Hello, welcome everybody, this is doctor  Bolad, board certified physician in cardiology,  
Hello, welcome everybody, this is doctor  Bolad, board certified physician in cardiology,  

interventional cardiology and internal medicine,  certified by the American Board of Internal  
interventional cardiology and internal medicine,  certified by the American Board of Internal  

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subscribers, thank you for your continued support.  Today I will talk to you about fast heart rate,  
subscribers, thank you for your continued support.  Today I will talk to you about fast heart rate,  

medically known as TACHYCARDIA. In normal  conditions, the heart beats at a rate of  
medically known as TACHYCARDIA. In normal  conditions, the heart beats at a rate of  

60 to 100 beats per minute. The heartbeat  originates in the upper right chamber of  
60 to 100 beats per minute. The heartbeat  originates in the upper right chamber of  

the heart from the SINOATRIAL NODE, travels  down the atrium to the ATRIOVENTRICULAR NODE  
the heart from the SINOATRIAL NODE, travels  down the atrium to the ATRIOVENTRICULAR NODE  

and then travels to the ventricles. This pattern  of beating is known as SINUS RHYTHM. When the  
and then travels to the ventricles. This pattern  of beating is known as SINUS RHYTHM. When the  

heart rate exceeds 100 beats per minute,  we label the individual as suffering from  
heart rate exceeds 100 beats per minute,  we label the individual as suffering from  

TACHYCARDIA. There are three  broad categories of tachycardia. 
TACHYCARDIA. There are three  broad categories of tachycardia. 

The first category is SINUS TACHYCARDIA  and this occurs when the heart is beating  
The first category is SINUS TACHYCARDIA  and this occurs when the heart is beating  

in the normal pattern I just described, but the  heart rate is increased to above 100 beats per  
in the normal pattern I just described, but the  heart rate is increased to above 100 beats per  

minute. In the vast majority of patients, sinus  tachycardia does not directly cause symptoms,  
minute. In the vast majority of patients, sinus  tachycardia does not directly cause symptoms,  

although a patient with a greater awareness of his  or her heartbeat may report palpitations, which is  
although a patient with a greater awareness of his  or her heartbeat may report palpitations, which is  

the subjective awareness of a rapid or forceful  heartbeat. In the great majority of patients,  
the subjective awareness of a rapid or forceful  heartbeat. In the great majority of patients,  

Sinus tachycardia occurs as a physiologic  response to a demand for greater cardiac output,  
Sinus tachycardia occurs as a physiologic  response to a demand for greater cardiac output,  

increased sympathomimetic state, or  parasympathetic withdrawal. Causes include fever,  
increased sympathomimetic state, or  parasympathetic withdrawal. Causes include fever,  

volume depletion, infection, anemia, anxiety,  overactive thyroid, heart failure, lung disease,  
volume depletion, infection, anemia, anxiety,  overactive thyroid, heart failure, lung disease,  

caffeine and nicotine intake and abrupt withdrawal  of certain medications like beta blockers. 
caffeine and nicotine intake and abrupt withdrawal  of certain medications like beta blockers. 

Sinus tachycardia also occurs in POSTURAL  ORTHOSTATIC TACHYCARDIA SYNDROME, generally  
Sinus tachycardia also occurs in POSTURAL  ORTHOSTATIC TACHYCARDIA SYNDROME, generally  

abbreviated as POTS . This is a condition  that occurs predominantly in young women  
abbreviated as POTS . This is a condition  that occurs predominantly in young women  

in the absence of structural heart disease.  Patients develop symptoms upon the STANDING,  
in the absence of structural heart disease.  Patients develop symptoms upon the STANDING,  

symptoms such as palpitations, fatigue,  lightheadedness, or exercise intolerance.  
symptoms such as palpitations, fatigue,  lightheadedness, or exercise intolerance.  

POTS is defined as an increase in heart  rate of more than 30 beats per minute  
POTS is defined as an increase in heart  rate of more than 30 beats per minute  

in the absence of a drop in systolic blood  pressure of more than more than 20 mmHg. 
in the absence of a drop in systolic blood  pressure of more than more than 20 mmHg. 

Another cause of sinus tachycardia is  known as INAPPROPRIATE SINUS TACHYCARDIA  
Another cause of sinus tachycardia is  known as INAPPROPRIATE SINUS TACHYCARDIA  

and it is an unusual condition that occurs in  individuals without apparent heart disease or  
and it is an unusual condition that occurs in  individuals without apparent heart disease or  

other cause for sinus tachycardia, such as fever  or overactive thyroid and is generally considered  
other cause for sinus tachycardia, such as fever  or overactive thyroid and is generally considered  

a diagnosis of exclusion. Patients are invariably  symptomatic, most commonly with palpitations,  
a diagnosis of exclusion. Patients are invariably  symptomatic, most commonly with palpitations,  

but other common symptoms include chest  discomfort, fatigue, dizziness, presyncope,  
but other common symptoms include chest  discomfort, fatigue, dizziness, presyncope,  

syncope, and shortness of breath The second large category of increased heart rate  
syncope, and shortness of breath The second large category of increased heart rate  

is known as SUPRAVENTRICULAR TACHYCARDIA. This is  an abnormality of rapid heart rhythm originating  
is known as SUPRAVENTRICULAR TACHYCARDIA. This is  an abnormality of rapid heart rhythm originating  

in the upper chambers of the heart, the  chambers above the ventricles. These are usually  
in the upper chambers of the heart, the  chambers above the ventricles. These are usually  

associated with hemodynamic compromise or severe  symptoms due to the tachycardia such as angina,  
associated with hemodynamic compromise or severe  symptoms due to the tachycardia such as angina,  

heart failure or low blood pressure requiring  rapid termination of the arrhythmia.  
heart failure or low blood pressure requiring  rapid termination of the arrhythmia.  

Causes of Supraventricular tachycardia include  ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA  
Causes of Supraventricular tachycardia include  ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA  

abbreviated as AVNRT. This is due to  dual electrical pathways in or near the  
abbreviated as AVNRT. This is due to  dual electrical pathways in or near the  

atrioventricular node and occurs more commonly  in women compared to men. The dual pathways are  
atrioventricular node and occurs more commonly  in women compared to men. The dual pathways are  

composed of a slow pathway and a fast pathway.  Another cause of supraventricular tachycardia  
composed of a slow pathway and a fast pathway.  Another cause of supraventricular tachycardia  

is known as ATRIOVENTRICULAR REENTRANT TACHYCARDIA  abbreviated as AVRT. This is caused by development  
is known as ATRIOVENTRICULAR REENTRANT TACHYCARDIA  abbreviated as AVRT. This is caused by development  

of an accessory pathway, short circuiting the  cardiac conduction system, and this accessory  
of an accessory pathway, short circuiting the  cardiac conduction system, and this accessory  

pathway is not related to the atrioventricular  node. Other causes of Supraventricular tachycardia  
pathway is not related to the atrioventricular  node. Other causes of Supraventricular tachycardia  

include FOCAL ATRIAL TACHYCARDIA which is usually  paroxysmal and self-limited fast heart rate,  
include FOCAL ATRIAL TACHYCARDIA which is usually  paroxysmal and self-limited fast heart rate,  

arising from a single site or area of  micro-reentry outside of the sinus node,  
arising from a single site or area of  micro-reentry outside of the sinus node,  

ATRIAL FLUTTER which occurs due to the development  of a macro-reentrant circuit in the upper chambers  
ATRIAL FLUTTER which occurs due to the development  of a macro-reentrant circuit in the upper chambers  

of the heart, ATRIAL FIBRILLATION which is fast  and IRREGULAR heart beating originating from the  
of the heart, ATRIAL FIBRILLATION which is fast  and IRREGULAR heart beating originating from the  

upper part of the heart, and MULTIFOCAL ATRIAL  TACHYCARDIA due to organized atrial activity  
upper part of the heart, and MULTIFOCAL ATRIAL  TACHYCARDIA due to organized atrial activity  

caused by electrical activity from three or  more sites in the upper part of the heart. 
caused by electrical activity from three or  more sites in the upper part of the heart. 

The third large category of increased heart rate  is known as VENTRICULAR TACHYCARDIA. This is  
The third large category of increased heart rate  is known as VENTRICULAR TACHYCARDIA. This is  

fast heart rate originating from the lower  chambers of the heart, the VENTRICLES. If  
fast heart rate originating from the lower  chambers of the heart, the VENTRICLES. If  

the heart rate of this arrhythmia is not very  fast, it might be well tolerated. However,  
the heart rate of this arrhythmia is not very  fast, it might be well tolerated. However,  

if the speed is very fast, this arrhythmia might  be life threatening and can lead to collapse and  
if the speed is very fast, this arrhythmia might  be life threatening and can lead to collapse and  

cardiac arrest. This is because the lower part  of the heart is beating too fast and does not  
cardiac arrest. This is because the lower part  of the heart is beating too fast and does not  

have enough time to fill with blood to pump and  to circulate the blood to the rest of the body.  
have enough time to fill with blood to pump and  to circulate the blood to the rest of the body.  

The seriousness of this tachycardia also  depends on whether the heart pumping function  
The seriousness of this tachycardia also  depends on whether the heart pumping function  

is normal or reduced, with the latter having  a more serious impact on the circulation. 
is normal or reduced, with the latter having  a more serious impact on the circulation. 

Treatment of the tachycardias depends on the CAUSE  of the tachycardia. Sinus tachycardias are treated  
Treatment of the tachycardias depends on the CAUSE  of the tachycardia. Sinus tachycardias are treated  

with correction of the underlying abnormality.  Supraventricular tachycardias are generally either  
with correction of the underlying abnormality.  Supraventricular tachycardias are generally either  

treated with medications to reduce the fast  heart rate or treated with cardiac ablation,  
treated with medications to reduce the fast  heart rate or treated with cardiac ablation,  

in which catheters are introduced to  the heart, and the focus of arrhythmia  
in which catheters are introduced to  the heart, and the focus of arrhythmia  

is ablated or destroyed by the catheter  either using heat therapy or cold therapy.  
is ablated or destroyed by the catheter  either using heat therapy or cold therapy.  

For ventricular tachycardias, treatments  depend on the cause of the arrhythmia  
For ventricular tachycardias, treatments  depend on the cause of the arrhythmia  

and the rate of the arrhythmia, and  include medications, cardiac ablation  
and the rate of the arrhythmia, and  include medications, cardiac ablation  

and implantation of a cardioverter defibrillator. If you have any question about what I presented to  
and implantation of a cardioverter defibrillator. If you have any question about what I presented to  

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This is Doctor Bolad, helping you with your heart  health, thanks for watching, and talk to you soon.
This is Doctor Bolad, helping you with your heart  health, thanks for watching, and talk to you soon.