Count the beats you feel for 10 seconds. Multiply this number by six to get your heart rate (pulse) per minute. Count your pulse: beats in 10 seconds x 6 = beats/minute. What is a normal pulse? Normal heart rates at rest: Children (ages 6 - 15) 70 – 100 beats per minute; Adults (age 18 and over) 60 – 100 beats per minute. If you’re sitting or lying and you’re calm, relaxed and aren’t ill, your heart rate is normally between 60 (beats per minute) and 100 (beats per minute). But a heart rate lower than 60 doesn’t necessarily signal a medical problem. It could be the result of taking a drug such as a beta blocker. As per the American Heart Association (AHA), if you are an adult, your heart rate should be in the range of 60 to 100 beats per minute. And if your age is between 6 and 15 years, your heart rate should be anywhere between 70 and 100 per minute. What is a good heart rate for my age?

By Julia H. Indik, MD, PhD, associate professor of medicine, University of Arizona Sarver Heart Center

The normal heart beat begins in the sinus node, located near the top of the right atrium. (See Figure below.) This electrical impulse spreads over the atrium, causing the atria to contract to pump the blood into the ventricles. But for the atrial impulse to get to the ventricles, it must go through the AV node and the His Bundle. The electrical impulse then travels down the bundle branches to the ventricular muscles, causing them to contract, producing a heartbeat that pumps the blood to the body. The normal heart rate is between 60 and 100 beats per minute.

If the sinus node is without nerves (for example a transplanted heart) the heart rate is about 80 beats per minute. Two types of nerves regulate the heart rate. The sympathetic nerve speeds up the heart rate with exertion or excitement. The vagal nerves slow the heart rate. Many athletes have a slow heart rate due to increased vagal tone. In non-athletes a slow heart rate can be a sign of a defective AV node. The heart rate also can be increased by adrenalin from the adrenal glands, due to exercise or excitement.

Normal conduction from the atrium to the ventricles

The electrical heart. Each heart beat is started electrically at the sinus node. Then the electrical impulse is carried to the AV node and relayed to the ventricles over the left and right bundle branches to the heart muscle.

Slow Heart Beat (Bradycardia)

An abnormally slow sinus heart rate is called the “sick sinus syndrome” and, if severe, results in symptoms of fatigue. In some such cases a permanent pacemaker is needed to be implanted to generate a normal heart rate. Many people with sick sinus syndrome also develop atrial fibrillation. These individuals have intermittent heart rates that are often either too fast or too slow.

From the atrium, the electrical impulse is carried through the AV node, which sits as an electrical “relay” between the upper chambers (atria) and lower chambers (ventricles). Slowdown in the AV node can be another cause for bradycardia, in which not all the sinus node discharges can make it through to the ventricle, a form of heart block. Sometimes the AV node slows down due to medications, which need to be adjusted.

After the AV node, comes the left and right bundle branches, very important electrical relays that are the final pathways to signal the ventricles to beat. A slowdown or block in this part of the conduction system may be serious and require a pacemaker as some patients can develop “complete heart block.” In complete heart block, no signals from the sinus node can penetrate to the ventricles, and the patient can have a dangerously slow pulse. Adjusting medications cannot fix this type of complete heart block; a pacemaker is needed.

Treating Slow Heart Rhythms

Sometimes a slow heart beat can be improved by adjusting medications. This may be the case with “sick sinus syndrome,” for example. When the slow heart beat cannot be improved by medication adjustments, a pacemaker is needed. Pacemakers also are needed when signals from the atrium are not conducted to the atrium; this is known as “complete heart block.”

Placing a pacemaker: Pacing leads (one to three) are positioned through the vein under the collarbone (subclavian vein) into the heart chambers and affixed to the heart muscle. These leads then are connected to the pacemaker generator, which is placed under the skin in the front chest region just below the collarbone. This procedure is performed in the electrophysiology laboratory and typically takes about one to two hours. If a third lead is needed for what is called “biventricular pacing” for heart failure, the procedure may take up to three hours.

Follow up and monitoring: The patient will have future follow-up appointments in the pacemaker clinic and can be followed remotely with a home monitoring unit. Very little in the typical environment interferes with a pacemaker. It is fine to use microwaves and cell phones, but not placing the cell phone directly over the device. A patient with a pacemaker cannot get an MRI, but a CT scan is all right. At the airport, the device will set off the metal detectors, so inform security that you have a pacemaker. At stores with anti-theft devices at the door, patients should simply walk through and not linger by the door.

Fast Heart Rhythms – Tachycardia

Tachycardia refers to a situation where the pulse is faster than 100 beats per minute (bpm). Sometimes this is absolutely normal. For instance, with exercise it is entirely appropriate for the pulse to rise above 100 bpm. However, when tachycardia occurs at rest, a cardiologist needs to determine the specific cause.

The first question is whether the tachycardia is originating from the upper chambers (“atria”) or the lower chambers (“ventricles”). Ventricular tachycardia refers to a fast heart beat that originates from the ventricles and can be potentially dangerous.

If tachycardia originates from the upper chambers, it will be one of three types:
1) Atrial fibrillation
2) Atrial flutter
3) Supraventricular tachycardia (SVT for short)

Atrial fibrillation is a chaotic, electrical disturbance of the atria in which an electrical impulse travels in a disorganized, very rapid fashion throughout the atrium. This electrical impulse then travels to the AV node and the rest of the conduction system to the lower chambers (ventricles) in an irregular fashion, resulting in a heartbeat that is perceived as irregular and often fast. It is the most common rhythm disturbance in older Americans, affecting 2.2 million Americans with an average age of about 75 years. Some people are very aware of their atrial fibrillation – they notice that their heart is beating very irregularly, without any pattern whatsoever and fast. Other people are completely unaware of being in atrial fibrillation. Most people are aware of this rhythm some of the time, but not at other times, even when they are certain that they can detect it “perfectly.”

Atrial fibrillation puts people at significant risk for a stroke. So, medical guidelines advise medication to thin the blood for those at risk for stroke. Some patients can be treated with aspirin, depending on their doctor’s assessment.
Atrial flutter is a heart rhythm disturbance that is similar to atrial fibrillation, except that the electrical discharges are semi-organized. An electrical impulse will typically revolve around the tricuspid valve. Patients with atrial flutter may feel the same symptoms as those with atrial fibrillation – a fast and irregular heartbeat, though maybe not quite as irregular. Atrial flutter also carries a potential risk for stroke and all the same indications for blood thinners, as outlined above, still apply.

Supraventricular tachycardia (SVT) is a fast heart rhythm disturbance that can be seen at any age. People will describe that their heart suddenly starts racing –it goes from a normal 60 beats per minute to as much as 150 to 200 beats per minute, and then stops just as abruptly.

Ventricular Tachycardia, which originates from the ventricles and is related to the lethal rhythm called ventricular fibrillation is the most critical and potentially dangerous of the lower-chamber tachycardias. Cardiac arrest in this country often is caused by these types of serious rhythm disturbances, so making an accurate diagnosis is very important. Ventricular tachycardia usually occurs in people who are having or who have had heart attacks.

Treating Fast Heart Rhythms

Many patients with a risk for ventricular tachycardia or ventricular fibrillation also have heart failure and may benefit from a device called an implantable cardiac defibrillator (ICD). An ICD is similar to a pacemaker, but larger. It monitors the heart rhythm to detect ventricular fibrillation or ventricular tachycardia and delivers therapy—rapid pacing or a shock—to restore a normal rhythm. The device is implanted in the upper chest below the collarbone, as is a pacemaker.

Biventricular pacing or “cardiac resynchronization therapy” is a special type of device that is usually coupled with an ICD to treat heart failure patients who have severe symptoms related to their heart failure and have evidence of an electrical condition called “left bundle branch block.” In this type of block, the electrical signal travels very slowly from the right side to the left side of the heart, causing the heart muscle to contract in an uncoordinated fashion. A pacing lead can be placed from a vein inside the heart to the left side of the heart to re-coordinate the heart and to improve symptoms of shortness of breath.

Electrophysiology (EP) Study and Ablation. This is a procedure where a fast heart rhythm problem can be treated by directly burning (cauterizing), or heating, the muscle tissue that is responsible for the problem. Cardiologists use x-rays to guide placement of catheters (small “spaghetti-sized” electrodes) into the veins (and sometimes artery) in the upper thighs of the legs. The catheters are positioned inside the heart in specific locations to record the electrical signals. Doctors then induce tachycardia and analyze how the heart is electrically activated to determine the areas that are responsible for starting or perpetuating the abnormal rhythm. Energy (typically radiofrequency) is then applied at that spot to cauterize the muscle tissue responsible for the abnormal rhythm. The success rate depends on the type of heart rhythm problem being treated and is greater than 90 percent for most heart rhythm problems. For ablation of atrial fibrillation, the success rate depends on the nature of the problem, but is usually between 60 and 80 percent.

Under normal conditions, a healthy adult’s heart rate range from 60 to 100 beats per minute. There may be a sudden occasional increase in heart beat, which resolves in a couple of minutes. The condition is referred to as tachycardia and is generally harmless. However, if your increased heart beat is recurring or persistent or if other symptoms are also present, then you should consult a physician.

What Are the Symptoms of Sudden Increase in Heart Rate?

When the heart beats too quickly, it is not able to effectively pump blood to the other organs of your body. This may deprive the tissues and organs of your body of oxygen and may result in the following symptoms and signs related to tachycardia:

• Lightheadedness
• Shortness of breath
• Increased pulse rate
• Chest pain
• Heart palpitations, irregular, uncomfortable or racing heartbeat or flopping sensation in chest
• Fainting or syncope

In some individuals, tachycardia may produce no symptoms and signs and the condition is discovered when a physical exam is conducted or during an electrocardiogram (a test to monitor heart).

When to Visit Your Physician?

Symptoms of tachycardia and increased heart rate can be caused by numerous medical conditions. It’s imperative to get accurate and prompt diagnosis of the condition and appropriate treatment. You should visit your physician if either your kid or you develop any symptoms of tachycardia.

If you develop a fainting episode, have difficulty in breathing or develop chest pain that lasts longer than few minutes, it is imperative to get immediate emergency medical care or you should call your local medical emergency number or 911. You should seek immediate emergency care if anyone else is having these symptoms.

Complications

The severity of complications of sudden increase in heart rate varies, depending on several factors including the kind of tachycardia, the duration and rate of tachycardia and presence of other problems of heart. Some of the possible complications are:

• Blood clots, which may lead to heart attack or stroke
• Heart failure, which is characterized by inability of heart to pump sufficient quantity of blood
• Frequent spells of fainting or unconsciousness
• Sudden death, which is usually associated with ventricular fibrillation or ventricular tachycardia

What Are the Possible Causes?

Tachycardia is usually caused by anything that creates a problem with the electrical impulses, which control rate of the pumping action of the heart. There are multiple things that can disrupt the electrical system of the heart. Some of these are:

• Damage to tissues of the heart due to heart disease
• Anemia
• Congenital disease or abnormality of heart
• Electrical pathways that are not normal and present in the heart at birth (congenital conditions such as long QT syndrome)
• Exercise
• Low or high blood pressure
• Sudden stress, for instance fright
• Smoking
• Drinking excessive alcohol
• Fever
• Drinking excessive caffeine containing beverages
• Side effects of medicines
• Recreational drug abuse, such as cocaine
• Hyperthyroidism (overactive thyroid)
• Electrolyte imbalance (as minerals are required for proper conduction of electrical impulses)

In certain cases, the cause of sudden increase in heart rate can’t exactly be found.

Risk Factors

The risk of getting tachycardia is increased by any condition, which strains the heart or causes damage to the tissues of the heart. Medical treatment or lifestyle changes may lower the risk that is increased by the below mentioned factors:

• High blood pressure
• Heart disease
• Sleep apnea
• Smoking
• Underactive or overactive thyroid gland
• Diabetes
• Heavy use of caffeine
• Heavy use of alcohol
• Anemia
• Psychological anxiety or stress
• Use of drugs of recreation

Certain other factors, which may raise your risk of getting tachycardia, are:

• Older age: Elderly are at an increased risk of getting tachycardia due to wear and tear of the heart related to age.
• Family: Positive family history of heart rhythm disorders and tachycardia in particular increases your risk.

Medical Tests

In case you are having a sudden increase in heart rate, your physician may do some tests on you to find the cause of the problem. An electrocardiogram is a recording of the electric signals produced by your heart. This test is non-invasive and may be done in a physician’s office or you may be sent home along with a portable device so that you can take the test while you are at home. The physician may also conduct an echocardiogram, which is an ultrasound of the heart. Other tests are a tilt table test and an electrophysiological test.

What Are the Treatment Options?

Vagal Maneuvers

Your heartbeat is regulated by the vagal nerve. Maneuvers, which affect vagal nerve are heaving (like you were passing stool), coughing and putting an ice pack on your face.

Medicine

You can take antiarrhythmic drugs either orally or get them injected. They make the heartbeat normal. The drugs are given in a hospital. The drugs that are available control heart rate; restore normal rhythm of heart or do both. Sometimes, you may need more than one drug to control your tachycardia.

Cardioversion

An electric shock is given to heart using patches or paddles. The electrical impulses of the heart are affected by this and this helps in restoring normal rhythm. This is done in hospital.

Learn the Prevention Measures

Certain measures can be taken to prevent a sudden increase in heartbeat or it becoming a health concern.

Ablation by Radiofrequency Catheter

Catheters are made to enter the heart through blood vessels. Electrodes are present at the catheter ends; they are heated and used to damage or ablate the small area of heart that is causing the fast heartbeat.

Medicines

Normal Heartbeat Per Minute Menopausal Women

Anti-arrhythmic drugs, if taken regularly can help in preventing tachycardia. Your physician may prescribe other medicines that should be taken along with anti-arrhythmic drugs including channel blockers, such as Cardizem (diltiazem) and Calan (verapamil), or beta-blockers, such as Inderal (propranolol) and Brevibloc (esmolol).

Normal Heart Beat Per Minute For Adults

ICD (Implantable Cardioverter Defibrillator)

It is a device, which monitors your heartbeat continuously. It is implanted surgically into the chest. It detects any abnormality in heartbeat and gives electric shocks to bring back heart rhythm to normal.

What Is A Safe Heart Rate

Surgery

In some cases surgery is required to remove an area of tissue. This is only done in cases where other therapies are ineffective or if the patient has another disorder of the heart.

Warfarin

Warfarin makes blood clotting difficult and is generally given to persons who have moderate or high risk of having heart attack or stroke. Though, with warfarin the risk of bleeding is raised, it is given to persons, in whom, the risk of heart attack or stroke is greater in comparison to risk of bleeding.