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Reasons For Fast Heartbeat: Tachycardia is a condition characterized by an abnormally fast heart rate, typically over 100 beats per minute in adults. While tachycardia is often linked to electrophysiology (EP), not all cases are purely EP-related. EP problems stem from abnormalities in the heart’s electrical conduction system which controls the rhythm and rate of the heartbeat. However, tachycardia can also arise from non-electrophysiological factors. Understanding the distinction is essential for accurate diagnosis and management.

In a conversation with Jagran English, Dr TS Kler, Chairman & HOD - BLK-Max Heart & Vascular Institute, Chairman Pan Max, Electrophysiology explained about fast heartbeat and the major causes behind arrhythmias.

Electrophysiology-Related Tachycardias

Supraventricular Tachycardia (SVT): This includes arrhythmias originating above the ventricles such as atrial fibrillation, atrial flutter and AV nodal reentrant tachycardia.
Ventricular Tachycardia (VT): Arising from the ventricles, this is often associated with structural heart diseases like ischemic cardiomyopathy.
Accessory Pathways: Conditions like Wolff-Parkinson-White (WPW) syndrome involve abnormal electrical pathways causing rapid conduction.
Automaticity Disorders: These include ectopic pacemaker activity causing inappropriate heart rate acceleration.

Non-Electrophysiological Causes of Tachycardia

Physiological Responses: Fever, dehydration, or exercise can increase heart rate as part of a normal response.
Endocrine Disorders: Hyperthyroidism or pheochromocytoma can induce tachycardia through systemic hormonal effects.
Drugs and Substances: Caffeine, alcohol, or medications like beta-agonists can cause a faster heart rate.
Psychological Stress: Anxiety, panic attacks, and emotional stress can activate the sympathetic nervous system, leading to tachycardia.

Seven Reasons For Arrhythmias Or Irregular Heartbeat

Arrhythmias are abnormal heart rhythms caused by disruptions in the electrical system of the heart. These disruptions may arise due to structural, functional or external factors. Seven possible causes are listed below.

Ischemic Heart Disease (IHD)

Cause: Reduced blood supply to the heart muscle due to blockages in coronary arteries.
Details: Myocardial ischemia can damage electrical pathways, leading to arrhythmias such as atrial fibrillation or ventricular tachycardia.
Example: Post-myocardial infarction scar tissue acts as a substrate for reentrant circuits, triggering VT.

Structural Heart Disease

Cause: Altered anatomy or scarring of the heart muscle.
Details: Conditions like cardiomyopathy, valvular heart disease, or congenital abnormalities disrupt electrical conduction.
Example: Hypertrophic cardiomyopathy predisposes to life-threatening arrhythmias like VT or sudden cardiac arrest.

Electrolyte Imbalances

Cause: Abnormal potassium, magnesium, calcium, or sodium levels.
Details: Electrolytes are crucial for maintaining the heart’s electrical stability. Imbalances can prolong QT intervals or induce ectopic beats.
Example: Hypokalemia can lead to Torsades de Pointes, a type of polymorphic VT.

Endocrine Disorders

Cause: Hormonal imbalances affecting heart rate and rhythm.
Details: Conditions like hyperthyroidism increase sympathetic activity, while pheochromocytoma releases excess catecholamines.
Example: Thyrotoxicosis is commonly associated with atrial fibrillation.

Autonomic Nervous System Imbalances

Cause: Overactivation or suppression of the sympathetic or parasympathetic nervous system.
Details: Sympathetic overdrive can lead to sinus tachycardia, while excessive vagal tone might cause bradyarrhythmias.
Example: Neurocardiogenic syncope can cause transient arrhythmias during vasovagal episodes.

Genetic Disorders

Cause: Inherited mutations in cardiac ion channels or structural proteins.
Details: Genetic syndromes like Long QT Syndrome (LQTS) and Brugada Syndrome predispose individuals to life-threatening arrhythmias.
Example: LQTS is characterized by prolonged QT intervals, leading to a high risk of ventricular fibrillation.

Drug Toxicity and Substance Use

Cause: Use or overdose of certain medications and recreational drugs.
Details: Antiarrhythmics, beta-agonists, or cocaine can disrupt normal heart rhythms.
Example: Digoxin toxicity can result in various arrhythmias, including atrial tachycardia with AV block.

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