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.

Definition

A period of very rapid and regular heart beats that begins and ends abruptly. The heart rate is usually between 160 and 200 beats per minute. This condition is also known as paroxysmal supraventricular tachycardia.

Description

The term paroxysmal means that the event begins suddenly, without warning and ends abruptly. Atrial tachycardia means that the upper chambers of the heart are beating abnormally fast. Paroxysmal atrial tachycardia can occur without any heart disease being present. It is usually more annoying than dangerous.

Causes & symptoms

Paroxysmal atrial tachycardia may be caused by several different things. The fast rate may be triggered by a premature atrial beat that sends an impulse along an abnormal electrical path to the ventricles. Other causes stem from anxiety, stimulants, overactive thyroid, and in some women, the onset of menstruation.

Though seldom life-threatening, paroxysmal atrial tachycardia produces annoying symptoms which can include lightheadedness, chest pain, palpitations, anxiety, sweating, and shortness of breath.

Diagnosis

Diagnosis is not always easy, because the event is usually over by the time the patient sees a doctor. A careful description of the episode will aid the doctor in his diagnosis. If the rapid heart rate is still occurring, an electrocardiograph (ECG) will show the condition. If the event is over, physicians often recommend a period of ambulatory electrocardiographic monitoring (called Holter monitoring) to confirm the diagnosis.

Treatment

The doctor may suggest that during an episode of paroxysmal atrial tachycardia the following practise may help. Briefly hold the nose and mouth closed and breathe out, or by bearing down, as though straining at a bowel movement. The doctor may try to stop the episode by gently massaging an area in the neck called the carotid sinus.

If these conservative measures don't work, an injection of the drug verapamil or adenosine should stop the episode quickly.

In rare cases, the drugs do not work and electrical shock (cardioversion) may be necessary, particularly if serious symptoms are also present with the tachycardia.

Prognosis

Paroxysmal atrial tachycardia is not a disease, and is seldom life-threatening. The episodes are usually more unpleasant than they are dangerous, and the prognosis is generally good.

Prevention

Frequent episodes are usually cause for medication. In rare cases, the doctor may recommend a procedure called catheter ablation, which will remove (or ablate) the precise area of the heart responsible for triggering the fast heart rate.

In a catheter ablation procedure, the doctor will place a special catheter against the area of the heart responsible for the problem. Radio-frequency energy is then passed to the tip of the catheter, so that it heats up and destroys the target area. Catheter ablation is considered a non-surgical technique.

Key Terms

Premature atrial beat: A beat that occurs before it would normally be expected.
Supraventricular: A term for an event that occurs in the upper chambers (atria) of the heart.

For Your Information

Books

McGoon, Michael D., ed. Mayo Clinic Heart Book: The Ultimate Guide to Heart Health. New York: William Morrow and Company, Inc., 1993.
Organizations
American Heart Association. 7320 Greenville Avenue, Dallas, TX 75231. 1-800-889-7943.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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