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Change in Heartbeat

Topic Overview

Picture of the heart

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.

Check Your Symptoms

Do you have a concern about your heartbeat or heart rhythm?
Yes
Concern about heartbeat or heart rhythm
No
Concern about heartbeat or heart rhythm
How old are you?
Less than 12 years
Less than 12 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female
Did you pass out completely (lose consciousness)?
Yes
Lost consciousness
No
Lost consciousness
If you are answering for someone else: Is the person unconscious now?
(If you are answering this question for yourself, say no.)
Yes
Unconscious now
No
Unconscious now
Are you back to your normal level of alertness?
After passing out, it's normal to feel a little confused, weak, or lightheaded when you first wake up or come to. But unless something else is wrong, these symptoms should pass pretty quickly and you should soon feel about as awake and alert as you normally do.
Yes
Has returned to normal after loss of consciousness
No
Has returned to normal after loss of consciousness
Did the loss of consciousness occur during the past 24 hours?
Yes
Loss of consciousness in past 24 hours
No
Loss of consciousness in past 24 hours
Do you have symptoms of shock?
Yes
Symptoms of shock
No
Symptoms of shock
Could you be having symptoms of a heart attack?
If you're having a heart attack, there are several areas where you may feel pain or other symptoms.
Yes
Symptoms of heart attack
No
Symptoms of heart attack
Are you having trouble breathing (more than a stuffy nose)?
Yes
Difficulty breathing more than a stuffy nose
No
Difficulty breathing more than a stuffy nose
Would you describe the breathing problem as severe, moderate, or mild?
Severe
Severe difficulty breathing
Moderate
Moderate difficulty breathing
Mild
Mild difficulty breathing
Yes
Arrhythmia or change in heart rate
No
Arrhythmia or change in heart rate
Was the change sudden?
Yes
Sudden change in heart rate or rhythm
No
Sudden change in heart rate or rhythm
Does your heartbeat return to normal when you lie down?
Yes
Heartbeat returns to normal after lying down
No
Heartbeat does not return to normal after lying down
Do you have other symptoms such as feeling nauseated, lightheaded or faint, or extremely tired for no reason?
Yes
Other symptoms such as nausea, lightheadedness, fainting, or severe fatigue
No
Other symptoms such as nausea, lightheadedness, fainting, or severe fatigue
Do you have a fast heart rate (more than 120 beats per minute) for no clear reason?
Many heart rate changes are minor and have an obvious cause.
Yes
Heart rate more than 120
No
Heart rate more than 120
Do you have a slow heart rate (less than 50 beats per minute) that is not normal for you?
A slow heart rate is normal for some people, especially endurance athletes. What you are looking for is a change in your usual heart rate.
Yes
Heart rate less than 50
No
Heart rate less than 50
Do you have an irregular heart rhythm that is new to you?
Yes
New irregular heart rhythm
No
New irregular heart rhythm
Do you have a history of heart problems, such as coronary artery disease, heart failure, high blood pressure, or heart rhythm problems like atrial fibrillation?
Yes
History of heart problems
No
History of heart problems
Do you feel lightheaded or dizzy, like you are going to faint?
It's normal for some people to feel a little lightheaded when they first stand up. But anything more than that may be serious.
Yes
Feels faint
No
Feels faint
Do you get short of breath during physical activity and have trouble getting your heartbeat and breathing under control?
It's normal to feel out of breath and have your heart rate speed up when you are exercising hard. But your breathing and heart rate should return to normal soon after you slow down or stop.
Yes
Fast heart rate and shortness of breath during physical activity
No
Fast heart rate and shortness of breath during physical activity
Do you think that a medicine or drug may be causing the change in your heart rate or rhythm?
Think about whether the heartbeat changes started after you began using a new medicine or a higher dose of a medicine.
Yes
Medicine may be causing heartbeat changes
No
Medicine may be causing heartbeat changes
Have you been noticing changes in your heartbeat for more than a week?
Yes
Heartbeat changes for more than 1 week
No
Heartbeat changes for more than 1 week

Heartbeat changes can include:

  • A faster or slower heartbeat than is normal for you. This would include a pulse rate of more than 120 beats per minute (when you are not exercising) or less than 50 beats per minute (unless that is normal for you).
  • A heart rate that does not have a steady pattern.
  • Skipped beats.
  • Extra beats.

Many things can make the heart beat faster or slower than usual. Some common examples are:

  • Stress.
  • Pain.
  • Illness or fever.
  • Dehydration.
  • Exercise.
  • Panic attacks.
  • Stimulants, such as caffeine and nicotine.
  • Medicine side effects.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Symptoms of shock in a child may include:

  • Passing out.
  • Being very sleepy or hard to wake up.
  • Not responding when being touched or talked to.
  • Breathing much faster than usual.
  • Acting confused. The child may not know where he or she is.

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Symptoms of shock (most of which will be present) include:

  • Passing out.
  • Feeling very dizzy or lightheaded, like you may pass out.
  • Feeling very weak or having trouble standing.
  • Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Call 911 Now

Based on your answers, you need emergency care.

Call911or other emergency services now.

After you call 911 , the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Many medicines and drugs can affect the rate and rhythm of the heart. A few examples are:

  • Asthma medicines.
  • Decongestants and cold medicines.
  • Illegal drugs such as cocaine or amphetamines.
  • Some heart and blood pressure medicines.
  • Some medicines for depression and anxiety.
  • Thyroid medicine.

Call 911 Now

Based on your answers, you need emergency care.

Call911or other emergency services now.

Severe trouble breathing means:

  • The child cannot eat or talk because he or she is breathing so hard.
  • The child's nostrils are flaring and the belly is moving in and out with every breath.
  • The child seems to be tiring out.
  • The child seems very sleepy or confused.

Moderate trouble breathing means:

  • The child is breathing a lot faster than usual.
  • The child has to take breaks from eating or talking to breathe.
  • The nostrils flare or the belly moves in and out at times when the child breathes.

Mild trouble breathing means:

  • The child is breathing a little faster than usual.
  • The child seems a little out of breath but can still eat or talk.

Symptoms of difficulty breathing can range from mild to severe. For example:

  • You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
  • It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).

Severe trouble breathing means:

  • You cannot talk at all.
  • You have to work very hard to breathe.
  • You feel like you can't get enough air.
  • You do not feel alert or cannot think clearly.

Moderate trouble breathing means:

  • It's hard to talk in full sentences.
  • It's hard to breathe with activity.

Mild trouble breathing means:

  • You feel a little out of breath but can still talk.
  • It's becoming hard to breathe with activity.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Symptoms of a heart attack may include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

The more of these symptoms you have, the more likely it is that you're having a heart attack. Chest pain or pressure is the most common symptom, but some people, especially women, may not notice it as much as other symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, numbness, tingling, or a strange feeling in your chest or other areas.

Home Treatment

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.

Prevention

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.

Preparing For Your Appointment

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.

Credits

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

Last Revised: September 13, 2012

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