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Your heart normally beats in a regular rhythm and rate that is just right for the work your body is doing at any moment. The usual resting heart rate for adults is between 50 to 100 beats per minute. Children have naturally higher normal heart rates than adults.

The heart is a pump made up of four chambers : two upper chambers (atria) and two lower chambers (ventricles). It is powered by an electrical system that puts out pulses in a regular rhythm. These pulses keep the heart pumping and keep blood flowing to the lungs and body.

When the heart beats too fast, too slow, or with a skipping (irregular) rhythm, a person is said to have an arrhythmia. A change in the heart's rhythm may feel like an extra-strong heartbeat (palpitation) or a fluttering in your chest. Premature ventricular contractions (PVCs) often cause this feeling.

A heartbeat that is occasionally irregular usually is not a concern if it does not cause other symptoms, such as dizziness, lightheadedness, or shortness of breath. It is not uncommon for children to have extra heartbeats. In healthy children, an extra heartbeat is not a cause for concern.

When heart rate or rhythm changes are minor

Many changes in heart rate or rhythm are minor and do not require medical treatment if you do not have other symptoms or a history of heart disease. Smoking, drinking alcohol or caffeine, or taking other stimulants such as diet pills or cough and cold medicines may cause your heart to beat faster or skip a beat. Your heart rate or rhythm can change when you are under stress or having pain. Your heart may beat faster when you have an illness or a fever. Hard physical exercise usually increases your heart rate, which can sometimes cause changes in your heart rhythm.

Dietary supplements, such as goldenseal, oleander, motherwort, or ephedra (also called ma huang), may cause irregular heartbeats.

It is not uncommon for pregnant women to have minor heart rate or rhythm changes. These changes usually are not a cause for concern for women who do not have a history of heart disease.

Well-trained athletes usually have slow heart rates with occasional pauses in the normal rhythm. Evaluation is usually not needed unless other symptoms are present, such as lightheadedness or fainting (syncope), or there is a family history of heart problems.

When heart rate or rhythm changes are more serious

Irregular heartbeats change the amount of blood that flows to the lungs and other parts of the body. The amount of blood that the heart pumps may be decreased when the heart pumps too slow or too fast.

Changes such as atrial fibrillation that start in the upper chambers of the heart can be serious, because they increase your risk of forming blood clots in your heart. This in turn can increase your risk for having a stroke or a blood clot in your lungs (pulmonary embolism). People who have heart disease, heart failure, or a history of heart attack should be more concerned with any changes in their usual heart rhythm or rate.

Fast heart rhythms that begin in the lower chambers of the heart are called ventricular arrhythmias. They usually are fast and regular, such as ventricular tachycardia, or fast and irregular, such as ventricular fibrillation. These types of heart rhythms make it hard for the heart to pump enough blood to the brain or the rest of the body and can be life-threatening. Ventricular arrhythmias may be caused by heart disease such as heart valve problems, impaired blood flow to the heart muscle (ischemia or a heart attack), a weakened heart muscle (cardiomyopathy), or heart failure.

Ventricular tachycardia is a life-threatening arrhythmia that can quickly lead to ventricular fibrillation, which causes death if not treated. Both usually cause fainting (syncope) within seconds, and you may have symptoms of a heart attack. Emergency medical treatment is needed, such as medicines and electrical shock (defibrillation).

When you have a change in your heart rhythm or rate, you also may have other symptoms, such as chest pain, shortness of breath, lightheadedness, fainting, confusion, or weakness. Changes in your heart rate or rhythm with other symptoms can be caused by a serious heart problem.

Taking illegal drugs (such as stimulants, like cocaine or methamphetamine) or misusing prescription and nonprescription medicines can cause serious heart rhythm or rate changes and may be life-threatening.

The U.S. Food and Drug Administration (FDA) has banned the sale of ephedra, a stimulant sold for weight loss and sports performance, because of concerns about safety. Ephedra has been linked to heart attacks, strokes, and some sudden deaths.

Check your symptoms to decide if and when you should see a doctor.

Home treatment can help relieve some problems that cause changes in your heart rate. When you think you have a change in your heart rate or rhythm:

  • Sit down and take your pulse for 1 minute.
  • If you become lightheaded, sit or lie down to avoid injuries that might occur if you faint and fall.
  • Take a few deep breaths and try to relax. This may slow down a racing heart rate. Be careful not to breathe too fast, which can cause hyperventilation.
  • Cut back or eliminate caffeine (including coffee, tea, colas, and chocolate). Some nonprescription medicines (such as Excedrin) contain caffeine. Caffeine can increase your heart rate and cause irregular rhythms.
  • Cut back or eliminate alcohol and tobacco, which also contain substances that can increase your heart rate or cause irregular rhythms.
  • If your doctor has told you that you have panic attacks, use home treatment measures to calm yourself.

You may find it helpful to keep a record of the date and time that you noticed the change.

  • What were you doing when your heart rate or rhythm changed? Were you active or resting at the time?
  • Were you straining to urinate or have a bowel movement?
  • Were you in a stressful or fearful situation?
  • Were you walking, standing, sitting, or lying down?
  • How long did the change in heart rate or rhythm last?
  • How many times did you have palpitations or a sense of a fast heart rate or irregular rhythm?
  • Did you have any other symptoms?
  • List what you did that helped your heart rate or rhythm to return to normal, such as lying down, deep breathing, or coughing. Did your heart rate or rhythm return to normal on its own?
  • Try "tapping out" the heart rhythm with your fingers and write it down so you can discuss it with your doctor.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • You continue to have changes in your heart rate or rhythm.
  • Lightheadedness develops.
  • Other symptoms develop when your heart rate or rhythm changes.
  • Your symptoms become more severe or frequent.

You often can reduce or prevent changes in your heart rate or rhythm.

  • Prevent fatigue by getting plenty of sleep and rest. If you become overtired, your changes in heart rate or rhythm may be more severe or occur more often.
  • Cut back or eliminate caffeine, including coffee, tea, colas, and chocolate. Some nonprescription medicines, such as Excedrin, contain caffeine. Caffeine increases your heart rate and can cause irregular rhythms.
  • Cut back or eliminate alcohol and tobacco, which also contain substances that increase heart rate and can cause irregular rhythms.
  • Stop using medicines that increase heart rate, such as cough and cold remedies, nose drops, or allergy relief medicines that contain pseudoephedrine, epinephrine, or ephedrine.
  • If stress affects your heart rhythm or rate, try relaxation exercises and deep breathing techniques. A healthy exercise program can help reduce stress. For more information, see the topic Stress Management.

Knowing CPR could be useful for anyone. Many parents learn CPR so they know what to do if their children need it. People who have family members with a heart problem also should learn CPR.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

  • Do you have a history of problems with your heart rate or rhythm? If so:
    • Did you see a doctor?
    • What was the diagnosis?
    • What tests were done?
    • How was it treated?
  • When did you first notice the change in your heart rate or irregular rhythm? What were you doing when it started? Were you walking, standing, sitting, or lying down?
  • Is the change in heart rate or irregular rhythm related to activity, or does it happen when you are resting?
  • How often does the change in heart rate or irregular rhythm occur? How long does it last?
  • Is the change in heart rate or irregular rhythm related to eating?
  • What does the change in heart rate or irregular rhythm feel like?
  • Did you have other symptoms with the change in heart rate or irregular rhythm? What were the other symptoms?
  • What have you tried at home to relieve the change in heart rate or irregular rhythm?
  • Do you have any health risks?

If you have kept a record of your heart rate or rhythm changes, be sure to discuss this with your doctor.

  • Anger, Hostility, and Violent Behavior
  • Anxiety
  • Chest Problems
  • Dizziness: Lightheadedness and Vertigo
  • Weakness and Fatigue

By: Healthwise Staff Last Revised: September 13, 2012
Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine
David Messenger, MD

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