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Checking Your Client's Heart Rate: how fast is too fast?

Updated: Feb 7, 2020

“Is everything ok,” my client sheepishly asked me as I felt his pulse. I think my expression must have showed some concern. “Well, your heart is beating quite fast,” I said, trying to sound not too worried. I counted forty beats in fifteen seconds and multiplied by four; his heart was racing at 160 beats per minute. He was young and the problems he’d been telling me about for the past hour and a half did not seem like pathology in the medical sense of the word. His career was a success, but he was unhappy, and was working too hard and drinking too much. Yes, clearly he needed help to get his life back in balance, but there was more to it. Thoughts of sending him to the emergency room stated going through my mind.   

As a naturopathic doctor, I view the conventional medical model as but one perspective, there are many others. Viewpoints offered by traditional Chinese medicine, for example, have been around for thousands of years and have a proven track record for helping people restore health. But while these ancient systems are good for healing, for predicting disease, conventional medicine (allopathic medicine, western medicine, whatever you want to call it) is the best. 

To understand what risks my client was in, I needed to switch my gaze from the healing arts which I know and love, to the science of pathology. That meant going through the list of diseases which could cause tachycardia (fast heart rate), discerning which fit in this situation, and then figuring out my next move. 

That first step is called “forming a differential diagnosis,” and this is what I will present here. My intent is that this will be useful for those learning or practicing healing arts but not yet educated in the science of modern pathology. 

Here are some possibilities to consider when facing someone with a fast heart rate: 

1. Fever: Whenever a person’s temperature rises, the heart rate increases. Fever can be a sign of infection such as influenza or pneumonia. With fever, the heart rate rarely goes up very high and it would be a sign of danger to see a fever produce a heart rate significantly above 100 beats per minute. A prompt medical visit should be considered in such cases. 

2. Panic Attack: This is perhaps the most common cause of a fast heart rate and I’ve seen this many times in my practice.  While I think the natural therapies offer the best help, it can be difficult for the client to accept that what they are experiencing is a panic attack and nothing else (they’re usually convinced something is wrong with the heart). It is for this reason that I often send people to urgent care or the emergency room when I suspect a panic attack. Urgent care is less stressful than an emergency room and here they will get a simple electrocardiogram test showing that the heart is fine. That generally calms them down enough to accept the help of natural therapies. 

3. Hyperthyroid: If excess hormone is produced by the thyroid gland, the heart rate will increase along with the temperature (fever). There can also be weight loss, sweating, insomnia, and loose stools. Thyroid hormone causes the body to become metabolically revved up and, as with fever, the heart rate will probably not elevate much beyond 100 beats per minute. Blood tests can rule out hyperthyroid. 

4. Heart Failure: When the the heart weakens and there is less blood being moved with each contraction, the heart rate will speed up to compensate. This is a condition more often effecting the elderly, but there can be early onset forms. Just like the other conditions covered so far, the heart rate rarely goes up that high unless it is an advanced case. In such a case, one would expect to see other signs and symptoms such as fatigue, difficulty breathing, and swelling ankles. 

5. Anemia and hypovolemia: These terms refer to either having too few blood cells (anemia) or loss of fluids and dehydration. These can be indications of serious conditions such as internal bleeding and fluid loss. Only in an acute crisis such as from hemorrhaging would I expect to see a heart rate as high as it was in my client’s case. Otherwise this is a common cause of heart rates above 100 beats per minute. 

6. Ventricular tachycardia: This condition will cause very fast heart rates, often even above 160 beats per minute. This happens when the heart’s internal electrical system (yes, the heart has an electrical system) has started misfiring. If ventricular tachycardia is suspected, or if there is nothing else to explain the heart rate, it warrants an emergency room visit. This condition is simple to rule out with an electrocardiogram, but only if the test is given during the episode (an Apple Watch will not work here). There are several other similar conditions of electrical misfiring which could be considered, but I bring up this one because it is the most dangerous. 

7. Medications and recreational drugs: There are many prescribed drugs which can will elevate the heart rate. This is a serious side effect and would likely mean that the person needs to stop the medication (only under medical supervision). The recreational drugs most known to elevate heart rate are cocaine, and methamphetamine. Alcohol will also raise the heart rate. 

So which was it with my client? It took me a little while to figure it out. At first I thought it could only be something like ventricular tachycardia, but once I started talking about taking a trip to the emergency room, he revealed a little more.

“Could it be from cocaine?” He asked me. “Well yes,” I said, completely surprised, but still not convinced. Cocaine lasts in the system for only a short time and he had been in my office for at least ninety minutes at that point. I still wanted him to go to the emergency room. 

But then he said “I did just have some.” This had me perplexed. How could he have just had cocaine, he’s been right in front of me the whole time? But then I realized he had gone to use the restroom right before I started checking his pulse. Apparently he had snorted cocaine (perhaps injected, or smoked) right in my restroom, something I never would have suspected. Now I understood why his heart rate was racing and the emergency room would be of no help here. Sure enough, when I rechecked a half hour later his heart rate was much slower. 

This is an example of a time when I did not send the client out for medical evaluation, but there are many other times when I have. Of course I always want to find natural solutions to people’s problems, but it would be dangerously naïve for me to assume that I always can. For those of us on the healer’s path, knowing the limits of natural healing is just as important as knowing the potential. 

Most of the above conditions are offered as a differential diagnosis for tachycardia in the book Current Diagnosis and Treatment*. This book is a good place to find the conventional medical perspective laid out simply and objectively. Although it may have its biases and flaws, the book is far beyond anything available for free on the internet. It is for this reason that I use it as my textbook when I teach pathology to healing arts professionals.  

For those who wish to learn more about the subjects of pathophysiology and diagnosis, I offer classes designed for holistic healers of all types. Find out more about these classes at

*McPhee, S. J., Papadakis, M. A., & Rabow, M. W. (2020). Current medical diagnosis & treatment 2020. 59th ed. New York: McGraw-Hill Medical.

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