Atrial Tachycardia

What is atrial tachycardia?

• Atrial tachycardia (AT) is a condition where the atrium in your heart beats much faster than it should. Your heart has four chambers (spaces), including two upper atria and two lower ventricles. The chamber walls are muscle tissue that beat (tighten and relax) constantly. With each beat, blood is pumped to other tissues and organs in your body. AT is a type of arrhythmia (abnormal heartbeat) called supraventricular (above the ventricle) tachycardia, or SVT. SVTs include other types of arrhythmias, such as atrial fibrillation and atrial flutter. Ask your caregiver for more information about these arrhythmias.
  
  
• Normally, a person's heart rate at rest is about 60 to 80 beats every minute. With AT, your atria may beat from 100 to 300 beats each minute. AT may come and go, and may last a few seconds or for many days. With AT, your heart may not be able to pump enough blood to the rest of your body. Your body may not get the oxygen it needs to function. You may feel tired or short of breath. Treatment may help improve your symptoms, such as breathing problems and weakness. Treatment may make your heart rate regular and prevent your AT from getting worse.

What causes atrial tachycardia?

Your heart has an electrical system inside it that controls your heart's rhythm (heartbeat). A problem with your heart's electrical system may lead to abnormal atrial beats and AT. Different types of AT can occur depending on where in your atria the electrical problem starts. Focal AT is when one area in the atria sends electrical impulses causing the atria to contract too quickly. Multifocal AT happens when more than one area in your atria sends out electrical impulses causing the atria to contract. Re-entrant AT is when the pathway of the impulse is blocked. This causes your heart to send repeat impulses to try to get past the blockage. Re-entrant AT can be focal or multifocal.

What increases my risk of having atrial tachycardia?

• Activity: For some, AT may only occur or worsen when doing activities such as exercising.
  
  
• Age and family history: As you age, your risk for AT increases. If a close family member has AT, your risk for AT increases.
  
  
• Alcohol, caffeine, smoking, and drug abuse: Drinking too much alcohol, too often, may increase your risk for AT. Alcohol is found in beer, wine, whiskey, and other adult drinks. Caffeine can increase your heart rate, leading to AT. Caffeine is found in coffee, chocolate, some sodas, and other drinks. Smoking cigarettes and using street drugs, such as cocaine and ecstasy, may also increase your risk for AT.
  
  
• Cardiac ablation to treat atrial fibrillation: Cardiac ablation is a procedure that uses heat energy to stop abnormal heart impulses. Atrial fibrillation (AF) is a type of SVT where your atria beats about 350 to 600 times each minute. AT may occur after having cardiac ablation to treat AF.
  
  
• Fluid and electrolyte imbalances: Dehydration occurs when you lose too much fluid from your body. Not drinking enough liquids, vomiting (throwing up) or having diarrhea (watery bowel movements) can cause dehydration. Electrolytes are minerals in your body that help your body function correctly. When you have low levels of the electrolytes potassium and magnesium, or high calcium levels, you may have AT.
  
  
• Medical conditions: Illness from an infection can increase your risk for AT. Hyperthyroidism occurs when you have too much thyroid hormone and can lead to AT. Heart conditions, such as rheumatic heart disease, heart failure, or a heart attack increase your risk. Lung conditions including pulmonary edema or chronic (long-term) lung disease may also increase your risk for AT. Ask your caregiver for more information about these and other medical conditions that increase your risk for AT.
  
  
• Medicines: Having too much of certain medicines in your blood, such as digoxin, can lead to AT. Digoxin is a heart medicine used to help your heart work better. Medicines to treat cancer may also increase your risk for AT.
  
  
• Heart surgery: Surgery to correct a heart problem may lead to AT. Surgeries include heart valve surgery and coronary artery bypass grafting.

What are the signs and symptoms of atrial tachycardia?

You may have no signs or symptoms of AT. You may also have any of the following:

• Feeling lightheaded or dizzy, and you may faint (pass out).
  
  
• Feeling like your heart is beating faster and harder than normal. You may feel like your heart is jumping or fluttering in your chest.
  
  
• Feeling more tired than usual.
  
  
• Having new or increased shortness of breath.
  
  
• Having pain, pressure, or tightness in your chest.
  
  
• Needing to urinate more often than usual.

How is atrial tachycardia diagnosed?

Your caregiver will ask about your symptoms and any health problems that you have. Tell your caregiver how often you have symptoms, and if they change during the day. Your caregiver will listen to your heart. Tell your caregiver if you are taking any medicines, including herbs, supplements, and over-the-counter (OTC) medicines. Ask your caregiver for more information about the following tests to diagnose AT:

• Electrocardiogram testing:
  
  
  • 12 lead ECG: A 12 lead ECG is also called an EKG. An ECG is done to check for damage or problems in different areas of your heart. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or a TV-like screen. The ECG records a short period of electrical activity in your heart muscle. Caregivers look closely for AT or changes in how your heart is working.
    
    
  • Holter monitor: A Holter monitor is also called an ambulatory ECG monitor. It is a small, battery-operated device that you wear. The monitor shows your heart's electrical activity while you do your usual activities. The monitor shows how fast your heart beats, and if it beats in a regular pattern.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Electrophysiologic study: An electrophysiologic study, or EPS, is used to "map out" the electrical pathways in your heart that control your heartbeat. Readings are taken through small wires that are fed through a blood vessel in your arm, neck, chest, or groin to your heart. Your doctor can also use these wires to trigger your heart rhythm problem, and find the best way to treat it.
  
  
• Echocardiogram: This type of ultrasound is also called an echo. An echo uses sound waves to show pictures of the size and shape of your heart. An echo also shows how your heart moves when it is beating. These pictures are seen on a TV-like screen. You will need to lie down on your back during the echo. Clear jelly will be squirted on your chest to help the ultrasound sensor slide easily. The sensor is moved across your chest to see your heart from different angles. You may hear a whooshing noise, which is the sound of your blood flow.
  
  
• Atrial electrograms: Atrial electrograms are ECG recordings taken from wires attached to your atria. The wires are temporary wires placed on your heart during heart surgery. The wires are connected to a monitor and show your heart's atrial activity. This test is done if caregivers believe you are having AT after heart surgery.
  
  
• Exercise stress test: An exercise stress test helps caregivers see the changes that take place in your heart during exercise. It checks for blockages in the arteries of your heart. An ECG is done while you ride an exercise bike or walk on a treadmill. Caregivers will ask you how you are feeling during the test. They want to know if you have chest pain or trouble breathing. An exercise stress test may be done if your AT only occurs with activity, such as exercise.

How is atrial tachycardia treated?

Treatments will depend on the type of AT you have. If your AT is caused by another condition, your caregiver will work with you to treat the condition and stop your AT. If your AT is caused by medicine, your caregiver may have you stop taking the medicine. Do not stop any medicines without talking with your caregiver first. Ask your caregiver for more information about the following treatments for AT:

• Vagal maneuvers: Vagal maneuvers (methods) can help slow the impulse from your atria to your ventricle and stop your AT. Vagal maneuvers include putting your face in ice cold water or bearing down like you are having a bowel movement. Your caregiver may teach you other vagal maneuvers to do on your own when you have an episode of AT. Your caregiver may also massage your carotid arteries (blood vessels in your neck that supply blood to your brain). Never try to massage your own carotid arteries. Carotid massage must only be done by a trained caregiver.
  
  
• Medicines:
  
  
  • Antiarrhythmia medicines: Antiarrhythmia medicines may help slow down your fast heartbeat and help make your heartbeat more normal. The medicine may also help decrease your AT symptoms.
    
    
  • Beta blockers: Beta blockers help keep your heartbeat regular.
    
    
  • Calcium channel blockers: Calcium channel blockers help slow your fast heartbeat.
    
    
  • Aspirin: You may need to take an aspirin a day to help prevent heart problems. Aspirin helps to prevent blood clots from forming and causing blood flow problems in the heart. If caregivers want you to take aspirin daily, do not take acetaminophen or ibuprofen instead. Do not take more or less aspirin than caregivers say to take. If you are on other blood thinner medicine, ask your caregiver before you take aspirin for any reason.
    
    
  • Blood thinners: Blood thinners help stop clots from forming in the blood, which may occur with abnormal heartbeats. Clots can cause a stroke, heart attack, and death. Blood thinners may make it easier to bleed or bruise. While taking this medicine, use a soft toothbrush to prevent bleeding gums. If you shave, use an electric shaver.
    
    
  • Electrolytes: You may be given electrolytes in the hospital if an electrolyte imbalance caused your AT.
  
  
• Cardioversion: This is a procedure where an electric shock is given to your heart. The shock is usually given through paddles or sticky patches placed on your chest or back. The shock helps your heart return to a normal beat. Cardioversion may be needed if medicine does not make your heart work better. You may need a cardioversion if your heart rhythm is making you sick or is dangerous. You may be given medicine to help you relax before getting the electric shock. If the shock works, your heart rate and rhythm will return to normal. Medicine may be needed to keep your heart in a normal rhythm. You may need a cardioversion more than once.
  
  
• Cardiac ablation: Cardiac ablation is a procedure used to treat problems with your heart muscle. A wire is fed to your heart through an artery or a vein. Your caregiver finds the area of the heart muscle causing the problems in your heart, and applies heat energy to it. This may help your heart beat in a more normal rhythm.
  
  
• Permanent pacemaker: A permanent pacemaker is a small device that helps control your heart rate. A permanent pacemaker is about the size of a wristwatch, and is implanted under your skin. You may need a pacemaker to slow your heartbeat down and make it more regular. A pacemaker is made up of leads and a generator (battery). Getting a pacemaker involves having a procedure done. Most pacemakers work only when they are needed. These are called demand pacemakers. Other pacemakers work all the time. Your caregiver will decide which pacemaker is right for you.
  
  
• Surgery: You may need surgery if other treatments do not work to stop your AT. Ask your caregiver for information about surgery to treat AT.

How can I manage my atrial tachycardia?

• Avoid alcohol and caffeine: Avoid alcohol and caffeine to decrease your risk for palpitations (fast, forceful heartbeats) and AT.
  
  
• Do not smoke: Smoking harms your body in many ways. Smoking can worsen your AT and cause other heart disease, lung disease, and cancer. Quitting smoking will improve your health and the health of those around you. Ask your caregiver for more information about how to stop smoking if you are having trouble quitting.
  
  
• Do not use drugs: Do not take any illegal street drugs. Street drugs can make your AT and symptoms worse. Talk to your caregiver if you use illegal drugs and need help to stop.
  
  
• Take your medicines exactly as ordered by your caregiver: Your caregiver may give you medicine to treat your AT and decrease your symptoms. You may also have medicine to help treat other health problems. Keep a written list of the medicines you take, the amounts, and why you take them. Do not stop taking your medicines unless you discuss it with your caregiver.
  
  
• Talk with your caregiver before playing sports: You may have to limit or stop playing sports depending on your symptoms and how your heartbeat reacts to treatment. Talk with your caregiver about if and when you may play sports.
  
  
• Talk with your caregiver if you are female and want to get pregnant: During pregnancy and childbirth, your heart works harder than usual. Your AT symptoms may get worse. Talk with your caregiver about safe ways to prevent pregnancy. If you do get pregnant, make sure your caregiver knows you have AT. Your medicines to treat AT may need to be changed while you are pregnant.

What are the risks of treating atrial tachycardia?

• Medicines to treat your AT may cause your heart to beat too slowly or your blood pressure to drop. Certain medicines may cause other types of arrhythmias. If you are a pregnant woman with AT, certain medicines to treat AT should not be taken. Medicines can lead to health problems for you and your unborn baby. If you have cardiac ablation, you may have bleeding, bruising, or get an infection where the wire was put in. You may get a blood clot that blocks blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot can cause chest pain, trouble breathing, and can cause you to have a stroke. Even after treatment, your AT and symptoms may return, and you may need more treatments.
  
  
• If your AT is not treated, you may not learn the cause of your abnormal heartbeats. You may not get proper treatment. Your symptoms, such as chest pain and trouble breathing may get worse. You may become weak, have dizziness, and you may faint often. You may get a blood clot in your heart. If your AT is not treated, your heart muscle may weaken and your heart may not work properly. Untreated AT also increases your risk for a heart attack and heart failure. Talk with your caregiver if you have questions or concerns about your condition, treatment, or care.

Where can I find more information?

Contact the following:

• American Heart Association
  7272 Greenville Avenue
  Dallas , TX 75231-4596
  Phone: 1- 800 - 242-8721
  Web Address: http://www.heart.org
  

• Heart Rhythm Society
  1400 K Street NW, Ste 500
  Washington , DC 20005
  Phone: 1- 202 - 464-3400
  Web Address: www.hrsonline.org
  

When should I call my caregiver?

Call your caregiver if:

• You are feeling more tired than usual.
  
  
• You have new or increased heart palpitations or you feel like your heart is skipping beats.
  
  
• You are urinating more often than usual.

When should I seek immediate help?

Seek care immediately or call 911 if:

• Call 911 or an ambulance if you have any signs of a heart attack:
  
  
  • Discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain, that lasts for more than a few minutes or keeps returning
    
    
  • Discomfort or pain in your back, neck, jaw, stomach, or one or both of your arms
    
    
  • Feeling sick to your stomach
    
    
  • Having trouble breathing
    
    
  • A sudden cold sweat, particularly in combination with chest discomfort or trouble breathing
    
    
  • Feeling very lightheaded or dizzy, particularly in combination with chest discomfort or trouble breathing
  
  
• You suddenly feel lightheaded and have trouble breathing.
  
  
• You have chest pain or trouble breathing that is getting worse over time.
  
  
• You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
  
  
• You have signs of a stroke: The following signs are an emergency. Call 911 immediately if you have any of the following:
  
  
  • Weakness or numbness in your arm, leg, or face (may be on only one side of your body)
    
    
  • Confusion and problems speaking or understanding speech
    
    
  • A very bad headache that may feel like the worst headache of your life
    
    
  • Not being able to see out of one or both of your eyes
    
    
  • Feeling too dizzy to stand

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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