Racing heart

and Sabine Schrör, medical journalist

Hanna Rutkowski is a freelance writer for the medical team.

More about the experts

Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

More about the experts All content is checked by medical journalists.

A rapid heartbeat with strong palpitations all the way up to the throat is typical of a racing heart (med .: tachycardia). This is how the body reacts to fear, excitement or anticipation, for example. But heart diseases can also be accompanied by a racing heart. If the heart continues to beat more than 100 times per minute, a doctor should definitely see it. Finally, palpitations can also lead to sudden cardiac death. Read everything you need to know about racing your heart here.

Brief overview

What is a racing heart? When the heart is racing (tachycardia), the heart beats more than 100 times per minute (adults). A distinction is made between supraventricular tachycardia (arises outside the ventricles) and ventricular tachycardia (arises in the ventricles) according to the location of its origin. A distinction is also made between acute and chronic tachycardia.
Causes: e.g. atrial flutter / atrial fibrillation, ventricular flutter / ventricular fibrillation, sinus tachycardia, AV node reentry tachycardia, Wolff-Parkinson-White syndrome, coronary heart disease (CHD), high blood pressure, overactive thyroid (hyperthyroidism), shock hormone fluctuations during menopause with great blood loss, anemia, pulmonary embolism, poisoning, medication, drugs, nicotine, caffeine.
First aid: alert the emergency doctor if there are additional symptoms such as shortness of breath, shortness of breath, tightness in the chest, severe chest pain, feelings of fear, unconsciousness, cardiac arrest. First aid for life-threatening ventricular fibrillation / ventricular flutter: chest compressions, use of a defibrillator or punch on the chest. Benign palpitations (palpitations) occur suddenly and usually go away on their own; Tips such as relaxation exercises, deep breathing in and out, and Valsalva maneuvers may help.
When to the doctor Palpitations should always be checked by a doctor!
Diagnosis: anamnesis, physical examination, EKG, long-term EKG, if necessary cardiac ultrasound.
Treatment: depending on the cause, for example with medication (beta blockers) or sedatives.

Palpitations: description and symptoms

In healthy adults, the heart beats between 60 and 80 times a minute. If the heart beats more than 100 beats per minute, it is called tachycardia. Pronounced tachycardia is present from 150 heartbeats per minute. The increased palpitations associated with the racing heart can be felt up into the throat!

Palpitations are not necessarily dangerous. Benign palpitations, colloquially called heart pounding, usually occurs as a side effect of harmless disorders. One example is the so-called AV node reentry tachycardia, in which the spread of excitation between the ventricles and auricles is disturbed. Benign palpitations occur suddenly again and again and just as unexpectedly go away completely by themselves. You can also recognize it by the following signs, for example:

The racing heart comes out of the blue, there is no recognizable connection with situations that trigger fear, excitement or anticipation.
The symptoms usually show up at rest or some time after you have exerted yourself.
The heart pounding may be accompanied by dizziness, pressure on the chest, or nausea.

In general, if the heart is healthy, it can cope with a sudden, benign racing heart. Nevertheless, you should definitely have a doctor clarify even benign palpitations in order to rule out more serious causes and avoid problems in everyday life. Because the ability to work and drive is restricted during an attack. It can even lead to fainting.

Forms of racing heart

Depending on where the rapid heartbeat originates, a distinction is made between:

Supraventricular tachycardia: This is where the palpitations develop outside the ventricles.
Ventricular tachycardia: This creates the accelerated pulse in the heart chamber. This is the dangerous form of the heart rate as it can result in life-threatening ventricular fibrillation.

Palpitations can also occur acutely or chronically.

Palpitations: causes

Physical exertion (for example during sport), stress, joy and fear can already make the pulse skyrocket. This is perfectly normal and not a cause for concern. How fast the heart normally beats also depends on age. As a rule, children have a higher heart rate than adults. That's why you usually don't have to worry about toddlers with a heart rate of 100 beats per minute.

It is different in adults with such a high pulse. Here it must be medically clarified what the cause is. It is found either in the heart itself, in another organ or in external influences.

The heart as the cause of tarchycardia

The heart itself is primarily responsible for tachycardia. To do this, you have to know how the vital muscle works: Specialized heart muscle cells generate electrical impulses (excitations). These are passed on via conduction pathways in the heart and trigger a muscle contraction - the heartbeat. The main role is played by the so-called sinus node in the right atrium of the heart with a frequency of 60 to 80 excitations per minute. If this excitation conduction system is disturbed, for example by reduced blood flow, additional conduction pathways or malfunctions of the sinus node, palpitations can occur.

The main cardiac causes of tachycardia are:

Atrial flutter / atrial fibrillation: Disordered electrical stimulation causes the muscles of the atria to flutter or flicker. The result is usually an accelerated, irregular pulse of more than 100 beats per minute. But that is not dangerous, many sufferers do not even notice the fluttering or flickering. However, there is an increased risk of thrombosis!
Coronary artery disease (CHD): This refers to circulatory disorders of the heart, which are based on a narrowing of the coronary vessels as a result of arteriosclerosis. Among other things, they can lead to arrhythmias (such as tachycardia) and heart attacks.
Ventricular flutter / ventricular fibrillation: Here the heart chambers contract very quickly (between 200 and 800 times per minute). As a result, the blood is no longer pumped into the circulation - the consequences are unconsciousness, respiratory and circulatory arrest. There is an acute danger to life!
Sinus tachycardia: The sinus node works here at an accelerated rate of more than 100 excitations per minute. This type of rapid heartbeat often shows up in anxiety, panic attacks, or fever.
AV node reentry tachycardia: During reentry, circular excitations spread between the ventricles and auricles and accelerate the pulse rate. Sudden palpitations of the heart, which go away by itself, are typical. AV nodal reentry tachycardia is not dangerous. Sometimes you can stop it yourself, for example by briefly pressing the carotid artery. But you have to have a doctor show you this beforehand!
Ventricular tachycardias: Additional impulses in the chambers make the heart beat faster and more inefficiently. Ventricular fibrillation can be dangerous.
Wolff-Parkinson-White syndrome: From birth, those affected have additional stimulus conduction between the atrium and ventricle. This can lead to a sudden racing heart and even loss of consciousness. Often, however, those affected are symptom-free and no treatment is required.
High blood pressure: Not only high blood pressure, but also a fast pulse can lead to increased heart palpitations.

Other common causes of palpitations

Overactive thyroid gland (hyperthyroidism)
Hormone fluctuations during menopause
Shock after injuries with great blood loss
Anemia (anemia)
Pulmonary embolism
Poisoning
Medication
Drugs
Nicotine and caffeine

Correct behavior in case of a racing heart

You can stop benign heartbeat yourself with a few techniques:

Breathe in and out deeply: Heart palpitations are often caused by stress or anxiety. In such situations, it can help to pause for a moment, sit down and consciously breathe in and out deeply.
Massage your neck: the carotid sinus nerve is located where you can feel your pulse on your neck. It records the pressure in the carotid arteries and controls the blood pressure. Massage this area lightly with your index and middle fingers. This can slow down the heartbeat. But be careful: the blood pressure usually drops a little too, which is why this technique should only be used while lying down or sitting.
Do the Valsalva maneuver: hold your nose and try to exhale gently with your mouth closed. This increases the pressure in the chest and slows the heartbeat.
Drink first, then burp: The same effect as the Valsalva maneuver is the quick drinking of a cold, preferably carbonated, drink and the subsequent burping.
Avoid coffee and cigarettes: If you suffer from rapid heartbeat, you should avoid substances that increase heartbeat and blood pressure. These are, for example, caffeine and nicotine.
Don't let yourself get stressed: The main cause of palpitations is and remains stress. Take it easy in everyday life and use relaxation techniques. These include, for example, progressive muscle relaxation, autogenic training or yoga.

Palpitations: When do you need to see a doctor?

As a matter of principle, you should always have a doctor examine a recurring palpitations - even if it disappears on its own. Only the doctor can identify the causes and initiate appropriate treatment steps.

If you have a racing heart, you should call an emergency doctor immediately in the following cases:

The tachycardia does not go away on its own, and actions such as pressure on the carotid artery do not help either.
Breathlessness, shortness of breath and tightness in the chest accompany the racing heart.
There are also severe chest pain, feelings of fear and shortness of breath.
It leads to unconsciousness and even cardiac arrest.

Note: With ventricular fibrillation and ventricular flutter there is an acute danger to life! Therefore, action must be taken immediately. A strong electrical impulse from a defibrillator or a punch on the chest can usually interrupt the rapid conduction and initiate a new, slow heartbeat.

Palpitations: the doctor does that

The doctor will talk to you first to get important information about your medical history (medical history). For example, he can ask the following questions:

When did the palpitations occur for the first time and when was the last time?
Does the rapid heartbeat only occur in situations associated with, for example, stress, fear or physical exertion?
How often do you have a racing heart?
Does the palpitation occur suddenly or gradually? And how does it go away?
How high is the pulse? Does the heart beat regularly while the heart is racing? How long does a seizure last?
Have you ever passed out during a seizure?
Can you get the tachycardia under control yourself (e.g. with a drug or your own actions)?
Are there any cases of palpitations in your family?
Do you have additional symptoms such as shortness of breath or a feeling of pressure in your chest?

This is followed by a physical exam, during which the doctor will also listen to your heartbeat. In addition, other examination methods are possible, for example:

Electrocardiography (EKG): The heart currents are recorded, which is essential for the diagnosis. If the heart currents are changed, this can indicate various heart diseases.
Long-term ECG: In contrast to the snapshot of the classic ECG, the heart's activity is recorded continuously for 24 hours with the long-term ECG. In this way, irregularities can be reliably identified.
Heart ultrasound (echocardiography): This examination can be performed from the outside through the skin or from the inside through the esophagus. It provides information about the function and shape of the heart valves and the size of the heart.

Tachycardia: treatment

Once it is clear what is causing the palpitations, the doctor will initiate appropriate treatment. Some examples:

Medicines often help against seizures or prolonged palpitations. For example, so-called antiarrhythmics (agents against cardiac arrhythmias) are often prescribed for atrial fibrillation. The patient has to take this whenever the heart gets out of step. Usually he also receives anticoagulants to counter the increased risk of thrombosis (such as stroke) with atrial fibrillation. If psychological factors such as stress or anxiety trigger the palpitations, tranquilizers such as benzodiazepines often help.

Medication is not always enough to get a tachycardia under control. Then, depending on the cause, other therapies come into question. In WPW syndrome, for example, it may be necessary to obliterate the excess conduction pathway (catheter ablation). If the racing heart is based on life-threatening ventricular fibrillation, one tries to end it as quickly as possible with the help of electric shocks (electrocardioversion).

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