Tachycardia

Tachycardia is a medical term for "rapid heart rate" (HR). Tachycardia is a common side-effect of practically every stimulant drug--cocaine, amphetamines, caffeine, MDMA, meth, ephedrine, and pseudoephedrine to name a few.

Many people suffer from tachycardia without ever taking drugs. Mechanisms behind rapid heart rate is generally one of two basic types:
1. Sympathetic-nervous-system-stimulation.
-the focus of THIS discussion.

2. Parasympathetic-nervous-system-inhibition.
-typically a result of poisoning by environmental toxins like nerve-gas and insecticides...this could also result from an overdose of acetylcholine-esterase inhibitors (nootropics, donezepil, piracetam, etc). That's all for this cause.

Sympathetic Nervous System-Stimulation:
The sympathetic nervous system is also known as the "Fight-or-Flight" response. As part of the sympathetic nervous system, there are receptors on the heart's surface (Beta-1 Receptors) where adrenaline will bind and cause the heart-rate to increase. Stimulant drugs typically work by causing release of the body's stored-up catecholamines (adrenaline/epinephrine/nor-epinephrine). Alternatively, some drugs actually bind to and activate the Beta-1 receptors themselves (i.e. dopamine, dobutamine, epinephrine, nor-epinephrine).

Tachycardia at rest.
Generally, a resting heart-rate should lie somewhere below 80 beats per minute. And, generally-speaking, the lower your resting pulse, the BETTER. Those of us who are overweight, unhealthy, and out-of-shape physically tend to have higher resting heart-rates.

Bradycardia at rest.
Athletes tend to have slow basal heart-rates because of the heart-conditioning-and-cardioprotective-effects of aerobic exercise. Many experts believe that our resting heart-rate is a direct reflection of our state of overall healthiness/unhealthiness. One popular belief that has never been DIS-proved is that each of our hearts came 'pre-programmed' to beat a certain number of times in our lifetime...according to this theory, the faster your resting heart-rate, the sooner you die. The relationship between fitness, aerobic exercise, resting heart-tone, and life-expectancy has been a major influence on fueling the 'fitness-kicks' of the last 30 years, and also is why obesity is currently considered one of our deadliest societal health risks.

Tachycardia as a Side-Effect.
Expect heart-rate to increase with the administration of psychostimulant drugs. Generally speaking, the size and timings of doses will correlate directly to the degree of heart-rate elevation.

How Fast is TOO FAST?
Always keep the following rule of thumb in your mind:
Your MAXIMUM Heart-Rate is = to 220-your age. If you're measuring your heart-rate in order to work-out effectively (and lower your basal rate), then your target heart-rate during aerobic exercise will be around 80% of your maximum heart rate.

Generally, any adult heart that tries to beat faster than around 200 will begin to rapidly lose effectiveness in pumping blood throughout the body. The result is a decompensation of the pump-mechanism. The time between beats will become too short for the heart to actually fill up with blood--this leads to congestion of blood entering the heart, swelling/edema in the lungs and in the periphery, shortness of breath, exhaustion, tiredness, congestive heart-failure, and could cause a fatal arrhythmia or a heart-attack (the heart muscle requires more and more oxygen to beat faster).

Myocardial Ischemia is a typically-painful situation that signifies cardiac decompensation and usually precedes a myocardial infarction or heart-attack in most drug-abuse-type situations. Myocardial Ischemia occurs is when the heart muscle begins to require more oxygen than the blood can provide...again, for most relatively young, healthy people this is usually going to involve heart-rates upwards of 160, probably closer to 200.

How do I know if I'm having Myocardial Ischemia?
Simple. Your chest will begin to hurt...chest pain originating from the heart itself is called 'angina.' New-onset of angina is always a good reason to head up to the emergency room--whether you're taking speed or not.

When should I go to the Emergency Room for Tachycardia?
This is a complicated issue. For starters, chest pain after or during stimulant-drug-use is a clear indication for urgent medical care. Have chest pain? GO TO THE EMERGENCY ROOM! Honestly, the benefits outweight the negatives in this situation.

Prompt medical attention can save your life. Note: in addition to being a heart-rate-accelerant, cocaine has additional properties that make this drug more likely to cause an MI/heart-attack. For this reason, extra caution should be exercised when cocaine is being used. Develop chest pain? go to the ER. Have pre-existing heart problems? DON'T DO COCAINE! You really should avoid ALL stimulants if you have heart disease or high blood pressure as the risk to your life is much greater in these situations.

Best advice for people who are going to take stimulant drugs:
1. Know your baseline (resting) heart rate. This information will help you understand how MUCH a drug affects your normal heart-rate and it will also give you an idea of your own cardiovascular health.
2. Know your maximum heart-rate. (220-age).
3. Take 80% of your max Heart-rate to find your target exercise heart-rate.
4. Now, you can think of this 80%Max as a ballpark figure for your ABSOLUTE MAXIMUM allowable heart-rate when taking stimulants. If at all possible try to stay FAR AWAY from this 80%Max rate. But, in the event that caution is thrown to the wind in favor of getting high, be aware that the closer you come to your max heart rate, you are essentially putting your life and future in jeopardy.

For some people, this 80%Max rate is still far too high for peace-of-mind. Those who should consider a lower threshold (like 60% Max rate) include people who are: overweight, inactive, sedentary, out-of-shape, have high cholesterol, or high blood pressure or diabetes or kidney disease/pancreatitis/liver disease/blood disorder/bleeding-clotting abnormality or any other chronic health conditions.

Best advice here is to err on the side of caution--if an idea sounds stupid, then it probably is stupid. Please consult your physician regarding your concerns on this issue! This information is what doctors went to school to learn. This is the information that they're paid to tell us...

5. Make a habit of monitoring your heart rate throughout your experiences with stimulants. Doing so will likely teach you some instinctive understanding of how much stress is being placed on your heart at any given time.

6. Better yet---monitor your own heart rate AND blood pressures. These 2 variables together carry much more weight than simply one or the other.

Remember high blood pressures can cause bleeding strokes into the brain. Warning signs of a stroke include headache, dizziness, sudden weakness or paralysis, difficulty speaking (i.e. you're slurring your words, your sentences make no sense to observers, you're confused trying to understand what others are saying to you..), difficulty walking, problems with balance, and visual changes. Any of these symptoms warrant emergent medical care.

Tachycardia can cause the heart-muscles to become depeleted of oxygen and 'pump-failure' from decreased filling times. Seek medical attention with any chest-pain. Typically heart-attack-pain is described as being heavy, crushing pain below the sternum...and the pain is also frequently felt in one arm or it may radiate up to your jaw. Any kind of symptoms such as these require urgent medical care.

Non-cardiac chest pain is usually related to acid-reflux/heart-burn/indigestion or trauma to the chest wall/ribs/muscles themselves. If lying down vs. sitting up makes pain go away, it's likely from acid reflux. If pushing around gently on your ribs causes the pain to increase, then your pain might be coming from your ribcage or the muscles of breathing.

Carotid Massage:

Carotid massage is one technique that can be tried at home to lower one's heart-rate. By physically massaging/rubbing your carotid body (where the carotid artery branches into internal and external carotids--about a centimeter higher than half-way up the neck, on either side of the neck). You should feel your pulse if you're at the right spot. Now, do NOT try and massage both left and right sides at once! This WILL make you blackout! (i.e. sleeper-hold!)