Palpitation (Tachycardia)

Definition: What Is Tachycardia?

Palpitation (med.: tachycardia) refers to an increase in heart rate of more than 100/min. For children, different limits apply depending on their age. The cause of such tachycardia is usually harmless, e.g., excitement or fear.  However, if the heartbeat is permanently accelerated, this can indicate heart disease, and a doctor should urgently examine the heart.

What Types of Tachycardia Are There?

1. Supraventricular tachycardia: the point of origin of the tachycardia is outside the ventricles, e.g., in the atria.

2. Ventricular tachycardia: the high pulse originates in the ventricle.

Is Tachycardia Dangerous?

The regular pulse in adults at rest is between 60 and 80 beats per minute. In tachycardia, the heart rate is permanently increased over 120 beats per minute, and a permanent pulse over 120 is threatening and over 150 life-threatening. However, not every tachycardia has a severe condition behind it. If there are sudden attacks, but they also pass quickly and are relieved by sitting down and resting, the chances are high that it is the benign heart palpitations.  This can seem distressing at the moment but is usually harmless. What is dangerous is palpitations that are triggered by heart disease . In this case, therapy should be carried out to avoid long-term damage.

Causes: What Triggers Palpitation?

Causes can be diseases such as:

• Coronary heart disease
• Potassium deficiency
• Hyperthyroidism
• Alcohol consumption
• Infection and inflammation
• Cardiac arrhythmia
• Blood poisoning
• Anemia
• Hypoglycemia
• Allergic reaction
• Caffeine consumption
• Side-effect of a drug

Tachycardia Symptoms

Typically, in addition to the pounding and thumping of the heart, the affected person also feels the following symptoms:

• Sweating and clammy hands.
• Dizziness
• Rapid breathing or shortness of breath
• Trembling and inner restlessness
• Nausea

Diagnosis: How Is Tachycardia Diagnosed?

First, the affected person is questioned in detail about their problem. This includes the first onset of tachycardia, the accompanying circumstances, other complaints, previous illnesses, current medication, etc. Then the doctor carries out a physical examination. During this examination, pulse and blood pressure are measured. In addition, the organs are palpated and auscultated with a stethoscope. Blood is also drawn for laboratory tests.

A practical tool for diagnosis is the electrocardiogram (ECG). The ECG provides a quick record of heart function and provides a lot of information about possible heart disease. However, it is only a brief recording of heart activity, so dysrhythmia is often missed in the resting ECG because it does not occur at the moment of recording. Therefore, a long-term ECG is always indicated in the case of palpitations. The patient wears an ECG device for 24 hours so that the measurement can take place over the entire period. In addition, further examinations may be indicated. These include an exercise ECG, an ultrasound examination of the heart, and a long-term blood pressure measurement.

Therapy: How Are Tachycardias Treated?

If the tachycardia appears to be natural, no therapy is usually necessary. Only in the case of cardiac arrhythmias should something be done. For example, treatment of atrial fibrillation is based on the following principles:

• Prevention of thromboembolic incidents.
• Prevention of excessively high ventricular rates
• Restoration of sinus rhythm in appropriate patients
• "Upstream therapy"

For this, medications can be given to bring the frequency or rhythm of the heart under control. Surgery to eradicate the cause of the arrhythmia may also be an option.

In the case of high blood pressure , there are drugs that lower blood pressure and at the same time protect the heart, which means, have a cardioprotective effect. In addition, a change of lifestyle, e.g., diet, sporty activity, and smoke-free living, can also contribute to a blood pressure lowering.

If the cause is hyperthyroidism, thyroid surgery , or the use of thyrostatic drugs or radioiodine therapy must be performed. Subsequently, the thyroid balance should be normalized, or an external supply of thyroid hormones is necessary.

Stress can also lead to pathological palpitation. However, stress reduction through changes in professional life, better sleep, or psychological treatment can positively affect.

Healing Chances and Process

The course depends on the disease that triggers the palpitation. Therefore, an individual prediction for the chances of healing or the process is challenging to make. However, if the cause is detected and treated early, the life expectancy of the patients is prolonged compared to those with conditions that are seen late.

Sources:

Dietel et al.: Harrisons Innere Medizin. 18. Auflage. ABW Wissenschaftsverlag 2012, ISBN 978-3-940-61520-6.

Vereckei: Current algorithms for the diagnosis of wide QRS complex tachycardias. In: Current cardiology reviews. Band 10, Nummer 3, 2014, S. 262–76.

Bakker et al.: The Lewis Lead: Making Recognition of P Waves Easy During Wide QRS Complex Tachycardia. In: Circulation. Band 119, Nummer 24, 2009, doi: 10.1161/circulationaha.109.852053, S. e592–e593.

Brugada et al.: A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. In: Circulation. Band 83, Nummer 5, 1991, S. 1649–59.

Chai et al.: The Value of Brugada Algorithm in the Differential Diagnosis of Broad QRS Complex Tachycardia: A Meta-Analysis. In: Journal of Cardiovascular Diseases & Diagnosis. Band 06, Nummer 02, 2018, doi: 10.4172/2329-9517.1000314.

Vereckei et al.: New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. In: Heart Rhythm. Band 5, Nummer 1, 2008, doi: 10.1016/j.hrthm.2007.09.020, S. 89–98.

Pava et al.: R-wave peak time at DII: A new criterion for differentiating between wide complex QRS tachycardias. In: Heart Rhythm. Band 7, Nummer 7, 2010, doi: 10.1016/j.hrthm.2010.03.001, S. 922–926.

Griffith et al.: Ventricular tachycardia as default diagnosis in broad complex tachycardia. In: Lancet (London, England). Band 343, Nummer 8894, 1994, S. 386–8.

Goy et al.: Electrocardiography (ECG). Bentham Science Publishers 2013, ISBN 978-1-608-05479-4.

Herold et al.: Innere Medizin. Eigenverlag 2012, ISBN 978-3-981-46602-7.

Haverkamp et al.: Medikamentenbedingte QT-Verlängerung und Torsade de pointes - Ein multidisziplinäres Problem. In: Deutsches Ärzteblatt. Band 99, Nummer 28-29, 2002, S. A1972 ff..

Delacrétaz: Medikamente und verlängertes QT-Intervall. In: Schweizerische Medizin-Forum. Nummer 7, 2007, S. 814–819.

Garner, Miller: Wide Complex Tachycardia – Ventricular Tachycardia or Not Ventricular Tachycardia, That Remains the Question. In: Arrhythmia & Electrophysiology Review. Band 2, Nummer 1, 2013, doi: 10.15420/aer.2013.2.1.23, S. 23.