Increased pulse rate during sleeping is seen in?

ESIC Nursing Officer 2016 (Shift -2)

Medical Surgical Nursing

Easy

Appeared in: ESIC Nursing Officer 2016 (Shift -2)

Explanation

Hyperthyroidism creates a hypermetabolic state due to excessive thyroid hormone levels (thyrotoxicosis).
These hormones directly stimulate the heart's sinoatrial (SA) node and increase its sensitivity to catecholamines, leading to tachycardia (a fast heart rate).
A key diagnostic feature is that this tachycardia persists even during sleep, when the heart rate would normally decrease.
A sleeping pulse rate that is consistently above 80 beats per minute is a classic clinical sign used to distinguish thyrotoxicosis from other causes of tachycardia, such as anxiety.

Option B: This condition is characterized by a hypometabolic (slowed metabolism) state due to insufficient thyroid hormone.
Option C: While long-standing diabetes can lead to cardiovascular autonomic neuropathy, which may cause a higher resting heart rate, the specific sign of a persistently elevated pulse during sleep is more characteristic of hyperthyroidism.
Option D: This disorder involves a deficiency of antidiuretic hormone (ADH), leading to excessive urination (polyuria) and thirst (polydipsia).

Visual 1: Diagram: The systemic effects of hyperthyroidism, showing the impact on the heart (tachycardia, palpitations), metabolism (weight loss), and nervous system (tremors).
Visual 2: Chart: A comparative chart of vital signs (pulse, temperature, BP) and key symptoms in hyperthyroidism versus hypothyroidism.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of endocrine disorders: Sleeping Tachycardia as background academic context rather than a clinical decision trigger.
Assessing the sleeping pulse rate is a simple, non-invasive bedside tool that can provide a strong clue for diagnosing hyperthyroidism, especially when differentiating it from anxiety-related tachycardia.
Nurses should educate patients suspected of having a thyroid disorder to measure their pulse at home immediately upon waking, before getting out of bed, and report the findings to their physician.
What if? If the patient also reported palpitations, weight loss despite a good appetite, and heat intolerance, the suspicion for hyperthyroidism would be even stronger, warranting an urgent thyroid function test (TFT).

How to Approach the Question

First, identify the key symptom in the question: 'increased pulse rate during sleeping'. This is a specific clinical sign.
Recall the primary metabolic effects of the conditions listed in the options.
Connect 'hyper-' conditions with increased function and 'hypo-' with decreased function. Hyperthyroidism means overactive thyroid, leading to a hypermetabolic state.
A hypermetabolic state logically leads to an increased heart rate to meet the body's high metabolic demands.
Recognize that a normally slow sleeping pulse becoming elevated points to a persistent pathological cause, not a temporary one like exercise or anxiety.
Evaluate and eliminate the other options. Hypothyroidism causes the opposite effect (bradycardia). Diabetes mellitus and insipidus do not primarily feature sleeping tachycardia as a classic sign.

Concept Tested & Keywords

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