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Rapid heartbeat at night
Rapid heartbeat (tachycardia) at night refers to a rapid heartbeat. Some immediate triggers are not diseases, but a normal reaction. When the circulatory system has to work harder, the heart pumps faster, for example when we "run out of breath" during long-distance running or "our hearts beat up" because we face the person of our dreams. Rapid heartbeat at night is a common phenomenon that can have organic and psychological causes. We also examine the causes and show when and how those affected can take action themselves.
When to the doctor?
If there are no such triggers and the heart rate rises to 140 or more beats per minute at night, then we should see a doctor. The causes are diverse, from smoking to alcohol to anxiety disorders. However, palpitations can also indicate dangerous, even fatal diseases, such as diseases of the heart and thyroid. Signs of such serious problems can include other symptoms such as stumbling, shortness of breath, shortness of breath or dizziness.
How does heartbeat develop?
Under certain circumstances, a "reentry cycle" begins. This means that electrical excitation of the heart returns to its exit and triggers the heartbeat again. The cause is, for example, a scar in the heart muscle. Some people have pathways between the ventricles and atria from birth, and these also sometimes lead to a reentry process. Typical of this recurring impulse is an accelerated but regular heartbeat.
Beware of an irregular heartbeat at night. Then smaller arousal processes alternate; it can be atrial fibrillation or ventricular fibrillation. Ventricular fibrillation stops the cardiovascular system - an immediate resuscitation is necessary, otherwise those affected die.
Another trigger is the increased automation on the sinus node. The sinus node controls the pulse rate. Changes in the vegetative nervous system affect it as well as caffeine, alcohol and medication.
Atrial fibrillation is accompanied by an accelerated heartbeat. Here the blood flow in the atria of the heart is disturbed and blood clots form. For this reason alone, people who suffer from a racing heart should consult a doctor. The blood clots can get into the brain and cause a stroke.
You should see a doctor straight away if your heart racing at night with the following symptoms: shortness of breath, chest tightness, chest pain, dizziness and nausea. Then it can be a developing heart attack.
Causes of the night racing heart
However, most causes of night racing heart are less dramatic and can be both psychological and physical. These include:
1) sleep disorders and or lack of sleep
2) An abnormality in electrolysis
3) Anxiety, panic attacks, but especially clinical anxiety disorders. Here the fear in the body triggers a permanent alarm state, the blood circulation is in full swing due to the signal "danger in delay".
Fears immediately activate the body's stress response. There is no boundary between physical and psychological, and the reaction has nothing to do with whether the reaction is objectively justified. The stress response causes immediate physiological, psychological, and emotional changes in the body to enable the body to respond immediately to a threat - to flee or to fight (fight or flight).
The accelerated heartbeat is not a sign of a disease (even if the anxiety disorder itself is one). Rather, the body needs increased blood flow to react acutely to a threat.
4) Excessive consumption of alcohol
5) lack of water
6) Certain dietary supplements such as ginseng, bitter orange or hawthorn
7) Physical exertion, hard work and competitive sports
8) excitement, euphoria and anger
10) hormone fluctuations, for example during pregnancy, menstruation or menopause
12) Coffee, chocolate, diet pills and energy drinks
13) low blood sugar (often in anorexia patients)
14) Low oxygen levels in the blood
16) Sudden rising or startling
18) Asthma and beta blockers
19) Cocaine and Metaamphetamine
Alcohol, consumed in quantities, causes rapid heartbeat at night, high blood pressure and low blood sugar. The last two alone also trigger an accelerated heartbeat.
So if you wake up from your sleep after a heady party night and your heart is racing, the cause is likely to be found in beer, wine, and schnapps. If you do not suffer from chronic alcoholism, the heavy palpitation of the heart has usually passed within 24 hours.
Young men in particular often suffer from “Holiday Heart Syndrome” after a “binge drinking”, atrial fibrillation in which the heart beats too quickly and at the same time irregularly. If this happens to them more often, the therapy is clear: steer clear of alcohol.
Fast heartbeat at night due to stress
Stress affects the autonomic nervous system. We cannot control this with our will. Stress activates the sympathetic nervous system. Now norepinephrine and adrenaline are released, and these make the heart beat faster and pump more blood into the circulation. The blood vessels narrow, digestion slows down.
In the event of permanent stress, the heart becomes chronically overloaded. Then there is not only a rapid heartbeat at night, but the risk increases to develop a coronary heart disease or a heart failure, perhaps even a heart attack.
The thyroid gland produces the metabolic hormones thyroxine (T4) and triiodothyronine (T3). These support the performance of the heart. At the same time, they potentiate the effects of noradrenaline and adrenaline. Both accelerate the heartbeat and strengthen the heart muscles. Due to the faster pulse, the heart has to pump more volume against greater pressure and needs more energy.
Nocturnal palpitations can indicate an overactive thyroid. This leads to an excessive level of T4 and T3. The result: too much adrenaline ensures that the heart receives a much stronger drive than necessary. There is a racing heart and sometimes even atrial fibrillation.
The suspicion of such an overactive thyroid increases with other key symptoms: increased reflexes, rapid weight loss, bulging eyes and high blood pressure.
Anemia can also cause an increased heartbeat at night. Here the body lacks blood and therefore oxygen. The organism is now trying to fill up the missing oxygen by quickly pumping the blood.
What to do if your heart is racing at night?
If the doctor determines a coronary heart disease, weak heart or an overactive thyroid gland, you can achieve little with home remedies. Follow the medical treatment. The situation is different when the heartbeat and palpitations are too fast as a result of anxiety behavior and other triggers of stress, alcohol, nicotine, cocaine or certain medications.
In the case of a stressed heartbeat, the symptoms disappear completely when the stress mode ends. With chronic stress, you can eliminate both the symptoms and the cause. Are exaggerated fears the trigger? Then psychotherapy helps to get the fears under control. Did the stress arise from time pressure and excessive demands at work? Then you see the increased heartbeat as a warning signal that something has to change in this structure.
In general, you can use relaxation techniques to reduce stress. These range from behavioral therapy to yoga and autogenic training to massages.
Exercise in the fresh air reduces stress, hiking or cycling are a boon - but not competitive sports, since this in turn increases blood pressure and increases the heart rate at night.
Checklist for racing your heart
In the case of an accelerated heartbeat, the German Heart Foundation recommends creating a checklist yourself so that the doctor can quickly classify the corresponding symptoms.
1) When did you first have a racing heart?
2) When was the last time?
3) How often do symptoms appear?
4) Does it start suddenly or gradually?
5) Are there certain triggers such as exertion or excitement or only at a certain time?
6) How often does the pulse beat while the heart is racing?
7) Does the pulse beat regularly or irregularly?
8) How long does the condition last?
9) Do you feel anything else while your heart is beating? Chest pressure, dizziness or shortness of breath, headache or nausea?
10) Have you ever passed out? If so, did you have a racing heart afterwards?
11) Can you stop the heart racing in the situation yourself? Through behavior or medication? Do relatives of them have a similar problem?
(Dr. Utz Anhalt)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- Karl Eberius: Rapid heartbeat: Clarify the cause with a heart foundation checklist, Deutsche Herzstiftung e. V., (accessed on 04.09.2019), DH
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH): Diabetes, Heart Disease, and Stroke, (accessed 04.09.2019), niddk
- Thomas Paul et al .: Guideline Pediatric Cardiology: Tachycardia Arrhythmias in Children, Adolescents and Young Adulthood (EMAH Patients), German Society for Pediatric Cardiology, (accessed 04.09.2019), AWMF
- Thomas Lambert, Clemens Steinwender: Cardiovascular Medicine, Trauner Verlag, 1st edition, 2019
- Dhein S., Hindricks G. (2004) Arrhythmias. In: Pharmacotherapy. Springer textbook. Springer, Berlin, Heidelberg
ICD codes for this disease: R00.0ICD codes are internationally valid encryption codes for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.