Health Library Change in HeartbeatFrom Healthwise

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. 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. 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.

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 difficult 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 misusing prescription and nonprescription medicines can cause serious heart rhythm or rate changes and may be life-threatening.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

• Unconsciousness. See Rescue Breathing and Cardiopulmonary Resuscitation (CPR) in the topic Dealing With Emergencies.
• Chest discomfort or pain that is crushing or squeezing or feels like a heavy weight on the chest
• Chest discomfort or pain that occurs with:
  • Sweating
  • Shortness of breath
  • Nausea or vomiting
  • Discomfort or pain that spreads from the chest to the neck, jaw, or one or both shoulders or arms
  • Dizziness or lightheadedness
  • Fast heart rate or irregular heart rhythm
• Moderate to severe difficulty breathing
• Shock
• Sudden heart rate or rhythm change with nausea, lightheadedness, fainting, or severe fatigue

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Chest pain: Go to the topic Chest Pain.

	Yes	Did you have a change in your heartbeat and you fainted, but now you are awake and feel fine?
When to See a Doctor See significance of fainting if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Did you faint, but now you are awake and feel fine? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Did you have a change in your heartbeat and you felt lightheaded?
When to See a Doctor See significance of feeling lightheaded if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Did you feel lightheaded? Yes Did you have palpitations? Yes Do you have a known heart problem? Yes Do you feel lightheaded, and your heart rate is faster than 100 beats per minute after 5 minutes of rest? Yes Do you feel lightheaded, and your heart rate is slower than 60 beats per minute? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a fast heart rate (more than 100 beats per minute)?
When to See a Doctor See significance of a fast heart rate if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Is your heart beating faster than 100 beats per minute without an obvious cause? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a slow heart rate (less than 50 beats per minute)?
When to See a Doctor See significance of a slow heart rate if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Is your heart beating slower than 50 beats per minute without other symptoms? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have episodes of a fast heart rate or irregular heart rhythm and shortness of breath during physical activities?
When to See a Doctor See significance of a fast heart rate or irregular heart rhythm and shortness of breath during physical activities if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have episodes of a fast heart rate with shortness of breath during physical activities? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have an irregular heart rhythm, but the rate is between 50 and 100 beats per minute?
When to See a Doctor See significance of an irregular heart rhythm if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Is your irregular heart rhythm new and you have a known heart problem? Call your health professional today if you answer "Yes" to the following question. Yes Do you have an irregular heart rhythm without other symptoms? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think the change in your heart rate or rhythm may be caused by a medicine?
When to See a Doctor See significance of a change in heart rate or rhythm caused by a medicine if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you think the change in your heart rate or rhythm may be caused by a medicine? Note: If you answered "Yes": Call the health professional who prescribed the medicine to determine whether you should stop taking it or take a different one. An appointment may not be necessary. If you are taking a nonprescription medicine, stop taking the medicine. Call your health professional if you feel you need to continue taking the medicine. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Fever: Go to the topic Fever, Age 4 and Older.
• Feeling anxious: Go to the topic Anxiety.
• Anger: Go to the topic Anger, Hostility, and Violent Behavior.
• Dizziness: Go to the topic Dizziness: Lightheadedness and Vertigo.
• Feeling weak or tired: Go to the topic Weakness and Fatigue.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

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 health professional 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 health professional.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms 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.

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

You can help your health professional 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 health professional?
  • 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 health professional. See the Home Treatment section for information on keeping a record.

• Atrial Fibrillation
• Bradycardia (Slow Heart Rate)
• Chest Pain
• Coronary Artery Disease
• Dealing With Emergencies
• Dizziness: Lightheadedness and Vertigo
• Heart Attack and Unstable Angina
• Panic Attacks and Panic Disorder
• Pulse Measurement
• Stress Management
• Stroke
• Supraventricular Tachycardia
• Transient Ischemic Attack (TIA)
• Weakness and Fatigue

Author:	Jan Nissl, RN, BS	Last Updated: April 27, 2007
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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