Anna Mironova

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“And it beats so hard that it seems like it’s about to jump out” - this is how people who are faced with symptoms of tachycardia usually explain their condition. In addition, there is difficulty breathing, a “lump in the throat” appears, it makes you sweat, and your eyes darken.

Where does tachycardia come from, and what to do if it takes you by surprise?

Causes of frequent and strong heartbeats - what causes tachycardia?

Heart rhythm is a constant process of contractions of the main organ in the human body. And the slightest failure of the heart is always a signal for examination.

The heart rate in a healthy person is usually equal to 60-80 beats per minute . With a sharp increase in this frequency up to 90 beats and more talk about tachycardia.

Such attacks tend to begin unexpectedly and end just as unexpectedly, and the duration of an attack can range from 3-4 seconds to several days. The more emotional a person is, the higher his risk of encountering tachycardia.

However, the reasons this symptom(precisely a symptom, because tachycardia is by no means not a disease , and a sign of some disorder in the body) is quite a lot.

Also important distinguish tachycardia from the body’s natural reaction to physical activity or an attack of anxiety or fear. On heartbeat various factors may influence...

For example, heart disease:

• Myocarditis ( associated symptoms: pain, weakness, low-grade fever).
• Heart defect (approx. – congenital or acquired defect).
• Arterial hypertension (pressure in this case rises from 140/90 and above).
• Myocardial dystrophy (due to impaired cardiac/muscle nutrition).
• Coronary artery disease (note – manifested by a heart attack or angina pectoris).
• Anomaly of heart development.
• Cardiomyopathy (note – deformation of the heart/muscle).
• Arrhythmia.

And also when…

• Menopause.
• Various deviations in work thyroid gland.
• Tumors.
• Decrease/increase in pressure.
• Anemia.
• For purulent infections.
• For ARVI, influenza.
• Loss of blood.
• Allergies.

It is worth noting other factors that can cause an attack of tachycardia:

• Mental/nervous disorders, stress, fear, etc.
• Lack of physical activity, sedentary work.
• Insomnia.
• Taking certain medications. For example, antidepressants. Or taking medications for too long (indiscriminately).
• Taking drugs or alcohol.
• Abuse of various drinks containing caffeine.
• Excess weight or advanced age.
• Magnesium deficiency.
• Chocolate abuse.

There are many reasons. And there are more of them than in the above list. The heart can react to any changes or disorders in the body.

How to determine whether you should worry?

The only option - consult a doctor .

Especially if this is not the first attack of tachycardia, and it is accompanied by the following symptoms:

1. It gets dark in the eyes and...
2. Weakness and shortness of breath appear.
3. Chest pain is felt.
4. Sweating, shortness of breath.
5. Tingling in fingers.
6. Panic.
7. Etc.

Types of tachycardia - is increased heartbeat chronic?

During the examination, the specialist, before making a diagnosis, will find out what kind of tachycardia is observed in the patient.

She may be…

• Chronic. In this case, the symptoms are permanent or recur at regular intervals.
• Paroxysmal. This type of tachycardia is usually a sign of arrhythmia.

Arrhythmia, in turn, can be of the following types:

• Sinus. Usually the patient independently determines the beginning and end of the attack. It is treated by eliminating influencing factors and changing lifestyle.
• Paroxysmal. It is confirmed during an attack using electrocardiography. The source of excitation is usually located in one of the parts of the cardiac system - the atrium or ventricle.

What is dangerous about rapid heartbeat - all the risks and consequences

It is naive to believe that tachycardia is just a temporary inconvenience. Especially when the attacks recur.

Be aware of the risks and complications of tachycardia.

For example…

1. Heart failure (if the heart is unable to transport the required amount of blood).
2. Pulmonary edema.
3. Heart attack, stroke.
4. Cardiac arrest, sudden death.
5. Fainting.
6. Cramps.
7. The appearance of blood clots in the lungs/arteries.

The most dangerous thing is when an attack “overtakes” a person suddenly and where no one can come to the rescue.

For example, while driving on the road, while swimming, when returning home from work, etc.

Therefore, even with minimal suspicion of tachycardia, there is no time to waste!

Timely consultation with a specialist can save lives!

First aid for sudden heart palpitations

In order to prevent complications after an attack of tachycardia, it is important to properly provide first aid until the doctor arrives and minimize the risk of damage to weak areas of the myocardium and subsequent heart attack.

The first thing you should do is call an ambulance.

Next you need...

• Place the person having a seizure so that the body is lower than the head.
• Open all the windows wide open. The patient needs oxygen.
• Place a damp, cool cloth on your forehead (or wash with ice water).
• Free the person from clothing that interferes with proper breathing. That is, take off excess, unbutton the shirt collar, etc.
• Find a sedative in your medicine cabinet to alleviate symptoms.
• Do breathing exercises. 1st: take a deep breath, hold your breath for 2-5 seconds and exhale sharply. 2nd: deep breaths and shallow exhalations with the tongue sticking out for 15 seconds. 3rd: Cough as hard as possible or induce vomiting. 4th: inhale for 6-7 seconds, exhale for 8-9 seconds. within 3 minutes.
• Brew tea from lemon balm or chamomile (green or regular tea, as well as coffee is strictly prohibited!).
• A massage will also help. 1: gently and gently press for 4-5 minutes on the right side of the neck - on the area where carotid artery. Massage is inadmissible in old age (it can cause a stroke). 2: place your fingers on your closed eyelids and massage eyeballs for 3-5 minutes using circular movements.

It is extremely important not to lose consciousness during an attack! Therefore, use all means to reduce your heart rate/rhythm. Including drinking cold water in small sips, acupressure and even bringing the eyes to the bridge of the nose(the method was also noted as one of the most effective).

Diagnostic program for frequent strong heartbeats

So is it still tachycardia or something else? How will the doctor determine whether it is worth worrying and getting treatment, or whether you can relax and forget about the attack?

Tachycardia (or its absence) will be diagnosed using the following procedures and methods:

1. Of course, an electrocardiogram heart to determine the frequency/rhythm of heart contractions.
2. Further ECG monitoring “according to Holter” to study all changes in the heart during the day, both during exercise and at rest.
3. Electrophysiological study.
4. Ultrasound, MRI and Echocardiography – they are needed to identify pathologies.
5. Sometimes bicycle ergometry is prescribed. This method involves examining the patient using equipment while exercising on an exercise bike.
6. Tests, thyroid examination, and blood pressure measurements will also be prescribed. and other procedures.

What might the doctor ask (be prepared)?

• How long does the attack last (you can time it if the attacks are repeated).
• How often, at what time and after what attacks usually occur.
• What is the pulse during an attack?
• What the patient ate, drank or took before the attack.

Even if an attack hits you for the first time, remember: this is extremely serious signal your body. That is, it’s time not only to get examined and follow the doctor’s orders, but also to change your lifestyle!

And, of course, it is necessary to organize.

The website warns: the information is provided for informational purposes only and does not constitute medical advice. Do not self-medicate under any circumstances! If you have any health problems, consult your doctor!

Pulse readings are very important in determining a person's health status. They point to possible deviations in the functioning of the heart, blood vessels and throughout the body. The cause of a high heart rate may be a stressful situation or a violation of acceptable physical activity. But in some cases, such a phenomenon signals serious pathological changes requiring immediate examination and subsequent treatment.

What heart rate is considered high?

It is unlikely that a healthy person would be bothered by this issue. But you should know that 60 to 90 beats per minute is considered normal. The frequency largely depends on the functioning of the body's systems, as well as on age and occupation.

So, for example, women have 6-9 more strokes than men of the same age group. In athletes, these indicators can be 40-50 units, since the heart muscle is quite well developed. Intensive metabolism in children under one year old explains the high rates - 120-140. With age, the frequency of oscillations gradually changes in a child, at 14 years old it reaches 75-85 beats within 60 seconds. For older people, the pulse may be below 60.

At any age (except for children), a pulse above 90 indicates tachycardia, that is, the inability of the heart muscle to carry out normal blood circulation. A pulse exceeding 120 beats is considered especially dangerous. Such manifestations should be a reason to consult a doctor in order to prevent the development of complex diseases.

Rapid heart rate is a condition characterized by increased heart rate, which can beat more than 100 beats per minute (with a normal contraction of approximately 60-100 beats per minute).

How fast is your pulse?

Rapid pulse and palpitations are a common type of heart rhythm disorder (arrhythmia), where the heart flutters more than usual. The rhythm can become more frequent due to physiology - during training, after physical exertion, a sudden increase in rhythm occurs under stress, as a physiological response to excitement, anxiety, injury, illness (sinus tachycardia).

Heart rhythm is controlled by electrical signals transmitted through the heart tissue. The heart rate increases when an abnormality in the heart causes electrical signals to speed up, causing the heart rate to rise, usually between 60 and 100 beats per minute at rest. During attacks of tachycardia, a person’s heart rate sometimes increases to 140–250 beats/min.

Important! The important role of heart rate is evidenced by its frequent mention in figurative senses. For example, from the words of a military leader from the times of the USSR: “...The pulse of heavy industry, the defense industry beat faster...”.

Causes of increased heart rate

Why does my heart rate increase? What are the causes of the condition? There are many factors and causes of increased heart rate. As mentioned above, palpitations are caused by a disruption of the normal electrical impulses that control the rate of cardiac pumping. Many factors can lead to problems with the electrical impulses of the heart, and therefore an increased heart rate. What does a rapid heart rate mean:

• damage to heart tissue due to heart disease;
• abnormalities of the electrical pathways in the heart present at birth (congenital heart disease);
• diseases or congenital abnormalities of the heart;
• anemia;
• physical exercise;
• increased heart rate - a consequence of a stressful situation, fear;
• high or low blood pressure;
• smoking;
• fever (pulse excitation is recorded with fever, colds, runny nose, bronchitis; increased pulse with colds and other febrile diseases is due to increased demands for action immune system, therefore, overstraining the body, using medications);
• a lot of alcohol;
• lots of caffeinated drinks;
• side effects of medications;
• use of drugs, in particular cocaine;
• imbalance of electrolytes, minerals, lack of vitamins;
• hypertrophy of the thyroid gland.

What may be the cause of increased heart rate with a specific type of tachycardia:

• Fatigue, fever, fear, stress, anxiety, certain medications, and street drugs can lead to sinus tachycardia. The next reason for this type of increased heart rate at rest is anemia, an overactive thyroid gland, and heart disease.
• With supraventricular tachycardia, factors that increase heart rate most often include smoking, excessive amounts of alcohol, and caffeine. In some cases, a condition where the pulse is increased is associated with high. The disease is more common in women and children.
• The ventricular type is associated with more severe circulatory disorders, of cardio-vascular system, such as oxygen deficiency, and with other conditions, in particular sarcoidosis. The problem of a rapid heart rate occurs due to congenital abnormalities of the electrical pathways, structural heart problems (cardiomyopathy), the use of medications, and electrolyte imbalances. Sometimes the reason why the heartbeat increases at rest remains unclear.

Relationship with blood pressure: normal, low, high

The combination of high blood pressure and rapid pulse is most often caused by the following factors:

• arteriosclerosis is one of the first causes of rapid pulse during high blood pressure, may appear late, when a complication occurs;
• heart attack, angina pectoris - chest pain, difficulty breathing, sweating, increased heart rate;
• myocarditis – fatigue, fever, difficulty breathing, chest pain, swelling, high heart rate;
• pericarditis – chest pain, frequent shortness of breath, fatigue, fever, cough, difficulty swallowing, hoarseness;
• narrowing of the heart valves - increased lower pressure, difficulty breathing, chest pain, fatigue, rapid heartbeat, swelling of the limbs, lungs, sometimes the person shakes, a feeling of fear and anxiety for no reason;
• heart failure - rapid pulse with high blood pressure is accompanied by arrhythmia, difficulty breathing, cough, swelling of the lips, fingers, sweating, chest pain;
• shock – cold sweat, palpitations, increased pulse rate, dizziness, fainting, dilation of the neck veins (which pulsate);
• cardiomyopathy – leads to increased heart rate, shortness of breath, fainting, pulmonary edema, arrhythmia, heart failure;
• congenital heart defects;
• snoring or his dangerous form– sleep apnea;
• an increase in heart rate caused by inappropriate food - and the pulse quickens, weakness occurs; if your blood pressure rises after eating (or your heart rate increases after eating), it is important to exclude foods that affect blood pressure (caffeine, alcohol, licorice, etc.).

Combination low blood pressure and increased heart rate can cause various factors both pathological and physiological. Low blood pressure and increased heart rate often occur simultaneously in the following conditions:

• Dehydration. Fluid loss can occur due to vomiting, diarrhea, fever, especially with reduced fluid intake. Pulse with low pressure is accompanied by weakness and dry skin.
• Heavy bleeding. An increase in heart rate with a decrease in blood pressure occurs due to excessive blood loss.
• Inflammation. If a rapid pulse is accompanied by low blood pressure and an increase in temperature, this may indicate an inflammatory process.
• Intoxication. Severe poisoning is characterized by increased pulsation in a sitting or lying position, low blood pressure, and gastrointestinal disorders.
• Vegetovascular dystonia. Increased heart rate with VSD it is combined with constant hypotension and headache; There may be a drop in heart rate with an increase when standing up suddenly. The disease sometimes manifests itself as apathy, a lack of healthy interest in the world around us.
• Pregnancy. Unlike increased heart rate during illness, the increase in heart rate during pregnancy subsides after childbirth. You can get rid of the problem using a regimen (maximum adherence to a healthy lifestyle), acceptable movements are possible (especially yoga for pregnant women).
• Osteochondrosis. Can there be an increased heart rate and low blood pressure with osteochondrosis? Yes. A disorder of the musculoskeletal system can lead to disorders of the cardiac and vascular system.
• Use of certain medications. In particular, the use of pills for hypertension.
• Anemia.
• Nutrition. Low blood pressure and increased heart rate after eating occur after eating foods that lower blood pressure (eg, large quantity beet juice).
• Diseases of the endocrine system.
• Intoxication syndrome after drinking alcohol or taking drugs.
• Heart diseases.

At rest

Tachycardia is a compensatory response of the heart to stimuli. The problem arises when this condition manifests itself disproportionately, i.e., when it occurs at rest. This may be a sign of a medical condition (eg, heart disease, thyroid disease). But sometimes tachycardia occurs as a result overuse caffeine or theine.

After alcohol

An increase in heart rate after drinking alcohol is caused by the effect of alcohol on blood vessels and cardiac activity. A condition characterized by a prolonged increase in heart rate and the presence of other symptoms of poisoning is called alcohol intoxication, causes impaired consciousness, rapid pulse; what to do in such a situation? How is it dangerous? Serious intoxication can lead to organ dysfunction, even failure.

When getting up

Increased heart rate in this case is usually associated with hypotension or VSD. This means that treatment of the condition depends on addressing the underlying cause. Having gotten rid of the primary disease, a person reduces the amount of heart rate.

Sleep disturbances due to tachycardia

The problem may be related to the musculoskeletal or nervous system. That is, we can talk about blocking the ribs at their connection with the spine, which causes a feeling of lack of air, sometimes secondary panic attack, which is manifested by increased heart rate and breathing. A person wakes up and finds it difficult to fall asleep again.

Nocturnal tachycardia - what to do?

To reduce the increased heart rate at night, you should use anti-anxiety medications. Sometimes it is enough to take them for palpitations once, when the symptom appears. It is recommended to consult a rehabilitation doctor who will check for the presence of a blockage and be able to remove it.

What medications should I take?

With sinus tachycardia, it is important to determine the cause, and in accordance with it, decide what to take to lower the heart rate. Lifestyle changes and stress avoidance are recommended. 1st line drug – Phenobarbital (Valoserdin). Validol, which has a vasodilating effect, is also used. These drugs will lower your heart rate even with low blood pressure.

Methods to lower the heart rate with supraventricular tachycardia include reducing caffeine, alcohol, quitting smoking, and getting enough sleep. Men should avoid using potency products (Via-gra, Fulibao, etc.). Recommended medicine (Concor).

Treatment for ventricular tachycardia includes therapy by resetting the electrical signals or cardiac ablation, procedures that destroy the abnormal heart tissue that leads to the condition. Sometimes a defibrillator is used to prevent the heart from beating rapidly.

Important! The decision on how to treat tachycardia, what to take and how much, is made by the doctor!

Supporting measures

First of all, the cause of the tachycardia should be determined. For arrhythmia, antiarrhythmic drugs are prescribed. If they are ineffective, electrical cardioversion is performed to return the correct heart rate.

Another option is a cardioverter defibrillator. With a pacemaker, the heart rhythm is controlled by an electrical discharge. If the cause is thyroid disease, hormonal treatment is used.

Is treatment necessary?

An accelerated heart rate does not always require treatment. But sometimes it can be life-threatening. Therefore, inform your doctor about the problem, and after the necessary research, he will advise what to do if your heart rate increases.

Prevention

Most effective method prevention – maintaining a healthy heart, reducing the risk of heart disease. If heart disease is present, follow the treatment plan to reduce the risk of tachycardia.

Prevention is regular physical activity. The heart adapts to greater load, stops responding to rapid acceleration. Avoid stressful situations.

Emergency help

At sudden change heart rate, chest pain, fainting sensations, immediate health care. A very fast heartbeat can be slowed down using the so-called. wandering maneuvers - massaging the neck, holding your breath, drinking a cold drink (it is important to know what to drink when your heart rate is elevated - avoid coffee, give preference to clean water).

Important! If you are unconscious, begin artificial respiration before the doctor arrives. indirect massage hearts.

Diagnosis and treatment

The doctor measures the heartbeat, listens to the heart using a phonendoscope. An ECG is performed.

Treatment is prescribed after receiving test results. Treatment for tachycardia includes medications and medical or surgical procedures.

Folk remedies

Many folk recipes help eliminate general body tension, have a moderate sedative effect, help eliminate arrhythmias, and reduce tachycardia. One plant infusion that you can drink to help with heart palpitations is valerian, which is widely used to treat heart disease.

Next in a fast way to calm the heart are: hawthorn, lemon balm, St. John's wort. Consumption of magnesium and garlic is recommended.

The human heart is a hollow muscular organ whose task is to push blood out of itself with such force that it can pass through the arteries without additional effort. different calibers, reaching every organ.

To do this correctly, you need a certain frequency of contractions. Then the heart will have time to gain sufficient volume, and in a split second “splash” it into the aorta. If there is a failure in the regulation of heart rhythm, and the frequency of contractions becomes more frequent, then a smaller amount of blood than necessary will enter the vessels. This will lead to disruption of the functioning of the organs supplied by these vessels.

In some cases, a rapid heartbeat is normal compensatory mechanism necessary for the body. In others, it is a sign of pathology. We will look at all the causes of palpitations, their dangers and methods that can be used to cope with the symptom before the doctor arrives.

What is considered an increased heart rate?

This term should be used to call your symptom when:

• pulse measured at rest, 10 minutes after some physical activity or after getting out of bed (immediately after jumping, running or doing exercises, the heart rate should be faster);
• the number of beats counted over an interval of 30 seconds or more exceeds age norm for 5-10 contractions.

So, for adults, a rapid heartbeat will be considered a pulse of more than 90 per minute; a rapid heartbeat in a child is when he does not cry or scream, but his heart beats faster than the indicated indicators:

There are physiological (that is, normal, which you don’t need to be afraid of) and pathological (from illness) causes of a rapid heartbeat. We will consider them later, after determining the causes that control heart contractions.

Who "commands" the heart

The main one who decides how often the heart will contract is the autonomic nervous system, which does not depend on our consciousness and regulates the activity of all internal organs person. Sympathetic nerves approach the heart, which are responsible for accelerating its activity in times of danger, during physical exertion and excitement. Next to them are the endings of our main parasympathetic nerve - the vagus. On the contrary, it reduces cardiac contractility. Nervus vagus has its own rhythm of “life activity”: its maximum activity occurs at 3-4 o’clock in the morning, when the minimum pulse is recorded.

Nerve fibers communicate their command to the main “command post” of the heart – the sinus node. This is a collection of modified muscle cells who know how to develop and conduct their own electrical impulse. From sinus node, located in the right atrium near the vessels, a “path” of similar cells that conduct the generated impulse stretches along the entire heart. This is the conduction system of the heart.

Since the heart is an incredibly important organ, its conduction system is equipped powerful protection: There are several more sinus nodes that are also able to generate an impulse. Normally they are “silent” and start own work only when they haven’t waited for the next command from the sinus node, which must deliver at least 65 pulses per minute, so that at least 0.8 seconds pass between them. All this work is calculated so that the “command” spreads from the atria along the interventricular septum - along one path, which then bifurcates and goes to each of the ventricles at the same speed so that the ventricles contract simultaneously. Normally, there are “roundabout ways” for conducting impulses, but they must be silent.

The cells of the conduction system of the heart lie in the thickness of the cells that ensure its contraction, that is, in the thickness of the myocardium. If the myocardium has been damaged by inflammation, if a piece of it at one of the key points of the conduction system has died at , the heart rhythm is disturbed. This may look like a blockade of the impulse at some level, “turning on” the nodes lower order or “disobedience” of an impulse that goes not only along the main, but also along additional paths.

You also need to know that the impulse generated in any of the nodes is not the same kind of electricity that powers electrical appliances. It involves the opening of cellular channels first in one, then in another cell, as a result of which sodium changes, enters the cell, and potassium leaves it. Accordingly, if the composition of potassium and sodium outside the heart cells is disrupted, it will be very difficult to generate an impulse. The same thing will happen if such a transfer of ions cannot be ensured energetically, which is what some hormones (mainly those of the thyroid gland), vitamins and enzymes do.

Thus, the heart rate may increase in the following cases:

• imbalance between parts – sympathetic and parasympathetic – autonomic nervous system;
• pathologies of that part of the brain from which both parts of the ancient, autonomic system;
• interference in the path of the “conducting path”: inflammation of adjacent heart cells or their death (that is, replacement by scar) when they cannot properly respond to the impulse;
• intoxication, affecting both commands from the autonomic system and the balance of electrolytes;
• congenital disorders of the “path” along which the impulse goes;
• imbalance on the part metabolic processes, which should provide normal work heart: for diseases endocrine organs, disturbances in the amount or ratio of magnesium, calcium, potassium and sodium in the blood, a decrease in the amount of vitamins, mainly B-group.

Most common reasons are:

• intoxication due to any inflammatory diseases, including those caused by poor nutrition (,);
• thyroid diseases;
• activation of additional pathways;
• activation of several nodes to generate impulses;
• “circling” the pulse generated in one of the nodes along the conductive system;
• imbalance of potassium, calcium and magnesium;
• in children and adolescents - an imbalance between two parts of the autonomic system, when examination makes it possible to make a diagnosis.

"Normal" increased heart rate

The reasons for a rapid pulse and heartbeat can be quite reasonable and logical. There is no need to be afraid of them.

Increased body temperature

Any inflammatory process under conditions of normal immunity, it is accompanied by an increase in body temperature. This is how the body tries to create conditions for the microbes that have entered its “holy of holies” in which they will not survive. At the same time, the body, fighting inflammation, activates blood flow in order to quickly “wash” and remove germs; at the same time, it also needs additional nutrients. All this “washing out” and accelerated delivery of oxygen ensures an increased heart rate.

In adults elevated temperature should not cause more than 120 beats per minute. In this case, you already need to take emergency measures. In children, the threshold to which it is necessary to deal only with cooling the child, without taking measures to slow down his pulse, is higher:

Age	Maximum heart rate as a function of temperature
	37,5	38	38,5	39	39,5	40
Up to 2 months	154	162	170	178	186	194
6 months	148	156	164	171	179	187
1 year	137	144	152	159	166	176
2 years	125	133	140	146	153	159
3 years	120	127	134	140	143	152
4 years	115	121	127	133	140	145
5 years	110	116	121	127	133	139
6 years	105	110	115	120	125	131
7 years	99	104	110	115	120	125
8-9 years	95	100	105	109	114	119
10-11 years	95	99	103	107	112	117
12-13 years old	90	95	100	105	109	114
14-15 years old	86	91	95	99	104	108

At the same time, you should notice that the decrease in temperature, which is carried out by physical means (wiping cold water, drinking water, cool enema) and using medicinal methods leads to a decrease in heart rate. If this does not happen, this may indicate the development of three variants of the event:

1. intoxication is significant (it can be caused by anything: and, and, and, and sore throat, and), requires adjustment of therapy;
2. there is a heart disease that was previously “silent”;
3. the onset of the disease is inflammation of the heart muscle.

walking up stairs;

walking (even calmly) against the wind, especially cold;

lifting weights;

running at any speed;

outdoor games;

jumping;

cycling/rollerblading/skateboarding;

games of badminton, tennis, ball and so on.

With this norm for an adult, the following heart rate increase and time for its recovery will be:

But there is also a nuance here: you can “allow” the heartbeat to increase up to certain limits, calculated using the formula:

Maximum contraction frequency in adults = 205.8 – (0.685* age in years).

For children, the formula is different: Max HR = ((220 – age) – HR before training) * 0.5 + age in years.

A person without diagnosed heart disease can exercise until he achieves this heart rate. If there is even the slightest manifestation of ischemia (that is, lack of oxygen) of the myocardium, the pulse cannot be “raised” above 130 per minute: the heart will receive even less oxygen, which will aggravate the course of the disease and can lead to the development. It is impossible not to train at all: only under conditions of the maximum permitted load can additional vessels appear in the heart, which will improve the situation.

Other physiological causes of heart palpitations

The pulse may increase normally and in the following cases:

• being in a hot climate;
• after taking black tea, alcohol, energy drinks, smoking;
• when using certain medications;
• during stress, anger, positive emotions;
• after rarely getting up;
• when experiencing sexual arousal;
• for pain;
• after overeating.

In these cases, the blows should follow each other evenly, not exceed 135 beats per minute, and occur soon after the end of the irritating factor.

Pathological causes of increased heart rate

To improve the description, they can be conditionally divided into intracardiac, that is, arising due to heart pathology, and extracardiac, located “in the department” of other organs and systems.

Intracardiac causes

These include:

• Severe angina. The disease manifests itself as pain behind the sternum or on the left side of the chest after physical activity (running, fast walking, lifting weights, walking against the wind). The pain usually goes away after stopping the exercise or taking nitroglycerin (Isoketa, Nitromac) under the tongue in the form of a tablet or spray. .
• Myocardial infarction. Usually the disease develops against the background of existing signs of angina, but it can appear suddenly. And although pain is considered the main symptom of a heart attack, this is not always the case: the disease can develop without pain, namely with the main symptom in the form of tachycardia or other arrhythmia.
• Heart defects. They have different symptoms. More often they are diagnosed when visiting a cardiologist due to cyanosis of the lips of the nasolabial triangle, frequent fainting, and sensations of “pulsation” of the vessels of the neck.
• Cardiosclerosis. This disease occurs as a result of atherosclerosis, after suffering myocarditis, myocardial dystrophy, against the background of coronary heart disease. The disease manifests itself as periodic rhythm disturbances, then, after varying periods of time, signs develop: shortness of breath, heart pain, swelling in the legs, deterioration in exercise tolerance. .
• Myocarditis. The disease most often develops as a complication of an infection, especially such as influenza, sore throat. It manifests itself as a pronounced increase in heart rate in response to minor physical exertion, swelling, filling of the neck veins, and pain in the heart. The disease can be cured, but it can also become chronic course, then its manifestations will increase.
• Endocarditis is inflammation of the inner lining of the heart due to an infectious lesion (most common in immunodeficiency). An increase in temperature, weakness, chills, shortness of breath, and chest pain appear.
• Cardiomyopathies. These are diseases when the heart suffers unknown reasons: there are no tumors, inflammation, or reduction in the lumen of blood vessels. It is believed that damage to the heart is caused by viruses that show almost no other symptoms, toxins, severe allergies, diseases of the endocrine organs or immunity. This group of diseases manifests itself by increased heart rate, “interruptions” in the heart rhythm, increasing swelling and shortness of breath, which accompanies less and less physical activity. .
• Pericarditis is inflammation of the outer lining of the heart, which occurs either with the release of fluid between its layers, or without fluid. They manifest themselves as weakness, pain in the chest, which intensifies when inhaling, shortness of breath or a frequent dry cough.
• Thromboembolism pulmonary artery - a disease that is characterized by blockage of blood vessels that serve to deliver oxygen-rich blood to the body, can begin with a rapid heartbeat. Subsequently, a cough develops, shortness of breath progresses, and the color of the skin of the face and fingers of the extremities changes to pale bluish.
• Post-infarction aneurysm. If a person suffered a myocardial infarction, and in the next six months he developed an attack of rapid heartbeat, this may indicate that the wall of the heart gave way under intracardiac pressure and, as a result, began to bulge.
• Prolapse mitral valve . It manifests itself as headaches, sensations of interruptions in the heart, dizziness, fainting, and pain in the heart.
• After heart surgery Attacks of rapid heartbeat may also occur, which need to be treated urgently.

All of the described pathologies can cause rapid heartbeat at night; the diagnosis is made only on the basis of an examination.

Extracardiac causes

The following can cause an attack of rapid heartbeat:

• Any disease accompanied by intoxication(weakness, mild nausea, fatigue, loss of appetite). In this case, in addition to a rapid heartbeat, signs of the underlying disease will come to the fore: with the flu - this heat, aches in muscles and joints, with pyelonephritis - high fever and pain in the lower back, with pneumonia, in most cases - cough, fever, but there may also be diarrhea and pain in the spine.
• Thyrotoxicosis is a condition when the thyroid gland produces too many hormones. In this case, attacks of rapid heartbeat are frequent, and along with them is often noted. People suffering from thyrotoxicosis are characterized by thinness and increased appetite, moist and hotter skin than those around you, shiny eyes and their gradual protrusion. Read more about.
• Anemia. If a person has recently undergone any surgical intervention, including aesthetic surgery, which was accompanied by blood loss, this is the reason for its decrease and, accordingly, the development of rapid heartbeat (in order for oxygen to be delivered in the same volume, but in fewer red blood cells, blood turnover must be increased). The same pathology can also be caused by heavy menstruation or bleeding from hemorrhoids. Read more about.

But anemia can also develop due to a lack of iron or other hematopoietic factors, as well as as a result of internal bleeding. So that the latter is not so scary, let us explain that internal bleeding is always accompanied by some other symptoms - blood cannot simply escape into the cavity and not make itself felt. So, bleeding into the abdominal cavity will be accompanied by pain in it, into the chest cavity - impaired inhalation, pain when breathing. If bleeding occurs in gastrointestinal tract, will appear or Brown vomiting or black diarrhea. If an ovary ruptures or fallopian tube Your lower abdomen will hurt a lot.

An option that can be described as “flopped in the stomach” can only occur when an aortic aneurysm ruptures. Such a disease, even before it ends in rupture, first manifests itself as a feeling of “vibration” or “trembling” in the abdomen, which intensifies if you place your hand on the abdomen. The rupture of an aneurysm is so abrupt that the person turns pale and quickly loses consciousness so that there is no time left to search the Internet for information.

• Addisonian crisis, which occurs during acute cessation of the adrenal glands, is also accompanied by rapid heartbeat. Typically, this condition is preceded by darkening of the skin and mucous membranes, weakness, fatigue, and loss of body weight. If such a condition develops abruptly, for example, due to hemorrhage into the substance of the adrenal glands, which happens with various infections(for example, meningococcal), the skin becomes covered with dark spots that do not fade when pressed, then quickly progress.
• Diabetic ketoacidosis. It occurs when (almost never accompanies type 2 diabetes) when a person does not control his blood glucose level and allows it to rise to high levels. In this case, against the background of increasing thirst and frequent urination weakness, vomiting, and possibly abdominal pain develop.
• Hypoglycemia. This is a complication diabetes mellitus when a person injects himself with insulin and does not eat, or overdoses on insulin. In this case, there is a rapid heartbeat, trembling hands, breaking into a cold sweat, from which the skin becomes sticky and cold, and consciousness becomes foggy quite quickly. If help is not provided, the person may fall into a coma. Read more about.
• Conditions in which a chronic lack of oxygen in the blood develops. This Chronical bronchitis, asbestosis, silicosis, various chronic rhinitis And .
• Pneumothorax is a condition in which air gets between the lung and its membrane, the pleura. This condition does not always occur with injury: many people live with congenital cavities in the lungs that can burst spontaneously. The condition is accompanied by pain in one half of the chest, palpitations, a feeling of lack of air, and the inability to take a full deep breath.
• Panic attack. Usually it develops after certain thoughts, in certain situations, accompanied by pronounced “animal” fear. Distinguish from serious illnesses you can use a test: if you think that all this is not scary, focus on deep breathing with a pause after exhalation, the panic goes away after a while.
• Tick ​​bite in the area upper limbs and breasts. In this case, you can find the place where the insect bit, it is red, it may itch and ooze. .
• Pheochromocytoma. This is a disease accompanied by increased production of adrenaline and norepinephrine. The next release of these hormones is accompanied by headaches and increased heart rate.
• Taking medications, such as Pentoxifylline, diuretics, and blood pressure lowering agents can cause increased heart rate.
• Withdrawal syndrome from chronic use of alcohol or drugs is accompanied by rapid heartbeat, restlessness, anxiety, increased irritability and insomnia. In this case, a person can understand for himself what his condition is connected with. It is better to seek medical help.

Increased heart rate and blood pressure

Let's look at three main cases that can be accompanied by rapid heartbeat.

Tachycardia and low blood pressure

This combination is typical for conditions when either the amount of blood in the vessels decreases, or this blood is poor in hemoglobin, or the vessels have become so wide that normal amount they perceive blood as small. This:

• blood loss;
• severe allergy;
• shock that occurs when cardiac contractility deteriorates (for example, during myocardial infarction);
• a condition where the disease was caused by bacteria and the person began taking antibiotics. In this case, the rapid and massive breakdown of bacteria dilates the blood vessels, causing little blood in them, the pressure drops and, in order to ensure blood supply to important organs, the heartbeat quickens;
• with fever, vomiting and diarrhea;
• acute pancreatitis;
• heatstroke;
• decrease in body temperature;
• pneumothorax;
• taking diuretics or antihypertensive drugs;
• Addisonian crisis.

The fact that a rapid heartbeat occurred against the background of reduced blood pressure is indicated by palpitations, weakness, drowsiness, trembling in the body, nausea, darkening, loss of consciousness.

Increased heart rate and high blood pressure

This combination is typical for:

• pheochromocytomas;
• VSD of the hypertensive type;
• thyrotoxicosis;
• panic attack;
• coffee overdose, strong tea or medications containing caffeine.

Symptoms of this condition are palpitations, headaches, spots before the eyes, pain in the heart, dizziness, and decreased visual acuity.

Tachycardia against the background of normal pressure

Can be called following reasons rapid heartbeat with normal blood pressure. These are intracardial pathologies:

• heart defects;
• mitral valve prolapse;
• cardiosclerosis;
• myocarditis;
• cardiomyopathy;
• endocarditis.

Diseases accompanied by intoxication are also accompanied by a rapid heartbeat with normal blood pressure: acute respiratory infections, pneumonia, tonsillitis, purulent-inflammatory processes.

Why your heart rate may increase after eating

Rapid heartbeat after eating is typical for:

• thyroid diseases;
• cardiac pathologies accompanied by myocardial ischemia;
• diaphragmatic hernia;
• obesity;
• overeating;
• arterial hypertension;
• heart failure.

When Children May Have a Rapid Heart Rate

A child may develop palpitations when:

• vegetative-vascular dystonia;
• myocarditis;
• emotional stress;
• electrolyte imbalances, especially low sodium levels;
• bacterial endocarditis;
• cardiomyopathies;
• pericarditis;
• heart defects;
• hypocorticism;
• bronchial asthma;
• allergic reactions;
• pneumothorax.

IN adolescence rapid heartbeat may not be due to organic cause, developing as a result of hormonal changes in the body.

Treatment for palpitations

Depending on which zone in the conduction system of the heart the rapid rhythm comes from, rapid heartbeat can be:

a) sinus. This is the relatively least dangerous type of tachycardia;

b) supraventricular, when the source is located between the sinus and the next, atrioventricular node. You can block the source by performing special actions (about them - in the section “How to stop a racing heart”). This type is more dangerous than the previous one, but can rarely develop into life-threatening arrhythmias;

c) ventricular. This is the most threatening type of tachycardia, which can turn into fibrillation, when individual sections of the ventricles contract at their own rhythm, as a result of which the heart will not be able to push out any significant amount of blood for the blood supply to the organs.

Diagnosis of these main types of acceleration is based on electrocardiography. Sometimes you can see this on the film being shot directly, if the doctors managed to arrive before the attack was over. If the attack passed while the ambulance was on the way and shows nothing, you need to walk around for 1-2 days with a device that will take a continuous cardiogram (Holter study).

But you can try to distinguish sinus tachycardia from the other two, dangerous, based on symptoms. The first is manifested only by the sensation of heartbeat, usually in daytime. At night, sinus tachycardia develops if it is caused by diseases of the thyroid gland or the person is on this moment is sick with one of those ailments that lead to intoxication.

Supraventricular and ventricular tachycardia are accompanied by:

• headaches;
• chest pain;
• trembling;
• sensation of “turning over” in the chest

and other unpleasant symptoms.

An attack of supraventricular tachycardia can begin in the form of a sharp shock in the chest, after which a rapid heartbeat develops. At the beginning of the attack, there is a desire to urinate frequently and copiously, while the urine is light-colored. The end of an attack can also be marked by a feeling of “freezing”, after which comes a feeling of easier breathing and heartbeat.

How quickly you can distinguish between the 2 main types of heart palpitations will help you. So, if your condition is more like sinus tachycardia during an attack, take Corvalol or Valocordin. Whereas in cases where it looks like the ventricular or supraventricular types of this condition, there is no time for this. In this case you need:

• cough strongly and actively: the contracting and unclenching of the lungs on both sides of the heart will normalize the heart rhythm. This can support life even with fibrillation - until the ambulance team arrives;
• try to inhale, hold your breath and strain while doing so;
• wrap your lips around your thumb and try to exhale into it;
• close your eyes and apply gentle pressure on your eyeballs for 10 seconds.

If you are close to fainting, do one of the following maneuvers:

• press on the point exactly in the middle of the central groove located above the upper lip;
• press on the point located between the index and thumb left hand;
• if you connect the pads thumb and the little finger of the left hand so that the nail of the thumb falls under the nail of the little finger. You need to press under the nail of your little finger.

Drug treatment should be prescribed by a cardiologist, depending on the type of tachycardia detected on the ECG:

• with the sinus form, the following come to the rescue: “Atenolol”, “Anaprilin”, “Carvedilol”;
• in case of supraventricular tachycardia, an ATP, Phenigidine or Nifedipine tablet may help;
• for the ventricular form, it is good to use Cordarone, Digoxin or injectable lidocaine.

There are situations when medications do not help well, then the doctor may choose a method of restoring the rhythm by applying a weak current to the conduction system of the heart. This manipulation is performed under light anesthesia.

Cardiac tachycardia: what is it and how to treat it

Excitement, stress, physical activity sometimes make your heart beat faster.

Tachycardia is often harmless and goes away after some time. However, contrary to popular belief, the cause of cardiac tachycardia can be not only stress or increased physical activity.

Persistent tachycardia may also indicate dysfunction of the cardiovascular system, and this problem requires immediate treatment.

Let's take a closer look at what it is and how to treat this condition.

What is cardiac tachycardia

Cardiac tachycardia - increase (heart rate). Tachycardia means the heart beats faster, thereby increasing the heart rate.

The human heart beats between 60 and 90 beats per minute. At physical activity The pulse can rise to 100 beats per minute. Also, the heart rate can accelerate due to mental tension, stress, the use of certain substances and various diseases.

Common causes of tachycardia are, for example:

• stress or nervous disorders;
• caffeine consumption;
• emotional stress;
• heavy physical activity;
• drinking alcohol, smoking;
• heart disease such as hypertension or mitral valve insufficiency;
• hyperthyroidism;
• (anemia).

In all these cases, the heart rate exceeds 90 beats per minute.

Also, there are ectopic and (a form of supraventricular tachyarrhythmia), and each of them requires separate attention and treatment.

Causes tachycardia

Tachycardia or palpitations should not be a cause for concern. Often this is a healthy reaction of the body to stress or stress.

When the heartbeat quickens, organs and muscles move blood better, and more oxygen enters the body. Through oxygen and sugar, muscles receive energy.

When you are afraid and nervous, it is also normal for your heart to beat faster. The body tends to run or fight - both work better if the muscles are well supplied with oxygen.

Diseases that cause heart palpitations

In addition, tachycardia may occur against the background. Typical reasons of this form of cardiac arrhythmia are:

• heart disease such as heart disease, heart muscle disease (cardiomyopathy), high blood pressure (hypertension);
• potassium deficiency;
• hyperthyroidism;
• alcohol;
• infections (for example);
• chest injuries;
• autonomic disorders.

Other possible reasons, in which the heart beats very quickly:

• anemia (anemia);
• low blood sugar;
• pulmonary embolism;
• heavy allergic reaction ();
• diseases of the musculoskeletal system;
• diseases of the endocrine system;
• blood poisoning ().

Heart disease

Here there is paroxysmal tachycardia, which is accompanied by attacks when the heart begins to beat strongly. In this case, the patient can name the exact time frame of when the attack began and when it ended, and this is what is considered distinctive feature diseases.

There are also additional symptoms, which include the following:

• dizziness;
• fainting;
• feeling as if the heart is jumping out of the chest;
• nausea;
• sweating

Heart disease can lead to the development of ventricular fibrillation, and subsequently to cardiac arrest. This disorder is extremely dangerous, and therefore it is recommended to consult a cardiologist. Treatment will depend directly on the results of the examination.

Group of autonomic disorders ( VSD, NDC)

There is no specific algorithm for detecting tachycardia, because there can be both attacks and a constant persistent increase in heart rate. The number of blows in this case can reach 140 blows.

A distinctive feature is that the patient with this disorder cannot even perform usual daily activities, for example, walking or climbing stairs.

The complexity of the disease is that in the presence of pronounced psychological symptoms it is almost impossible to distinguish it from psychosis or neurosis.

Other symptoms of cardiac tachycardia include:

• dizziness;
• weakness;
• fast fatiguability;
• increased anxiety;
• mood swings;
• sudden changes in body temperature;

With (NCD) the following symptoms can be observed:

• pale skin;
• cold extremities;
• headache;
• dizziness;
• weakness;
• increased fatigue;
• high pressure.

In these cases, for treatment it is necessary to contact a neurologist or cardiologist, depending on the prevailing symptoms.

Endocrine disorders

Hyperthyroidism is often accompanied by tachycardia, and characteristic feature is that the pulse exceeds 110 beats per minute.

Additional symptoms characteristic of endocrine disorders:

• enlargement of the thyroid gland;
• pain in the stomach;
• increased sweating;
• sudden weight loss despite increased appetite;
• irritability;
• increased fatigue;
• in guys - decreased potency;
• in girls – disturbance and increase in breast size;
• an increase that remains reversible;
• increased content (determined only after testing).

Tachycardia during pregnancy

Rapid heartbeat during pregnancy can be associated with many factors, because during this period of life a woman’s body undergoes hormonal changes, which can primarily cause frequent tachycardia.

The main causes of tachycardia during pregnancy are:

• hormonal changes;
• malfunction of the thyroid gland;
• nervous tension;
• an increase in the hormones estrogen and progesterone.

Rapid heartbeat during pregnancy can also occur when infectious diseases( , ) . In this case, the expectant mother is recommended to begin treatment immediately.

Why does your heartbeat increase when drinking alcohol?

Alcohol consumption itself does not always lead to tachycardia; rather, it is caused by certain factors:

• alcohol poisoning, which leads to heart failure;
• improper functioning of blood vessels. If the patient’s blood vessels have disturbances even without drinking alcohol, in the future this can lead to stressful situations the body strives to speed up processes. This causes the heart to beat faster;
• insufficient amounts of vitamins or other nutrients. With frequent alcohol consumption, when the body does not have time to compensate on its own.

It is important to pay attention if tachycardia occurs even after a small amount of alcohol. This condition is not normal and requires immediate attention to a specialist.

Tachycardia at night before bedtime

Rapid heartbeat at night, especially after eating, can be caused by:

• emotional shock;
• anxiety, fear;
• previously drunk coffee or energy drink (the caffeine contained in these drinks stays in the body for 5-6 hours);
• allergic reaction;
• by-effect from any medicine;
• missing or poor circulation indoor air;
• the above-described diseases of the cardiovascular system.

If the heart begins to beat faster only against the background of some situation that has occurred recently, and there are no other prerequisites for the disease, a tincture of valerian or motherwort will help calm the heart. These natural medicines are excellent in helping to cope with tachycardia that arises on an emotional, nervous basis.

Active substances that cause cardiac tachycardia

Many substances affect the heartbeat. For example, caffeine causes the adrenal glands to release more adrenaline. This stress hormone speeds up your heart rate and increases your (short-term) blood pressure.

Sometimes tachycardia also occurs as a side effect of certain medications, such as:

• antidepressants (Citalopram and Escitalopram);
• levothyroxine sodium (thyroid hormone), tachycardia occurs in case of overdose;
• when taking Cetirizine.

Diagnosis of tachycardia

Anyone who experiences heart palpitations or tachycardia for a long time should see a doctor. This will help determine whether the symptoms have a harmless cause or whether it is a serious heart arrhythmia that needs treatment.

During the diagnostic process, a complete examination of the body is carried out, during which the condition of the cardiovascular system, internal organs, thyroid gland and nervous system is checked. They take additionally general analysis blood and urine.

If tachycardia is detected, the first step is to consult a cardiologist. It is this specialist who can conduct the initial examination.

To determine the reasons rapid heartbeat The following additional examinations are prescribed:

• ultrasound examination of the heart (echocardiography);
• ECG of different types;
• chest x-ray;
• measuring blood (arterial) pressure.

The so-called electrocardiogram (ECG) is one of the important examination methods. An ECG will provide information about the condition of the heart. The doctor inserts several electrodes into the chest area, which measure and record the heart's currents. This allows the doctor to know whether the patient's heart rhythm is regular or, for example, chaotic.

Because many patients only occasionally have cardiac arrhythmia, long-term ECG monitoring over 24 or 48 hours may be required. To do this, the patient receives a small ECG device, which he must carry with him for a day or two.

What to do with tachycardia?

When tachycardia is due to agitation or exercise, there is usually no need for therapy. If the problem is the cause of the disease, only the doctor knows how to treat it: in general, cardiac arrhythmias such as atrial fibrillation can be treated with antiarrhythmic drugs (Lidocaine, Difenin, Mexiletine, etc.).

Tachycardia due to hypertension is treated with medications ACE inhibitor and beta blockers. In addition, people with high blood pressure And coronary disease hearts can help themselves. You should

• no smoking;
• avoid excess weight and, if necessary, lose weight;
• move more;
• eat healthy food.

If palpitations are a consequence of hyperthyroidism, the main drugs in its treatment are antithyroid drugs. If tachycardia is caused by an overdose of high doses of levothyroxine, the doctor will adjust the dosage.

In cases of stress or mental overload, relaxation exercises such as progressive muscle relaxation can help.

How to quickly calm your heart?

You can calm your heartbeat at home. Experts recommend taking the following steps for tachycardia:

• calm down. No matter how difficult it may be, at the time of an attack, it is important to gather yourself and not let your nerves take over;
• immediately stop any activity. It is better to sit down or even lie down, but the main thing is to bring the body to a state of rest;
• if you have sedatives at hand, give them: they are suitable as sedatives motherwort, valerian, validol, corvalol;
• give the patient more fresh air. To do this, you can open windows, doors, and take the patient outside.

In most cases, a rapid heartbeat or tachycardia tells the body that it needs to rest. Perhaps you should take a vacation or a day off for a while.

Folk remedies

To cure tachycardia, you can do without medicines. It is medications or intolerance to some of the components that sometimes lead to tachycardia or rapid pulse, and therefore you should not give up folk remedies.

Some of the most popular recipes include:

• or motherwort. Ingredients (20 drops each) need to be poured warm water(200 ml), stir and drink;
• Herbal infusions. You can choose any combination of herbs that have calming properties (motherwort, valerian root), take 1 spoon of each, and pour a liter of boiling water over them. For preventive purposes, just one glass a day is enough, which is best divided into several doses throughout the day;
• Sand immortelle. Just 15 g of this plant is enough, which needs to be poured with a glass (200 ml) of boiling water, then left to infuse for 1 hour. Half a glass 2 times a day will be quite enough to treat tachycardia;
• Little finger massage. If an attack takes you by surprise, you can massage your little fingers and pay special attention to the area near the nail.

It is important to note that before consuming the above decoctions, you need to undergo an examination. In case of allergies and other disorders, some of them may be contraindicated and, therefore, may lead to a worsening of the patient’s condition.

Tips for preventing tachycardia:

• do not smoke, do not use nicotine;
• abstain from alcohol or consume it in moderation;
• find balance in stressful situations Everyday life. Regular relaxation exercises (progressive muscle relaxation), quiet hobbies;
• stick to a certain regime day, sleep at least 8 hours a day, go to bed at the same time.

It is important to remember about water, you need to drink 2 liters of water every day. This is necessary to improve blood circulation and get rid of toxins that are present in the body.

Prognosis for tachycardia

The prognosis for tachycardia is favorable. A rapid heartbeat is a physiological norm for some people.

If tachycardia is a consequence of disease, it is necessary to follow all recommendations of specialists. This will help completely get rid of tachycardia. For patients who have already gotten rid of this state, it is strongly recommended to monitor your diet and daily routine to prevent recurrence of tachycardia.

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