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Tachycardia

Tachycardia is an abnormally rapid beating of the heart, defined as a resting heart rate of over 100 beats per minute. more...

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It can have harmful effects in two ways. First, when the heart beats too rapidly, it performs inefficiently (since there is not enough time for the ventricles to fill completely), causing blood flow and blood pressure to diminish. Second, it increases the work of the heart, causing it to require more oxygen while also reducing the blood flow to the cardiac muscle tissue, increasing the risk of ischemia and resultantly infarction.

Tachycardia is a general symptomatic term that does not describe the cause of the rapid rate. Common causes are autonomic nervous system or endocrine system activity, hemodynamic responses, and various forms of cardiac arrhythmia.

Autonomic and endocrine causes

An increase in sympathetic nervous system stimulation causes the heart rate to increase, both by the direct action of sympathetic nerve fibers on the heart, and by causing the endocrine system to release hormones such as epinephrine (adrenaline) which have a similar effect. Increased sympathetic stimulation is usually due to physical or psychological stress (the so-called "fight or flight" response), but can also be induced by stimulants such as amphetamines.

Endocrine disorders such as pheochromocytoma can cause epinephrine release and tachycardia independent of the nervous system.

Hemodynamic responses

The body contains several feedback mechanisms to maintain adequate blood flow and blood pressure. If blood pressure decreases, the heart beats faster in an attempt to raise it. This is called reflex tachycardia

This can happen in response to a decrease in blood volume (through dehydration or bleeding), or an unexpected change in blood flow. The most common cause of the latter is orthostatic hypotension (also called postural hypotension), a sudden drop of blood pressure that occurs with a change in body position (e.g., going from lying down to standing up). When tachycardia occurs for this reason, it is called postural orthostatic tachycardia syndrome (POTS).

Tachycardic arrhythmias

An electrocardiogram tracing can distinguish several different forms of rapid abnormal heartbeat:

If the heart's electrical system is functioning normally, except that the rate is in excess of 100 beats per minute, it is called sinus tachycardia. This is caused by any of the factors mentioned above, rather than a malfunction of the heart itself.

Supraventricular tachycardia (SVT) occurs when an abnormal electrical impulse originates above the ventricles, but instead of causing a single beat and a pause, it travels in circles and causes many rapid beats. To distinguish SVT from Sinus Tachycardia one must simply look at the rate: If the rate of contraction is more than 150 bpm, then it is considered SVT. Otherwise it is Sinus Tachycardia. Ventricular tachycardia (VT or "V-tach") is a similar phenomenon occurring within the tissue of the ventricles, causing an extremely rapid rate with poor pumping action. Both of these rhythms normally last for only a few seconds (paroxysmal tachycardia), but if VT persists it is extremely dangerous, often leading to ventricular fibrillation.

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Stopping tachycardia
From Saturday Evening Post, 7/1/05 by Douglas P. Zipes

Reader: I have had two catheter ablation attempts at excellent teaching hospitals, but I go into heart block each time they tried to ablate. I am very athletic and am now taking Sotalol. It seems to be working better than my other medications, but I would like to know if there are any other procedures available.

Dr. Zipes: I assume from your question that you have episodes of rapid heartbeats, so-called "tachycardia," that are related to an "extra" pathway in your heart, and that your doctors tried to eliminate it by the procedure called catheter ablation. As you know, this involves threading a catheter (skinny wire) into your heart and positioning the tip near this extra pathway to burn it and stop the tachycardias. Most likely, in your case, the extra pathway is very close to your heart's normal conducting system, and each time the doctors tried to burn the abnormal pathway, they temporarily blocked your normal pathway also. You don't say how long ago these procedures were tried, but there have been many improvements in catheter ablation over the past few years. I suggest you talk with the doctors who last tried the procedure and ask if they think it might be worthwhile to try again. If you like, you can contact me directly for suggestions of other doctors who might help.

Internationally acclaimed cardiologist, professor, author and inventor, Dr. Douglas P. Zipes contributes to The Saturday Evening Post magazine as a featured columnist in "Heart Health." Dr. Zipes, an authority on what is ca(led pacing and electrophysiology (rhythms of the heart), hosts a "heart to heart" discussion about your heart-felt concerns. Contents are not intended to substitute for medical attention from a physician.

Please send questions to: Dr. Douglas Zipes, SatEvePost, 1100 Waterway Blvd., Indianapolis, IN 46202.

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