Tachycardia consultation at Mayo Clinic
A thorough physical exam, medical history and testing is required to diagnose tachycardia.
To diagnose your condition and determine the specific type of tachycardia, your doctor will evaluate your symptoms, perform a physical examination, and ask you about your health habits and medical history.
Several heart tests also may be necessary to diagnose tachycardia.
An electrocardiogram (ECG or EKG) records the electrical signal from your heart to check for different heart conditions. Electrodes are placed on your chest to record your heart's electrical signals, which cause your heart to beat. The signals are shown as waves on an attached computer monitor or printer.
An electrocardiogram, also called an ECG or EKG, is the most common tool used to diagnose tachycardia. It's a painless test that detects and records your heart's electrical activity using small sensors (electrodes) attached to your chest and arms.
An ECG records the timing and strength of electrical signals as they travel through your heart. Your doctor can look for signal patterns to determine what kind of tachycardia you have and how problems in the heart may be causing a fast heart rate.
A Holter monitor uses electrodes and a recording device to track your heart's rhythm for 24 to 72 hours. Your doctor can print an electrocardiogram strip using the data on the recording device to see your heart's rhythm during the period you wore the monitor.
Cardiac event monitor
A wearable cardiac event monitor may be used to diagnose tachycardia. This type of portable ECG device records heart activity only during episodes of abnormal heartbeat.
Your doctor may ask you to use a portable ECG device at home to provide more information about your heart rate. Portable, or remote, ECG devices include:
Holter monitor. This portable ECG device is carried in your pocket or worn on a belt or shoulder strap. It records your heart's activity for an entire 24-hour period, which provides your doctor with a prolonged look at your heart rhythms.
Your doctor will likely ask you to keep a diary during the same 24 hours. You'll describe any symptoms you experience and record the time they occur.
Event monitor. This portable ECG device is intended to monitor your heart activity over a week to a few months. You wear it all day, but it records only at certain times for a few minutes at a time. With many event monitors, you activate them by pushing a button when you have symptoms of a fast heart rate.
Other monitors automatically sense abnormal heart rhythms and then start recording. These monitors allow your doctor to look at your heart rhythm at the time of your symptoms.
- Other portable monitors. Some personal devices, such as smartwatches, offer electrocardiogram monitoring. Ask your doctor if this is an option for you.
Your doctor may recommend an electrophysiological test to confirm the diagnosis or to pinpoint the location of problems in your heart's circuitry.
During this test, a doctor inserts thin, flexible tubes (catheters) tipped with electrodes into your groin, arm or neck and guides them through your blood vessels to various spots in your heart. Once in place, the electrodes can precisely map the spread of electrical impulses during each beat and identify abnormalities in your circuitry.
Imaging of the heart may be performed to determine if structural abnormalities are affecting blood flow and contributing to tachycardia.
An echocardiogram checks how your heart's chambers and valves are pumping blood through your heart. An echocardiogram uses electrodes to check your heart rhythm and ultrasound technology to see how blood moves through your heart. An echocardiogram can help your doctor diagnose heart conditions.
To complete a coronary angiogram, a catheter is inserted in an artery in your groin or arm and threaded through your blood vessels to your heart. Your doctor uses the angiogram to check for blocked or narrowed blood vessels in your heart.
Cardiac imaging tests used to diagnose tachycardia include:
- Echocardiogram. An echocardiogram creates a moving picture of your heart using sound waves. It can identify areas of poor blood flow, abnormal heart valves and heart muscle that's not working normally.
- Magnetic resonance imaging (MRI). A cardiac MRI can provide still or moving pictures of how the blood is flowing through the heart and detect irregularities.
- Computerized tomography (CT). CT scans combine several X-ray images to provide a more detailed cross-sectional view of the heart.
- Coronary angiogram. To study the flow of blood through your heart and blood vessels, your doctor may use a coronary angiogram to reveal potential blockages or abnormalities. It uses a dye and special X-rays to show the inside of your coronary arteries.
- Chest X-ray. This test is used to take still pictures of your heart and lungs and can detect if your heart is enlarged.
Your doctor may recommend a stress test to see how your heart functions while it is working hard during exercise or when medication is given to make it beat fast.
In an exercise stress test, electrodes are placed on your chest to monitor heart function while you exercise, usually by walking on a treadmill. Other heart tests may be done with a stress test.
Tilt table test
This test is sometimes used to help your doctor better understand how your tachycardia contributes to fainting spells. Under careful monitoring, you'll receive a medication that causes a tachycardia episode. You lie flat on a special table, and then the table is tilted as if you were standing up. Your doctor notes how your heart and nervous system respond to these changes in position.
Your doctor may order additional tests as needed to diagnose an underlying condition that is contributing to tachycardia and judge the condition of your heart.
The goal of tachycardia treatment is to:
- Slow the fast heart rate when it occurs
- Prevent future episodes
- Reduce complications
- Treat underlying disease that may contribute to tachycardia
Slowing a fast heart rate
During cardioversion, shocks are delivered to your chest by the cardioversion machine while your heart rhythm is monitored.
A fast heart rate may correct itself. You also may be able to slow your heart rate using simple physical movements. However, medication or other medical treatments may be needed to slow down your heartbeat.
Ways to slow your heartbeat include:
- Vagal maneuvers. Your doctor may ask you to perform an action, called a vagal maneuver, during an episode of a fast heartbeat. The maneuvers include coughing, bearing down as if you're having a bowel movement and putting an ice pack on your face. Vagal maneuvers affect the vagus nerve, which helps control your heartbeat.
- Medications. If vagal maneuvers don't stop the fast heartbeat, you may need an injection of an anti-arrhythmic drug to restore a normal heart rate. An injection of this drug is given at a hospital. Anti-arrhythmic medicine is also available in pill form.
- Cardioversion. In this procedure, a shock is delivered to your heart through paddles, an automated external defibrillator (AED) or patches on your chest. The current affects the electrical impulses in your heart and restores a normal heartbeat. It's generally used when emergency care is needed or when maneuvers and medications don't work.
Preventing episodes of a fast heart rate
Cardiac ablation is a procedure to scar or destroy tissue in your heart that's allowing incorrect electrical signals to cause an abnormal heart rhythm. Diagnostic catheters are threaded through blood vessels to your heart where they are used to map your heart's electrical signals. Ablation catheters transmit heat or cold to scar or destroy tissue. This illustration shows ablation catheters being applied near the pulmonary veins in a type of cardiac ablation called pulmonary vein isolation, which is often used to treat atrial fibrillation.
With the following treatments, it may be possible to prevent or manage episodes of tachycardia.
Catheter ablation. This procedure is often used when an extra electrical pathway is responsible for an increased heart rate.
In this procedure, a doctor inserts catheters into your groin, arm or neck and guides them through the blood vessels to your heart. Electrodes at the catheter tips can use extreme cold or radiofrequency energy to damage (ablate) the extra electrical pathway and prevent it from sending electrical signals.
Catheter ablation does not require surgery to access the heart, but it may also be performed in conjunction with other heart valve or artery repair surgeries.
Medications. Anti-arrhythmic medications taken by mouth may prevent a fast heart rate when taken regularly.
Other heart medications, such as calcium channel blockers and beta blockers, may be prescribed instead or in combination with anti-arrhythmic drugs.
- Pacemaker. Some types of tachycardias may be treated with a pacemaker. A pacemaker is a small device that's surgically implanted under your skin. When the device senses an abnormal heartbeat, it sends an electrical pulse that helps the heart resume a normal beat.
- Implantable cardioverter. If you're at risk of having a life-threatening tachycardia episode, your doctor may recommend an implantable cardioverter-defibrillator (ICD). The pager-sized device is surgically implanted in your chest. The ICD continuously monitors your heartbeat, detects an increase in heart rate and delivers precisely calibrated electrical shocks, if needed, to restore a normal heart rhythm.
Surgery. Open-heart surgery may be needed in some cases to destroy an extra electrical pathway causing tachycardia.
Tachycardia may also be treated with a maze procedure. During this procedure, a surgeon makes small incisions in heart tissue to create a pattern or maze of scar tissue. Because scar tissue doesn't conduct electricity, it interferes with stray electrical impulses that cause some types of tachycardia.
Surgery is usually used 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.
Preventing blood clots
Some people with tachycardia have an increased risk of developing a blood clot that could cause a stroke or heart attack. Your doctor may prescribe a blood-thinning medication to help lower your risk.
Treating an underlying disease
If another medical condition is contributing to tachycardia, such as some form of heart disease or hyperthyroidism, treating the underlying problem may prevent or minimize tachycardia episodes.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.
Lifestyle and home remedies
Exercise and weight loss can help limit some of the health risks associated with tachycardia by reducing the negative effects of high blood pressure and sleep apnea.
Coping and support
If you have a plan in place to deal with an episode of a fast heartbeat, you may feel calmer and more in control when one occurs. Talk to your doctor about:
- How to take your pulse and what a normal pulse rate is for you
- When and how to use vagal maneuvers if they are appropriate for you
- When to call your doctor
- When to seek emergency care
Seeking support from family and friends also can help you reduce stress and better manage your tachycardia.
Preparing for your appointment
Whether you first see your family doctor or get emergency care, you'll likely be referred to a doctor trained in heart conditions (cardiologist) for one or more appointments for a complete evaluation.
If possible, bring along a family member or friend who can give some moral support and help you keep track of new information. Because there may be a lot to discuss, it will be helpful to prepare as much as possible.
What you can do
Make a list ahead of time that you can share with your doctor. Your list should include:
- Symptoms you've experienced, including any that may seem unrelated to your heart
- Key personal information, including any major stresses or recent life changes
- Medications, including vitamins or supplements
- Questions to ask your doctor
List your questions from most important to least important in case time runs out. Basic questions to ask your doctor include:
- What is likely causing my fast heart rate?
- What kinds of tests do I need?
- 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 visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing 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 arrhythmias?
- Has anyone in your family experienced cardiac arrest or died suddenly?
- Do you smoke?
- How much alcohol or caffeine do you use?
- Do you use recreational drugs?
- Are you being treated for high blood pressure, high cholesterol or other conditions that may affect your circulatory system?
- What medications do you take for these conditions, and do you take them as prescribed?
Oct. 30, 2020