What causes nocturnal tachycardia (rapid heart beat at night)?

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Last updated: March 28, 2025 • View editorial policy

Differential Diagnosis for Rapid Heart Beat in the Middle of the Night

  • Single Most Likely Diagnosis + Anxiety or panic attack: This is often a common cause of rapid heartbeat, especially if it occurs in the middle of the night and is accompanied by other symptoms such as shortness of breath, sweating, or feelings of impending doom.
  • Other Likely Diagnoses + Sleep apnea: This condition can cause pauses in breathing during sleep, leading to a rapid heartbeat as the body tries to compensate for the lack of oxygen. + Dehydration or electrolyte imbalance: Dehydration or an imbalance of essential electrolytes like potassium or magnesium can disrupt heart function, leading to rapid heartbeat. + Caffeine or nicotine intake: Consuming these substances, especially in large amounts or close to bedtime, can stimulate the heart and cause a rapid heartbeat. + Hormonal changes: Hormonal fluctuations during menstruation, menopause, or pregnancy can lead to rapid heartbeat.
  • Do Not Miss Diagnoses + Myocardial infarction (heart attack): Although less common, a heart attack can present with rapid heartbeat, especially in women, and is a medical emergency. + Pulmonary embolism: A blood clot in the lungs can cause rapid heartbeat, chest pain, and shortness of breath, and requires immediate medical attention. + Cardiac arrhythmias (e.g., atrial fibrillation): Certain arrhythmias can be life-threatening if not treated promptly. + Hyperthyroidism: An overactive thyroid gland can cause rapid heartbeat, among other symptoms, and requires medical evaluation.
  • Rare Diagnoses + Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodes of rapid heartbeat, hypertension, and sweating. + Thyroid storm: A life-threatening complication of hyperthyroidism that can cause rapid heartbeat, fever, and confusion. + Cardiac tamponade: Fluid accumulation in the sac surrounding the heart can compress the heart and lead to rapid heartbeat, although this is typically accompanied by other severe symptoms.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.