Tachycardia consultation at Mayo Clinic
A thorough physical exam, medical history and testing are required to diagnose tachycardia.
To diagnose tachycardia, a health care provider will usually do a physical exam and ask questions about your symptoms, health habits and medical history.
Tests, including cardiac imaging tests, may be done to confirm an unusually fast heartbeat and look for conditions that can cause an irregular heart rhythm (arrythmia). Tests to diagnose tachycardia may include:
Electrocardiogram (ECG or EKG)
An electrocardiogram (ECG or EKG) is a simple test to determine how the heart is beating. Sensors (electrodes) placed on the chest record the heart's electrical signals. The signals are shown as waves on an attached computer monitor or printer.
A Holter monitor uses electrodes and a recording device to track the heart's rhythm for 24 to 72 hours. A health care provider can print an electrocardiogram strip using the data on the recording device to see the heart's rhythm during the period the monitor was worn.
In a coronary angiogram, a flexible tube called a catheter is inserted into an artery, usually in the groin, arm or neck. It's threaded through the artery to the heart. A coronary angiogram can show blocked or narrowed blood vessels in the heart.
Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. During an ECG, sensors (electrodes) are attached to the chest and sometimes to the arms or legs. An ECG measures the timing and duration of each electrical phase in the heartbeat. Your health care provider can look for signal patterns to determine the type of tachycardia and how problems in the heart may be causing the fast heart rate.
Some personal devices, such as smartwatches, offer electrocardiogram monitoring. Ask your health care provider if this is an option for you.
- Holter monitor. Your health care provider may recommend monitoring your heartbeat at home. This portable ECG device can be worn for a day or more to record the heart's activity during daily activities.
- Event monitor. This portable ECG device is intended to be worn for up to 30 days or until you have an arrhythmia or symptoms. You typically press a button when symptoms occur.
- Echocardiogram. An echocardiogram uses sound waves to create pictures of the heart in motion. It can identify problems with blood flow, the heart valves and the heart muscle.
- Chest X-ray. A chest X-ray can show the condition of the heart and lungs.
- Cardiac magnetic resonance imaging (MRI). A cardiac MRI can provide still or moving pictures of blood flow through the heart. This test is most often done to determine a cause of ventricular tachycardia or ventricular fibrillation.
- Computerized tomography (CT). CT scans combine several X-ray images to provide a more detailed cross-sectional view of the area being studied. A CT scan of the heart (cardiac CT) may be done if a health care provider is looking for a 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 coronary arteries. A coronary angiogram may be done to look at the heart's blood supply in people who have ventricular tachycardia or ventricular fibrillation.
Electrophysiological (EP) testing and mapping. This test, also called an EP study, may be done to confirm a diagnosis of tachycardia or to determine where in the heart the faulty signaling occurs. An EP study is mostly used to diagnose isolated arrythmias. Less commonly, it may be used to evaluate sinus tachycardia.
In this test, a health care provider threads thin, flexible tubes (catheters) tipped with electrodes through the blood vessels to different areas within the heart. Once in place, 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, the heart's activity is typically monitored while riding on a stationary bicycle or walking on a treadmill. Other heart tests may be done with a stress test. If you have difficulty exercising, a drug may be given to stimulate the heart in a way that's similar to exercise.
- Tilt table test. This test is sometimes used to help better understand how tachycardia contributes to fainting. Heart rate and blood pressure are monitored while lying flat on a table. Then, under careful supervision, the table is tilted to a position that mimics standing. The health care provider watches how the heart and the nervous system that controls it respond to the changes in position.
The goals of tachycardia treatment are to slow a rapid heartbeat when it occurs and to prevent future episodes of a fast heart rate.
If another medical condition is causing tachycardia, treating the underlying problem may reduce or prevent episodes of a fast heartbeat.
Slowing a fast heart rate
A fast heart rate may correct itself. But sometimes medication or other medical treatments are needed to slow down the heartbeat.
Ways to slow a fast heart rate include:
- Vagal maneuvers. Vagal maneuvers include coughing, bearing down as if having a bowel movement and putting an ice pack on the face. Your health care provider may ask you to perform these specific actions during an episode of a fast heartbeat. These actions affect the vagus nerve, which helps control the heartbeat.
- Medications. If vagal maneuvers don't stop the fast heartbeat, medication may be needed to restore the heart rhythm.
- Cardioversion. This medical procedure is usually done by sending electric shocks to the heart through sensors (electrodes) placed on the chest. The shock affects the heart's electrical signals and restores a normal heartbeat. Cardioversion is generally used when emergency care is needed or when vagal maneuvers and medications don't work. It's also possible to do cardioversion with medications.
Preventing future episodes of a fast heart rate
The treatment of tachycardia involves taking steps to prevent the heart from beating too fast. This may involve medication, implanted devices, or other surgeries or procedures.
- Medications. Drugs to control the heart rate and restore a normal heart rhythm are typically prescribed for most people with tachycardia.
Catheter ablation. In this procedure, a health care provider threads one or more thin, flexible tubes (catheters) through an artery, usually in the groin, and guides them to the heart. Sensors (electrodes) on the tip of the catheter use heat or cold energy to create tiny scars in the heart to block irregular electrical signals and restore the heart rhythm. It's often done when an extra signaling pathway is responsible for an increased heart rate.
Catheter ablation doesn't require surgery to access the heart, but it may be done at the same time as other heart surgeries.
- Pacemaker. A pacemaker is a small device that's surgically implanted under the skin in the chest area. When the device senses an irregular heartbeat, it sends an electrical pulse that helps the heart resume the correct rhythm.
Implantable cardioverter-defibrillator (ICD). Your health care provider may recommend this device if you're at high risk of developing ventricular tachycardia or ventricular fibrillation.
An ICD is a battery-powered unit that's implanted under the skin near the collarbone — similar to a pacemaker. The ICD continuously monitors the heart rhythm. If the device detects an irregular heartbeat, it sends out low- or high-energy shocks to reset the heart's rhythm.
- Maze procedure. In this procedure, a surgeon makes tiny incisions in the upper half of the heart (atria) to create a pattern (or maze) of scar tissue. The heart's signals can't pass through scar tissue. So the maze can block stray electrical heart signals that cause some types of tachycardia.
- Surgery. Sometimes open-heart surgery may be needed to destroy an extra electrical pathway causing tachycardia. Surgery is usually done only when other treatment options don't work or when surgery is needed to treat another heart disorder.
Tachycardia consultation at Mayo Clinic
An implantable device, such as a pacemaker or implantable cardioverter-defibrillator (ICD), may be used to treat some types of tachycardia.
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Lifestyle and home remedies
If you have tachycardia or any type of heart disease, your health care provider will likely recommend following a heart-healthy lifestyle. Take these steps:
- Eat a healthy diet
- Don't smoke
- Get regular exercise
- Maintain a healthy weight
- Limit or avoid alcohol
Stress-relief techniques, such as meditation and yoga, might help slow the heartbeat and reduce tachycardia symptoms
Coping and support
If you have a plan in place to manage an episode of a fast heartbeat, you may feel calmer and more in control when one occurs. Ask your health care provider:
- How to take your pulse and what heart rate is best for you
- When and how to use vagal maneuvers, if appropriate
- When to call a health care provider
- When to seek emergency care
Seeking support from family and friends also may help reduce stress and better manage tachycardia.
Preparing for your appointment
If you have tachycardia, you'll likely be referred to a doctor trained in heart conditions (cardiologist).
Because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from the health care provider.
What you can do
Make a list ahead of time that you can share with your health care provider. Your list should include:
- Any symptoms, including those that may seem unrelated to your heart
- Key personal information, including any major stresses or recent life changes
- All medications you take and the dosages, including vitamins and supplements and drugs bought without a prescription
- Questions to ask your health care provider
Basic questions to ask your health care provider include:
- What is the likely cause of my fast heart rate?
- What kinds of tests are needed?
- What's the most appropriate treatment?
- What kind of risks does my heart condition create?
- How will we monitor my heart?
- How often will I need follow-up appointments?
- How will other conditions I have or medications I take affect my heart problem?
- Do I need to restrict my activities?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend?
In addition to the questions that you've prepared to ask your health care provider, don't hesitate to ask additional questions.
What to expect from your doctor
Your health care provider is likely to ask you a number of questions. Being ready to answer them may save time to go over any details you want to spend more time on. Your health care provider may ask:
- When did you first begin having symptoms?
- How often have you had episodes of a fast heartbeat?
- How long have the episodes lasted?
- Does anything, such as exercise, stress or caffeine, seem to trigger or worsen episodes?
- Does anyone in your family have heart disease or a history of irregular heart rhythms (arrhythmias)?
- Has anyone in your family had cardiac arrest or died suddenly?
- Do you smoke?
- How much alcohol or caffeine do you use, if any?
- Do you use stimulant drugs?
- Are you being treated for high blood pressure, high cholesterol or other conditions that may affect your heart health?
- What medications do you take for these conditions, and do you take them as prescribed?
Oct. 22, 2022