Tachycardia

Tachycardia (tak-ih-KAHR-dee-uh) is the medical term for a heart rate over 100 beats a minute. Many types of irregular heartbeats, called arrhythmias, can cause tachycardia.

A fast heart rate isn't always something to worry about. For instance, the heart may beat faster during exercise or when a person has a lot of stress.

Tachycardia may not cause any symptoms or complications. But sometimes it's a warning of a condition that needs medical care.(16) Some types of tachycardia can lead to serious health conditions if not treated. Examples are heart failure, stroke or sudden cardiac death.

Treatment for tachycardia may include specific actions or movements, medicine, a heart procedure called cardioversion, or surgery.

Types

There are many types of tachycardia.

Sinus tachycardia is a usual rise in the heart rate often caused by exercise or stress.

Other types of tachycardia are grouped according to their cause and the part of the heart causing the fast heart rate. Common types of tachycardia include:

• Atrial fibrillation (AFib). This is the most common type of tachycardia. Chaotic, irregular electrical signals start in the upper chambers of the heart, called the atria. These signals trigger a fast heartbeat. AFib may be short-lived. But sometimes treatment is needed to fix the irregular heartbeat.
• Atrial flutter. Atrial flutter is similar to AFib. But the heartbeats are more organized. Atrial flutter may go away on its own. But some people need treatment. People who have atrial flutter also often have AFib at other times.
• Ventricular tachycardia (V-tach). This irregular heart rhythm starts in the lower heart chambers, called the ventricles. The fast heart rate doesn't let the lower chambers fill and squeeze to pump enough blood to the body. V-tach may be brief and last only a few seconds without causing harm. But when it lasts more than a few seconds, it can be life-threatening.
• Supraventricular tachycardia (SVT). This is a broad term that includes irregular heart rhythms that start above the lower heart chambers. SVT causes a pounding heartbeat that starts and ends abruptly.
• Ventricular fibrillation (VFib). This is a serious condition. It can be deadly if the heart rhythm isn't fixed within minutes. Very fast, chaotic heart signals cause the lower heart chambers to quiver instead of squeezing in a coordinated way. Most people with VFib have heart disease or have had a serious injury, such as being struck by lightning.

Some people with tachycardia have no symptoms. The fast heartbeat may be found when a physical exam or heart tests are done for another reason.

In general, tachycardia may cause these symptoms:

• Racing, pounding heartbeat or flopping in the chest, called palpitations.
• Chest pain.
• Fainting.
• Lightheadedness.
• Fast pulse.
• Shortness of breath.

When to see a doctor

Many things can cause tachycardia. If you feel like your heart is beating too fast, make an appointment for a health checkup.

Get medical help right away if you have:(

• Chest pain or discomfort.
• Shortness of breath.
• Weakness.
• Dizziness or lightheadedness.
• Fainting or near fainting.

A type of tachycardia called ventricular fibrillation (VFib) is an emergency. It needs to be treated right away. During VFib, blood pressure drops dramatically. The person's breathing and pulse stop because the heart is not pumping any blood to the body. This also is called cardiac arrest. The person usually falls down, also called collapses.

If this happens, do the following:

• Call 911 or the emergency number in your area.
• Start CPR. CPR helps keep blood flowing to the organs until other treatments can start.
• If you're not trained in CPR or worried about giving rescue breaths, then provide hands-only CPR. Push hard and fast on the center of the chest at a rate of 100 to 120 compressions a minute until paramedics arrive. The American Heart Association suggests doing compressions to the beat of the song "Stayin' Alive" or another song that has 100 to 120 beats a minute. You don't need to do rescue breathing.
• Have someone get an automated external defibrillator (AED) if one is nearby. An AED is a device that sends a shock to the heart to reset it's rhythm. No training is needed to use it. The AED tells you what to do. It's programmed to give a shock only when necessary.

Tachycardia is an increased heart rate for any reason. If a fast heart rate is caused by exercise or stress, it's called sinus tachycardia. Sinus tachycardia is a symptom, not a condition.

Most heart conditions can lead to different forms of tachycardia. Irregular heart rhythms, called arrhythmias, are one cause. An example is atrial fibrillation (AFib).(

Health conditions and treatments that may lead to tachycardia include:

• A low number of red blood cells, called anemia.
• Changes in the level of minerals in the body, called electrolytes. Examples are potassium, sodium, calcium and magnesium.
• Fever.
• Heart attack.
• High or low blood pressure.
• Overactive thyroid gland, called hyperthyroidism.
• Some medicines.

Lifestyle habits and behaviors that may lead to tachycardia include:

• Excessive alcohol use. If you choose to drink alcohol, limit how often you drink and keep the amount small. That often means less than two drinks a day on any specific day.
• Alcohol withdrawal.
• Too much caffeine.
• Smoking or nicotine use.
• Use of illicit drugs such as cocaine or methamphetamine.

Sometimes the exact cause of tachycardia is not known.

How does the heart beat?

To understand the cause of tachycardia, it may help to know how the heart usually works.

The heart has four chambers:

• The two upper chambers are called the atria.
• The two lower chambers are called the ventricles.

Inside the upper right heart chamber is a group of cells called the sinus node. These cells make the signals that start each heartbeat.

The signals move across the upper heart chambers. Then they get to a group of cells called the AV node, where they usually slow down. Next, the signals go to the lower heart chambers.

In a healthy heart, this signaling process usually goes smoothly. The heart usually beats 60 to 100 times each minute when at rest. But in tachycardia, something makes the heart beat faster than 100 beats a minute.

In general, things that may raise the risk of irregular heart rhythms that commonly cause tachycardia include:

• Older age.
• A family history of some heart rhythm disorders.
• High blood pressure.

Lifestyle changes or treatment of heart conditions may lower the risk of tachycardia.

When the heart beats too fast, it may not pump enough blood to the body. As a result, the organs and tissues may not get enough oxygen.

Complications of tachycardia depend on:

• The type of tachycardia.
• How fast the heart is beating.
• How long the fast heartbeat lasts.
• Whether you have other heart conditions.

Possible complications of tachycardia may include:

• Blood clots that can cause a heart attack or stroke. Blood-thinning medicine may be used to lower this risk.
• Fainting a lot or unconsciousness.
• Heart failure.
• Sudden cardiac death. This is usually only associated with ventricular tachycardia or ventricular fibrillation.

The best way to prevent tachycardia is to keep the heart healthy. Have regular health checkups. If you have heart disease, follow your treatment plan. Take all medicines as told.

Try these tips to prevent heart disease and keep the heart healthy:

• Don't smoke.
• Choose foods that are low in salt and saturated fat.
• Exercise at least 30 minutes a day on most days of the week.
• Keep a healthy weight.
• Reduce and manage stress.
• Manage high blood pressure, high cholesterol and diabetes.
• Get good sleep. Adults should try to get 7 to 9 hours daily.

Talk to your healthcare team before using any medicines. Some cold and cough medicines have stimulants that may start a fast heartbeat. Illicit drugs such as cocaine and methamphetamine are other stimulants that can cause changes in the heartbeat.

To diagnose tachycardia, a healthcare professional examines you and asks questions about your symptoms, health habits and medical history.

Tests

Tests may be done to confirm an unusually fast heartbeat and to look for the cause. Tests to diagnose tachycardia may include:

• Electrocardiogram (ECG or EKG). This quick test checks the heartbeat. Sticky patches with sensors on them, called electrodes, go on the chest and sometimes the arms or legs. An ECG shows how fast or how slow the heart is beating. Some personal devices, such as smartwatches, can do ECGs. Ask your care team if this is an option for you.
• Holter monitor. This small, wearable device records the heart's rhythm for a day or more while you do your daily activities. This test can find irregular heartbeats that aren't seen on a regular electrocardiogram.
• Event monitor. This device is like a Holter monitor, but it records only at certain times for a few minutes at a time. It's typically worn for about 30 days. You usually push a button when you feel symptoms. Some devices automatically record when an irregular heart rhythm is noticed.
• Echocardiogram. Sound waves make images of the beating heart. This test can show how blood flows through the heart and heart valves.
• Chest X-ray. A chest X-ray shows the condition of the heart and lungs.
• MRI scan of the heart. Also called a cardiac MRI, this test uses magnetic fields and radio waves to create detailed images of the heart. It's most often done to find a cause of ventricular tachycardia or ventricular fibrillation.
• CT scan of the heart. Also called a cardiac CT, this test takes several X-ray images to provide a more detailed look of the heart. It may be done to find the cause of ventricular tachycardia.
• Coronary angiogram. A coronary angiogram is done to check for blocked or narrowed blood vessels in the heart. It uses a dye and special X-rays to show the inside of the heart's arteries. The test may be done to look at the heart's blood supply in people who have ventricular tachycardia or ventricular fibrillation.

• Electrophysiological (EP) study. This test may be done to confirm a diagnosis of tachycardia. It can help find where in the heart the wrong signaling occurs. An EP study is mostly used to diagnose some specific types of tachycardias and irregular heartbeats.

  During this test, one or more flexible tubes are guided through a blood vessel, usually in the groin, to various areas in the heart. Sensors on the tips of the tubes record the heart's electrical signals.

• Stress tests. Exercise can trigger or worsen some types of tachycardia. Stress tests are done to see how exercise affects the heart. They often involve walking on a treadmill or pedaling a stationary bike while the heart is checked. If you can't exercise, you may get medicine that raises the heart rate like exercise does. Sometimes an echocardiogram is done during a stress test.
• Tilt table test. This test may be done to find out if a fast heartbeat leads to fainting. A healthcare professional checks your heart rate and rhythm and blood pressure while you lie flat on a table. Then, under careful supervision, the table is tilted to a standing position. The health professional watches how your heart and the nervous system that controls it respond to the changes in position.

The goals of tachycardia treatment are to:

• Slow the fast heartbeat.
• Prevent the fast heartbeat from happening again.

If another health condition is causing tachycardia, treating the condition may reduce or prevent the fast heartbeat.

Slowing a fast heartbeat

A fast heartbeat may fix itself. But sometimes medicine or other treatments are needed to slow down the heartbeat.

Ways to slow a fast heartbeat include:

• Vagal maneuvers. Simple but specific actions such as coughing, bearing down as if passing stool or putting an ice pack on the face can help slow down the heartbeat. Your healthcare team may ask you to do these specific actions if your heart starts beating very fast. The actions affect the vagus nerve. That nerve helps control the heartbeat.
• Medicines. If vagal maneuvers don't stop the fast heartbeat, medicine may be needed to correct the heart rhythm.
• Cardioversion. Paddles or patches on the chest are used to electrically shock the heart and reset the heart rhythm. Cardioversion is generally used when emergency care is needed or when vagal maneuvers and medicines don't work. It's also possible to do cardioversion with medicines.

Preventing a fast heartbeat

Tachycardia treatment also involves taking steps to make sure the fast heartbeat doesn't come back. This may involve medicines, implanted devices, or heart surgeries or procedures.

• Medicines. Medicines are often used to slow or control the heartbeat.

• Catheter ablation. A doctor inserts one or more thin, flexible tubes called catheters through a blood vessel, usually in the groin. Sensors on the tip of the catheters use heat or cold energy to create tiny scars in the heart. The scars block irregular electrical signals. This helps restore a typical heartbeat.

  Catheter ablation doesn't need surgery to reach the heart. But it may be done at the same time as other heart surgeries.

• Pacemaker. This is a small device that prevents the heart from beating too slowly. It is placed under the skin near the collarbone. When the device finds an irregular heartbeat, it sends an electrical pulse that helps fix the heart's rhythm.
• Implantable cardioverter-defibrillator (ICD). This battery-powered device is placed under the skin near the collarbone. It continuously checks the heart rhythm. If the device finds an irregular heartbeat, it sends out low- or high-energy shocks to reset the heart's rhythm. A healthcare professional may suggest an ICD if you have a high risk of ventricular tachycardia or ventricular fibrillation.
• Maze procedure. A surgeon makes tiny cuts in the upper chambers of the heart to create a pattern of scar tissue. The pattern is called a maze. The heart's signals can't pass through scar tissue. So the maze can block stray heart signals that cause some types of tachycardia.
• Surgery. Sometimes open-heart surgery is needed to destroy an extra heart-signaling pathway causing tachycardia. Surgery is usually done only when other treatment options don't work or when surgery is needed to treat another heart condition.

If you have tachycardia or any type of heart disease, it's important to take steps to keep your heart healthy. Eat healthy foods, get regular exercise, and don't smoke or use tobacco. Your care team also may suggest that you limit or do not use caffeine.

Some stress-relief methods, such as meditation and yoga, might help slow the heartbeat. This can reduce tachycardia symptoms.

If you have a plan to manage tachycardia, you may feel calmer and more in control when it happens. Ask your care team:

• How to take your pulse.
• What heart rate is best for you.
• When and how to do treatments called vagal maneuvers, if appropriate.
• When to get emergency care.

If you have tachycardia, you may see a doctor trained in heart conditions, called a cardiologist. You also might see a doctor trained in heart rhythm disorders, called an electrophysiologist.

There's often a lot to discuss at a health checkup. It's a good idea to be prepared for your appointment. Here's some information to help you get ready.

What you can do

Make a list ahead of time that you can share with your healthcare team. Your list should include:

• Any symptoms, including those that may seem unrelated to your heart.
• Important personal information, including any major stresses or recent life changes.
• All medicines that you take. Include vitamins, supplements and medicines bought with or without a prescription. Also include the dosages.
• Questions to ask your healthcare professional.

Basic questions to ask your healthcare professional include:

• What is the likely cause of my fast heartbeat?
• What tests do I need?
• What's the most appropriate treatment?
• What are the risks of my heart condition?
• How do we check my heart?
• How often do I need checkups?
• I have other health conditions. How will they or their treatments affect my heart condition?
• What changes do I need to make to my activities or diet?
• Is there any information that I can take home with me? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your healthcare team is likely to ask you many questions. Being ready to answer them may save time to go over any details you want to spend more time on. Your care team may ask:

• When did the symptoms start?
• How often does your heart beat fast?
• How long does the fast heartbeat last?
• Does anything, such as exercise, stress or caffeine, make your symptoms worse?
• Does anyone in your family have heart disease or a history of irregular heartbeats?
• Has anyone in your family had cardiac arrest or died suddenly?
• Do you smoke or have you ever smoked?
• How much alcohol or caffeine do you use, if any?
• What medicines do you take?
• Do you have any conditions that may affect your heart health? For example, are you being treated for high blood pressure or high cholesterol?