How to Slow a Fast Heart Rate

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How to Slow a Fast Heart Rate

In the photo, the carotid artery (red) runs up the neck between the Adam’s apple and the internal jugular vein (blue). This is good to know when you need to do the carotid maneuver. (See the post.)

by James Hubbard, MD, MPH

You’re in the middle of a disaster or on a long hike, and suddenly you feel a little faint. Or maybe you feel butterflies in your chest.

You check your pulse, and it’s going really fast. Since your pulse is an extension of your heart, that means you have a really fast heart rate also. What do you do?

Until you can get medical help:

1. Sit down if you can.

2. Check your pulse rate. (See the “Check Your Normal” insert below.) If it’s going at a speed of 100–110, and it’s at a regular rate (maybe a few skips) you could be just overtired or nervous. Sit or lie there for a few minutes and try to relax. Dehydration, fever, and anemia can cause the heart to beat fast like this also.

But …

If the heart rate is closer to 150 or higher, you’re probably in what we call supraventricular tachycardia (SVT). In SVT, your heart’s electrical system, which controls the heart rate, gets out of kilter. (See the insert about the electrical system below.) This can result in two things.

First, when the rate’s that fast, the heart can’t efficiently empty the blood from its chambers. Second, those chambers’ pumping rhythms can get out of sync. (Normally your atria pump blood to your ventricles, which pump it out milliseconds later. You can hear that when you listen through a stethoscope. Tadump, tadump. That system can get out of whack in SVT.)

The Heart’s Electrical System

Normally the heart rate is triggered at the “sinus,” or “sinoatrial,” node (1). The impulse then travels through the heart, syncing the beats of the four chambers (atria and ventricles). The sinus node knows when to speed up or slow down the rate if it thinks the body needs more or less blood to furnish its needs.

Sometimes, for various reasons, the “supraventricular node” (2) can take over. It will trigger the heart to beat around 150 times per minute (supraventricular tachycardia—SVT). This is an abnormal rate and always too fast.

Occasionally, the left ventricle (7) can take over the rate at around 300 beats per minute (ventricular tachycardia—VT). That rate is unsustainable for life. If VT happens, you can try a hard thump with your fist to the middle of the chest, or hope the vagal maneuvers work. Neither method works very often, and if you can’t make it to a medical facility quickly, you’re likely not to survive.

(Ignore the other numbers in the picture for our purposes.)

Any of this is a big stress on the heart. Your blood pressure may drop because your heart isn’t pumping blood out as efficiently. If you have underlying heart disease you could have a heart attack.

Causes for SVT include thyroid disease, prescription medications, smoking, anxiety, recreational drugs, and a condition called Wolff-Parkinson-White syndrome (a slight electrical system abnormality you’re born with). Often, though, the cause remains unknown.

 Get The Survival Doctor’s interactive guidebooks here. They do an anxious heart good.

3. If you think it’s SVT, get your heart rate down. Until you can get medical help there are a few things you can try to kick it back into a normal, safer, more-efficient rate. All of these stimulate your vagus nerve (which has direct connections to your heart) and help control the rhythm. After each “vagal maneuver,” check the pulse to see if your heart rate has slowed.

a. Valsalva maneuver.
Hold your breath and bear down in a strain (like if you’re constipated and straining to have a bowel movement). Do this for five seconds, then breathe. This changes the pressure in your chest and therefore in the big blood vessels in it. That fools your body into thinking your heart should slow down. If the pulse hasn’t slowed, try again. Another way to do the Valsalva maneuver is to stick a finger in your throat and gag yourself.

b. Carotid maneuver.
Find your carotid pulse (see top photo) just below your jaw. The vagus nerve runs next to it. Massage very firmly for five seconds. Warning: In rare cases this could knock off a piece of a blood clot lodged in this area and cause a stroke. Don’t do this in elderly people or anyone with a history of a stroke.

c. Ice-water facial.
A little odd, I know, but if you have cold water (preferably ice water,) dip your face in it a few seconds. This stimulates your vagus nerve to slow your heart by causing what’s known as the dive reflex. It’s the same reflex that helps some people survive for a long time under cold water by slowing the body’s metabolism down.


Whether or not one of these things works, or your heart rate converts back to normal on its own, get checked by a doc as soon as you can. SVT can also be prevented with prescriptions medicines.

Has anyone ever experienced a fast heart rate? What did you or the medical personnel do? How was it treated, or did it just go away?

This is where you find the radial pulse. Always use two fingers to feel for a pulse. It helps you make sure you’re not mistaking your own pulse in your finger for someone else’s.

Check Your Normal

Go ahead and check your pulse now. Yes, right now. If you know where to find it and what a normal pulse feels like, it’s going to be lot easier to check it when it’s abnormal. See the photos (right and top) to locate two of the most common areas.

Notice the regular rhythm, speed, and force of your normal pulse. If you have a watch, count the rate for ten seconds and multiply times six for the heart rate per minute. Or check the rate for fifteen seconds and multiply times four. The normal rate is 60–100 beats per minute. Some athletes may have slower normal rates because their heart pumps blood so efficiently.

Then check your pulse without counting to get a feel of what a normal rate is so that if you don’t have a watch when you need it, you can discern when it’s beating way too fast.

One trick of estimating the rate is to take it to the beat of the song “Stayin’ Alive” (or “Another One Bites the Dust”). Both tunes are at 100 beats per minute.

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Carotid artery photo by Shannan Muskopf on Flickr. Illustration of the heart’s electrical system by J. Heuser, based on an illustration by Patrick J. Lynch, illustrator, and C. Carl Jaffe, MD, cardiologist, Yale University Center for Advanced Instructional Media. The illustration (only) is licensed under the Creative Commons Attribution 2.5 Generic license.

  • engineering_student

    Adderall has been doing some nasty things to my heart rate and blood pressure. Thank you for the tips.

    • James Hubbard, MD, MPH

      You’re welcome.

  • dani k

    I am 20 years old and I was diagnosed with an electronic arrhythmia in my heart. I feel palpitations often but it is so much worse when I drink coffee. I know I shouldn’t have caffeine, but i find t really hard to stay energized without it. I need advice for what to do when the palpitations come and also how to stay energized without hurting my heart.. any suggestions?

    • James Hubbard, MD, MPH

      Dani, it sounds like you’ll have to chose between palpitations and caffeine. Maybe, cut back at least. I’m assuming you’ve had a blood check for thyroid problems and anemia. In general, regular exercise such a walking at a moderate pace (where you’re a little breathy but still able to talk) for 20-30 minutes a day increases energy and decreases palpitations.

  • Nordlys

    My heart rate doesn’t make sense. 100 every minute, with high stamina and low sense of fatigue when I do sport.
    It doesn’t even match my breath rate that is average, compared to heartbeat.

    • James Hubbard, MD, MPH

      If I understand correctly, your resting heart rate is 100 even though you’re in pretty good shape. (The breath rate has nothing to do with your heart rate.) You might consider a good checkup that includes blood tests such as for anemia and for thyroid disease.

  • TicklePick

    Use the app Breath Pacer on your iPhone or iPad to pace your breaths!

  • TwitterBabe

    I started having heart palpitations after I started taking the fish oil pills , and the one a day vitamins. I take a fish oil pill when my palpitations start and it slows my heart after a while. I don’t have any shortness of breath or fainting or anything like that. I went to a doctor and he said my heart was okay, I was having some form of panic attack. Can my palpitations be cured? I’m tired of living like this. I’m 24 years old and I can’t understand this.

    • James Hubbard, MD, MPH

      First, you need to know what the underlying problem is. I’d suggest you see a cardiologist. When you know what’s causing the palpitations, you should be able to treat it.

      • TwitterBabe

        Thank you for responding it means a lot.

  • mhefets

    Thank you Dr. Hubbard for the clear explanations and advice. I’m 65 years old and had SVT episode once a few months ago after squatting only 10 times. I was highly anxious at the time after having an argument with my wife…I noticed the unusual high heart rate and that its was irregular. I sat down and tried to relax breathing deeply and exhaling very slowly. It did not help. After a few minutes I notified my wife, a Physical Therapist, who immediately ordered me to lie down and checked my pulse. She confirmed something was terribly wrong and asked me whether to call 911. Within minutes the LAFD was at my home and took me to the nearest hospital. There, the ER doctor injected something via my IV that caused my face to feel really hot; the first “flushing” did not work in slowing my heart but the second did. Since then I’m taking Atenolol (20 mg) that usually keeps my heart rate at about 64 with low pressure as well. After complaining that I feel dizzy at times, my doctor cut the Atenolol to half of the above dosage. So far so good; even when I do exercise my heart rate goes very slowly up and does not go higher than 120.

    • James Hubbard, MD, MPH

      Thanks for sharing. I’m glad you’re better.

  • Brandon Lucas, 18

    I honestly don’t know what is wrong right now but I have had an extremely high heart rate for the past three hours and can’t get it to go away for anything. I’ve tried all of the methods I’ve been reading and nothing works, this happens every now and then but this time is definitely one of the worst. Any suggestions? ??

    • James Hubbard, MD, MPH

      Have someone check you. A nurse, parent, doctor. If your heart rate is much over a hundred, you should see a doctor today. Even if not, you should have a checkup soon.

  • Brittney

    My resting heart rate is 136. I am on Matoprolol 100mg 2x daily and it barely does anything. I also have hyperthyroidism and recently had RAI done. But now my levels are worse than before. So my heart rate is worse than ever. I don’t know what to do. I’m going to try some of the things that you have suggested. I’ve also found that drinking ice ice ice cold water with extra ice makes me feel better for a bit (plus I’m craving it). Any other suggestions?

    • James Hubbard, MD, MPH

      Brittney, have you seen a cardiologist?

      • Brittney

        No. I just see my endocrinologist. I just saw him today. While on 100mg 2x daily of Matoprolol my heart rate is down to 78. So I guess that’s good.

  • Concerned Mama

    Hi Dr Hubbard,
    I just found your excellent website while trying to figure out what is causing my 10 year daughter’s rapid heart rate (~120 at rest but harder to measure as it skips or races suddenly). Her heart rate goes down if she runs or is active .
    I read here that ( )

    an 11 year old also has a similar phenomenon.

    She trains more than 8 hours a week in a competitive sport.. Her doctor has done blood tests to check for thyroid problems but the results are negative. She has clammy hands and feels fatigue. She questions whether it is harder to diagnose thyroid problems in children… We could ask for an ECG, Holter test.

    Any suggestions would be appreciated.
    Thank you very much!

    Concerned Mama

    • James Hubbard, MD, MPH

      Concerned, you could certainly ask her doctor what he/she thinks, and ask if your daughter could have an ECG and holter. At least, start with the ECG. Also, if you don’t get a good answer for the problem, ask her to be referred to a pediatric cardiologist. In addition, ask about the thyroid problems. I don’t think it’s a more of a problem to be diagnosed in children, but ask. Anemia is another possibility. If her resting heart rate is 120, I don’t think she should be exercising unless she is ok’d to do this by a doctor.

  • Victoria p

    I’m on methadone have been for 1.5 years I’m on my way to getting off of it I’m down to 30 mg my heart rate has been extremely high the last 6 months, I know it’s because of the methadone but what should I do?

    • James Hubbard, MD, MPH

      Go to your doctor and have a good checkup. After the exam the doctor can tell you specifically what to do for your specific problem.