a raised temp could mean the infection is getting worse, so you'd want to keep an eye on the patient. However if there are no signs or or reasons to suspect an infection, there's no need to worry - you can have a slightly raised temp,eg, its a hot day, for any number of reasons and that in itself isn't harmful.

It would be fine if we didn't have to bring her back today (yesterday) for being deathly pale and fainting. She never actually fell down today as she was unsteady and we put her sitting down for a while and gave her a drink and then she seemed to be not with it so we brought her back to the hospital. She is young enough I guess. 71
It's exhausting on her and me to sit in A&E while she's suffering only to be told 10 hours later that there's nothing wrong.

@JetTail was the medication Cyclizine by any chance? If so it has a similar reaction in myself and I’m much younger than your DM with no underlying heart issues if that helps reassure you regarding the original medication reaction.

A normal heart rate (HR) is 60 - 100 at rest, and that means lying down for 10 mins.

Your HR fluctuates all the time in response to you sitting down, standing up, you digesting food etc.

So a HR that is high when you are lying on a hospital bed indicates a problem

A HR of 120 while walking around in someone who has a HR at 100 lying down is not a problem.

I'm fairly sure they will have looked at her ECG, the shape of the ECG indicates where the initiation of the electrical activity is and how it travels through the heart.

On top of all that there are other factors, in this case a reaction to the medication.

I know it can be confusing, but the A and E staff will have taken lots of things in to account.

OK an example of when something can be a problem in one situation and not another.

Imagine sitting in your garden in a summer dress and cardigan and you decide you are too warm and take the cardigan off.

If it is a hot summer's day then that is a perfectly normal thing we all do.

But if it is February and 2 degrees you may have hypothermia or you may have some mental illness or you may have some other medical condition that means you cannot control your body temperature.

So the exact same action in one case is normal and in the other could be very serious.

I thought it sounded like they wanted her heart rate to go down because it started off at 140. That's a lot higher than 117. So they needed to make sure it's OK after a massive 140 reading but 117 is still within the realms of normal so not as worrying.

I might be talking shit but I had to be admitted when my heart rate was 140 and I've had my heart rate 120 ish before and not been admitted so I suppose there are rules or thresholds to be met.

I'm so sorry for the delayed response but this thread didn't show up in my threads or notify me of responses until the new change to the site yesterday. Yes, the medication was Cyclizine 50mg. Strangely, my pregnant neighbour is on this medication for morning sickness. It's not one I'd be willing to take if pregnant! I haven't told my neighbour as I'm sure doctors know about potential side effects and me worrying her wouldn't be helpful!

Lol. I appreciate your effort to reassure me but I'm not sure that the comparison is remotely analogous!

My heart rate is always high - over 100 - has gone up to 160/170 before. Had all sorts of tests done. Everything was absolutely normal, that’s just a normal heart rate for me. 117-120 isn’t that high considering if you were to run around or run up and down the stairs it will probably be that anyway.