Diagnosis

To diagnose your condition and determine the specific type of tachycardia, your doctor will evaluate your symptoms, conduct a thorough physical examination, and ask you about your health habits and medical history.

Several heart tests also may be necessary to diagnose tachycardia.

Electrocardiogram (ECG)

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 patterns among these signals to determine what kind of tachycardia you have and how abnormalities in the heart may be contributing to a fast heart rate.

Your doctor may also ask you to use portable ECG devices at home to provide more information about your heart rate. These 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 few weeks 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 experience 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.

Electrophysiological test

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.

Cardiac imaging

Imaging of the heart may be performed to determine if structural abnormalities are affecting blood flow and contributing to tachycardia.

Types of cardiac imaging used to diagnose tachycardia include:

  • Echocardiogram (echo). An echocardiogram creates a moving picture of your heart using sound waves. An echo 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.

Stress Test

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 also be performed in conjunction 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 observes how your heart and nervous system respond to these changes in position.

Additional tests

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.

Treatment

Treatments for tachycardia are designed to address the cause of the condition as well as slow a fast heart rate when it occurs, prevent future episodes and minimize complications.

Stopping a fast heart rate

A fast heartbeat may correct itself, and you may be able to slow your heart rate using simple physical movements. However, you may need medication or other medical treatment 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.

    Vagal maneuvers affect the vagus nerve, which helps regulate your heartbeat. The maneuvers include coughing, bearing down as if you're having a bowel movement and putting an ice pack on your face.

  • Medications. If vagal maneuvers don't stop the fast heartbeat, you may need an injection of an anti-arrhythmic medication to restore a normal heart rate. An injection of this drug is administered at a hospital.

    Your doctor also may prescribe a pill version of an anti-arrhythmic drug to take if you have an episode of a fast heartbeat that doesn't respond to vagal maneuvers.

  • 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 rhythm. It's generally used when emergency care is needed or when maneuvers and medications aren't effective.

Preventing episodes of a fast heart rate

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. Pill versions of anti-arrhythmic medications may prevent a fast heart rate when taken regularly.

    Other types of drugs, such as calcium channel blockers and beta blockers, may be prescribed either as an alternative to or in combination with anti-arrhythmic medications.

  • 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 emits 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.

    In another type of surgery, called the maze 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.

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.

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?