Tachycardia refers to a rapid heart rate or a heart rate higher than 100 beats per minute at rest. It can originate in the upper or lower chambers of your heart and can range from mild to life-threatening. Some people with tachycardia may have no symptoms, and complications may never develop. Others may experience palpitations, dizziness, and other changes.
However, tachycardia can increase the risk of heart failure, sudden cardiac arrest, and death. Treatment is provided through medications, a procedure called coronary ablation, and the placement of an implantable cardioverter-defibrillator (ICD), pacemakers, and other surgical interventions.
How does the heart work?
In order to understand the occurrence of tachycardia, it’s important to know how the heart works, specifically the cardiac conduction system. The heart consists of four chambers – two upper chambers called the left and right atria, and two lower chambers called the ventricles. The heart rhythm is controlled by a natural pacemaker (sinus node) located in the right upper atrium. The sinus node sends out electrical signals that normally initiate each heartbeat. These electrical signals travel across the atria, causing the heart muscles to contract and pump blood into the ventricles.
Next, the signals reach the atrioventricular (AV) node, where they slow down. This slight delay allows the ventricles to fill with blood. When the electrical signals reach the ventricles, the ventricles contract and pump blood to the lungs or the rest of the body. In normal heart function, this process of cardiac signaling usually proceeds smoothly, resulting in a resting heart rate of 60 to 100 beats per minute. An increased heart rate exceeding 100 beats per minute represents tachycardia.
Types of tachycardia
There are many different types of tachycardia. Sinus tachycardia refers to a typical increase in heart rate often caused by exercise or stress. Other types of tachycardia are grouped according to the part of the heart responsible for the rapid heartbeat and the cause. Common types of tachycardia caused by an irregular heart rhythm (arrhythmias) include:
Supraventricular tachycardia (SVT)
Supraventricular tachycardia (SVT) is a rapid heartbeat that originates in the upper chambers of the heart. It can occur due to abnormal electrical pathways or structural abnormalities in the heart. SVT disrupts the normal electrical signals coming from the sinus node, which regulates the heart’s rhythm. As a result, the heart beats faster than usual. This rapid heartbeat can hinder the chambers of the heart from filling completely between contractions, potentially affecting blood flow to the rest of the body. SVT episodes are characterized by sudden onset and termination of palpitations (a strong heartbeat). There are several types of supraventricular tachycardia (SVT):
Atrioventricular nodal reagent tachycardia (AVNRT)
It is a common type of supraventricular tachycardia. People with AVNRT have episodes of irregularly fast heartbeats (more than 100 beats per minute) that often start and end suddenly. These episodes are caused by an additional pathway, known as a reentrant circuit, located in or near the AV node, which leads to rapid heartbeats.
Paroxysmal supraventricular tachycardia (PSVT)
It belongs to the antechamber arrhythmias and implies the sudden appearance of an acceleration of heart rate. It occurs due to a short circuit – an abnormal electrical pathway made of heart cells – that allows the current to move in a circle and repeat the signal over and over again. As a result, the ventricles contract rapidly, which can disrupt heart function and cause symptoms such as dizziness or shortness of breath.
Paroxysmal atrial tachycardia (PAT)
Paroxysmal atrial tachycardia (PAT) is a type of paroxysmal supraventricular tachycardia (PSVT). It begins with a sudden onset of very fast heartbeats, which can often be alarming. It can last from a few minutes to several hours. PAT can occur in otherwise healthy individuals who have consumed excessive stimulants such as tobacco or caffeine.
Wolf-Parkinson-White (WPW) syndrome:
Wolf-Parkinson-White (WPW) syndrome refers to the presence of an additional abnormal electrical pathway in the heart that causes tachycardia. This abnormal pathway directly connects the atria and ventricles at a location other than the AV node.
Premature atrial contractions
Premature atrial contractions (PACs) typically resolve on their own and do not require treatment. They originate in the upper chambers of the heart and may cause a sensation of an extra or skipped heartbeat. If PACs occur frequently, it is advisable to consult a doctor.
Atrial tachycardia
Atrial tachycardia is a type of arrhythmia that causes the upper chambers of the heart to beat faster than normal. The heart rate can range from 100 to 250 beats per minute. It is generally not considered dangerous and can be treated with medication.
Atrial fibrillation (AF)
Atrial fibrillation (AF) is the most common type of tachycardia characterized by chaotic, irregular electrical signals in the upper chambers of the heart (atria). AF can be a temporary condition, but it may also require treatment. Symptoms of atrial fibrillation include fatigue, heart palpitations, shortness of breath, and dizziness. Risk factors for developing atrial fibrillation include high blood pressure, coronary artery disease, and obesity. Untreated AF can lead to a stroke.
Atrial flutter
Atrial flutter is similar to atrial fibrillation, but the heartbeats are more organized. Episodes of atrial flutter can resolve on their own or may require treatment.
Ventricular tachycardia
Ventricular tachycardia is a type of tachycardia that originates in the lower chambers of the heart (ventricles). The rapid heartbeats, greater than 100 per minute, prevent the ventricles from filling and contracting effectively to pump enough blood. Episodes of ventricular tachycardia that are very brief are unlikely to pose a health risk. However, episodes lasting longer than a few seconds can be life-threatening.
Ventricular fibrillation
Ventricular fibrillation is characterized by rapid, chaotic electrical signals that cause the ventricles to quiver instead of contracting in a coordinated manner. This serious condition can lead to death if the heart rhythm is not restored within a few minutes. Most people who experience ventricular fibrillation have an underlying heart disease or have experienced severe trauma, such as a lightning strike.
Who can get tachycardia?
Atrial or supraventricular tachycardia is more common in:
- Women and children, especially those who suffer from anxiety
- Anyone who is very tired or drinks a lot of alcohol or caffeine
- Smokers, especially passionate.
Ventricular tachycardia or fibrillation is more prone to people who have:
- Had a heart attack.
- Cardiomyopathy (a problem with the heart muscles).
- Myocarditis (inflammation of the heart muscle).
- Heart failure or heart disease.
- People who smoke or have high blood pressure or diabetes.
Symptoms of tachycardia
Tachycardia can lead to the development of various symptoms such as:
- shortness of breath
- chest pain
- Heart palpitations (rapid or pounding heartbeat)
- Dizziness
- Feeling of unconsciousness
In extreme cases, people with atrial fibrillation or SVT may have:
- Faint
- Cardiac arrest
Some individuals with tachycardia may not have any symptoms. The condition can be discovered during a physical examination or through cardiac tests conducted for other reasons.
Causes and risks of tachycardia
Tachycardia, depending on the type, can have multiple causes:
- Anxiety
- Fear
- Stress
- Intense physical exercise
- High temperature
- Consuming more caffeine or alcohol than recommended by your doctor
- Smoking or use of tobacco products.
- Cardiomyopathy, heart attack, heart disease or other cardiac problems
- Sarcoidosis (an inflammatory disease that affects the skin or body tissues)
- Insufficient blood supply to the coronary arteries, leading to inadequate oxygen delivery to the heart
- Certain medications
- Use of illicit substances such as cocaine or methamphetamine
- Imbalance of electrolytes necessary for conducting electrical impulses
Other less common causes may include anemia, infection, hyperthyroidism, myocardial damage due to heart attack or heart failure, severe bleeding, very low blood pressure, and lung disease.
Risk factors for tachycardia
- Use of tobacco products
- Family history of tachycardia
- Stress
- High blood pressure
- Obesity
- Excessive consumption of caffeine or alcohol
- Unregulated thyroid gland problem
- Use of illicit substances and medications
- Certain heart problems
- Taking certain types of heart medications.
Medical conditions that can cause tachycardia
Ventricular tachycardia commonly occurs when the heart muscle is damaged, and scar tissue creates abnormal electrical pathways in the ventricles. Causes can include:
Myocardial infarction (heart attack): A heart attack is a serious condition that occurs due to a lack of blood flow to the heart muscle. The blockage of one or more arteries in the heart is usually associated with the lack of blood flow. Without blood flow, the affected heart muscle will start to die. If blood flow is not restored quickly, a heart attack can cause permanent heart damage and death. The damaged muscle disrupts the electrical signals that control the heart, leading to tachycardia symptoms such as palpitations a feeling of throbbing, flickering or improper heartbeat, which is felt in the chest or throat.
Cardiomyopathy or heart failure: Cardiomyopathy is a disease of the heart muscle that makes it difficult for the heart to pump blood to the rest of the body. Cardiomyopathy can lead to heart failure. The main types of cardiomyopathy are dilated, hypertrophic and restrictive cardiomyopathy. In the early stages of cardiomyopathy, there may be no symptoms of disease. As the disease progresses, patients may experience an irregular or rapid heartbeat (palpitations).
Myocarditis: Myocarditis is inflammation of the heart muscle (myocardium) and can weaken the heart muscle, making it difficult for the heart to function properly. People with myocarditis often feel tired, have shortness of breath, chest pain, or palpitations.
Heart valve disease: If the heart valves are diseased, the heart has difficulty pumping blood throughout the body, and it has to work harder, which can lead to heart failure, sudden cardiac arrest (when the heart stops beating), and death. Symptoms that may accompany valve disease can include chest pain or palpitations, shortness of breath, fatigue, weakness.
Complications of tachycardia
The complications of tachycardia depend on the type of tachycardia, how long the rapid heartbeat lasts, and how fast the heart is beating.
Tachycardia can lead to complications such as:
– blood clots
– stroke
– cardiac arrest
Diagnosis and tests
To diagnose tachycardia, the doctor will perform a physical examination of the patient and ask questions about symptoms, health habits, and medical history. Then, they will determine one or more diagnostic methods to detect tachycardia and identify its cause. These may include:
Electrocardiogram (ECG): A fast and painless test that measures the electrical activity of the heart. An ECG records the timing and duration of each electrical phase of the heartbeat. Based on this, the doctor can determine the type of tachycardia.
Holter monitor: Enables heart rate monitoring at home. This portable ECG device can be worn for a day or longer to record heart activity during daily activities.
Echocardiogram (heart ultrasound): Can identify problems with blood flow, heart valves, and heart muscle.
Chest X-ray: X-ray images of the chest can show the condition of the heart and lungs.
Cardiac Magnetic Resonance Imaging (MRI): Cardiac MRI can provide still or moving images of blood flow through the heart. This test is commonly performed to determine the cause of ventricular tachycardia or ventricular fibrillation.
Computed Tomography (CT): CT scanning provides a more detailed cross-sectional view of the area being studied. Cardiac CT can be performed if the doctor suspects ventricular tachycardia.
Coronary Angiography: Coronary angiography is performed to check for blocked or narrowed blood vessels in the heart. It is a procedure used to evaluate blood supply to the heart in individuals with ventricular tachycardia or ventricular fibrillation.
Electrophysiological (EP) testing and mapping: This test, also known as an EP study, may be conducted to confirm the diagnosis of tachycardia or to identify where the incorrect signals are occurring in the heart. An EP study is mainly used for diagnosing isolated arrhythmias. In rare cases, it may be used to evaluate sinus tachycardia. During this test, the doctor guides thin, flexible tubes (catheters) with electrodes at the tips through blood vessels into different areas of the heart. The electrodes can map the spread of electrical signals through the heart.
Stress test: Some types of tachycardia are triggered or worsened by exercise. During a stress test, heart activity is typically monitored while the patient rides a stationary bicycle or walks on a treadmill.
Treatment of tachycardia
The treatment of tachycardia aims to slow down the accelerated heart rate and prevent future episodes of rapid heart rhythm. If the cause is another underlying health condition, treating the underlying problem may reduce or prevent tachycardia episodes.
Slowing down the rapid heartbeat
Fast heart rates can be corrected, but sometimes medications or other medical treatments are needed to achieve this. Ways to slow down the heart rate include:
Vagal maneuvers
They include coughing, breath holding, and applying ice to the face. The doctor may ask the patient to perform these specific actions during an episode of rapid heart rate. These maneuvers affect the vagus nerve, which helps control heart rate.
Medications
If vagal maneuvers fail to stop the rapid heart rate, medications are used to restore the heart’s rhythm.
Cardioversion
This medical procedure is typically performed by delivering electrical shocks to the heart through sensors (electrodes) placed on the chest. The shocks affect the heart’s electrical signals and restore normal heart rhythm. Cardioversion is generally used when urgent assistance is required or when vagal maneuvers and medications are ineffective. It is also possible to perform pharmacological cardioversion.
Preventing future episodes of rapid heartbeat
Treating tachycardia involves taking steps to prevent fast heart rate episodes. This may include the use of medications, implantable devices, certain surgeries, and procedures.
Medications
Medications for controlling heart rate and restoring normal heart rhythm are usually prescribed for most people with tachycardia. The doctor may prescribe medications such as beta-blockers, antiarrhythmic drugs, blood thinners, or anticoagulants (for atrial fibrillation).
Catheter ablation
In this procedure, a healthcare professional threads one or more thin, flexible tubes (catheters) through an artery, usually in the groin, and guides them to the heart. Sensors (electrodes) at the tip of the catheter use heat or cold energy to create tiny scars in the heart to block irregular electrical signals and restore heart rhythm. It is often performed when an additional electrical pathway is responsible for the increased heart rate. Catheter ablation does not require open-heart surgery to access the heart, but it can be done simultaneously with other heart surgeries.
Pacemaker
A pacemaker is a small device surgically implanted under the skin in the chest area. When the device senses irregular heart activity, it sends an electrical impulse that helps the heart maintain a proper rhythm.
Implantable cardioverter-defibrillator (ICD)
A doctor may recommend this device if there is a high risk of developing ventricular tachycardia or ventricular fibrillation. An ICD is a battery-powered device that is implanted under the skin near the collarbone—similar to a pacemaker. The ICD continuously monitors the heart’s rhythm, and if it detects an irregular heartbeat, it delivers low or high-energy shocks to reset the heart’s rhythm.
Surgery
Sometimes, open-heart surgery may be necessary to remove an extra electrical pathway causing tachycardia. Surgery is typically done only when other treatment options fail or when surgery is needed to address another heart disorder.
Prevention and reducing the risk of tachycardia
The best ways to prevent tachycardia are to maintain heart health and prevent heart disease. If you already have a heart condition, follow the treatment plan and advice of your doctor.
Lifestyle changes to reduce the risk of heart disease can help prevent cardiac arrhythmias. Take the following steps:
-Eat a healthy diet: It is recommended to have a diet rich in whole grains, lean meats, low-fat dairy products, fruits, and vegetables. Limit salt, sugar, alcohol, and saturated and trans fats.
-Exercise regularly: Try to engage in at least 30 minutes of exercise five days a week.
-Maintain a healthy weight: Excess weight increases the risk of developing heart disease.
-Keep blood pressure and cholesterol levels under control: Practice healthy lifestyles and take medications as prescribed to control high blood pressure (hypertension) or high cholesterol.
-Quit smoking: If you are a smoker and cannot quit on your own, talk to your doctor about strategies or programs that can help you break the habit.
-Moderate alcohol consumption: For healthy adults, this means up to one drink per day for women and up to two drinks per day for men. For certain health conditions, it is recommended to completely avoid alcohol. Ask your doctor for advice specific to your condition.
-Avoid psychoactive substances or stimulants such as cocaine.
-Use medications with caution: Some cold and cough medications contain stimulants that can cause a rapid heartbeat.
-Ask your doctor which medications you should avoid.
-Limit caffeine: If you consume caffeinated beverages, do not exceed one to two drinks per day.
-Manage stress: Find ways to reduce emotional stress. Increased exercise and mindfulness practices are some ways to reduce stress.
-Regularly undergo physical examinations and report any changes in heart rate to your doctor.
-Alternative medicine: Stress-reducing techniques such as meditation and yoga can help slow down the heart rate and reduce tachycardia symptoms.
IMPORTANT: If symptoms change or worsen, or new ones occur, contact your doctor immediately.
Prognosis if you have tachycardia
Tachycardia may not cause any symptoms or complications. However, some forms of tachycardia can lead to serious health problems, including heart failure, stroke or sudden cardiac death and therefore need to be treated, and lifestyle adjustments are also necessary. Although medications cannot cure tachycardia, they can help you regulate and keep it under control. Ventricular fibrillation can be fatal without immediate treatment.
If you have sinus tachycardia, your symptoms will disappear when the fear, anxiety, or other emotion that caused the rapid beats stop. For most other types of tachycardia, you’ll need medication or even a procedure to keep the symptoms from recurring. Therefore, it is important for a person with tachycardia to be under the supervision of a doctor, to follow their advice and take the prescribed therapy.
Living with tachycardia
If you know how to cope with an episode of rapid heartbeat, you will be calmer and have better control over your tachycardia. Therefore, ask your doctor about how to measure your pulse and what heart rate range is best for you, as well as when and how to use vagal maneuvers.
Take medications exactly as prescribed by your doctor, and if you feel that a medication is not suiting you or you are experiencing unpleasant symptoms, consult your doctor.
Avoid consuming caffeine and alcohol. Maintain a balanced diet, avoiding foods that contribute to atherosclerosis and high blood pressure.
Avoid stressful situations whenever possible.
Is tachycardia an arrhythmia?
Yes, tachycardia is a type of arrhythmia. Arrhythmia refers to a problem with the speed or rhythm of the heartbeat. It means that the heart beats too fast, too slow, or irregularly. When the heart beats faster than normal, it is called tachycardia.
When to seek emergency medical help
Seek immediate medical help if you experience:
- Shortness of breath
- Weakness
- Dizziness
- Fainting
- Chest pain or discomfort
A type of tachycardia called ventricular fibrillation can lead to a dramatic drop in blood pressure and requires immediate medical intervention.
Symptoms of tachycardia can range from mild to severe, depending on the type of tachycardia. Visit a doctor, preferably cardiologist, if you have symptoms of tachycardia, especially more pronounced ones. After an examination, the doctor will be able to determine if the symptoms are a cause for concern. Continue taking the medications prescribed by your doctor, especially those for the heart. Do not stop taking them without the approval of your doctor. And be sure to continue attending all appointments.
