Fast Heart Beat | Palpitations

Remarkable as it may seem the healthy human heart beats 50,000,000 times a year, pumping the equivalent of three and a half million litres of blood around the body in the process.

Under normal resting conditions a healthy heart will beat 60 to100 times per minute and, more often than not, we are completely unaware of this routine bodily function as it is usually almost imperceptible under normal circumstances.

On the other hand, when we exercise it is quite normal for our heart rate to increase above 100 beats per minute and, during sleep, it is not uncommon for our heart rate to fall below 60 beats per minute.

The term palpitation, which is derived from the Latin word palpitare meaning “to flutter”, may mean different things to different people but generally speaking it indicates that the affected person is unduly aware that their heart is beating – fast or slow, regular or irregular, or even more forceful than usual.

So one can appreciate that there is no single definition for the term palpitation and when a patient uses this term to describe their symptoms their doctor will want to ask further questions in order to characterise the precise nature in a particular individual.

When a person’s heart rate exceeds 100 beats per minute the term tachycardia may be used by their doctor to describe this state.  The next two things to be ascertained if a patient presents with tachycardia are whether the heart rhythm is regular or irregular and whether the tachycardia develops gradually over time or starts abruptly.

Gradual onset tachycardias are usually due to normal physiological adjustments that occur with exercise or emotion but may also occur if a patient develops a high fever or is unwell for other reasons such as anaemia or an overactive thyroid gland.

When tachycardias are irregular, it may be that the patient has developed an abnormal rhythm arising from the heart’s upper chambers – the atria – most commonly atrial fibrillation.

Tachycardias that start abruptly are usually due to an electrical short circuit in the wiring system of the heart.  If possible, during such a tachycardia, it is very helpful to obtain an electrical trace of the heart – known as an ECG (or “EKG” in North America) – during the tachycardia as this will usually provide the treating doctor with clues as to the most likely cause for the short circuit, thereby allowing the doctor to advise the patient about the nature of their problem and the various treatments available.

In addition to discussing the nature of any associated symptoms the patient may notice when experiencing their fast heartbeats or palpitations – eg a feeling of apprehension, breathlessness, chest discomfort, or dizziness – it may be necessary to organise specific tests designed to obtain ECG information during a typical episode of symptoms.

Such a prolonged ECG recording may capture the heart’s rate and rhythm when a patient is aware of their fast heartbeats/palpitations, greatly helping the doctor to make an accurate diagnosis.  Such investigations – which may be known as Holter recordings, 24-hour taped ECG recordings or patient activated cardiac event recordings – can be most helpful in determining the precise nature of fast heartbeat/palpitation symptoms.

In many cases fast heartbeats/palpitations, which are shown to be due to the simple awareness of normal accelerations in the heart’s rate, do not require any specific treatment, merely reassurance that nothing untoward has occurred.

However, fast heart beating or palpitation symptoms due to atrial fibrillation or an electrical short circuit generally do require treatment either to control symptoms or to reduce the potential risk of adverse consequences.  The range of treatment options available will vary from teaching the patient simple measures to self-terminate an episode, to prescribing specific medication to prevent/terminate episodes, to thinning the blood if there is an increased risk of stroke, or to a key-hole technique known as catheter ablation which may cure their condition.


London bridge hospital