Bidirectional Tachycardia: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 2, 2026.
What kind of doctor treats Bidirectional Tachycardia?
A cardiologist usually treats bidirectional tachycardia, and many patients see an electrophysiologist, a cardiologist with extra training in heart rhythm problems. A primary care doctor often makes the first referral after an abnormal EKG. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What it is
Bidirectional tachycardia is a rare heart rhythm problem in which fast heartbeats alternate in direction: the electrical signals that make the heart squeeze switch between two patterns, which doctors can see on an electrocardiogram. A very fast heartbeat can keep the heart from pumping blood well.
Symptoms
Symptoms come from the heart beating too fast: palpitations, or a pounding or fluttering in the chest, along with dizziness, lightheadedness, shortness of breath, and chest discomfort. Some people faint because the fast rhythm lowers blood flow to the brain. Anyone with these symptoms needs medical attention right away.
Causes and who gets it
Bidirectional tachycardia usually happens when something disturbs the heart's electrical system. One known cause is digoxin toxicity: taking too much of this heart medicine can poison the heart's electrical signals. Another is catecholaminergic polymorphic ventricular tachycardia, a rare inherited condition where stress or exercise triggers dangerous fast heartbeats. Salt imbalances can also play a role.
How doctors diagnose it
Doctors start by asking about symptoms and medical history, listening to the heart, and checking the pulse. The main test is an electrocardiogram, or EKG, which records the heart's electrical signals. On an EKG, this rhythm has a distinctive pattern where the fast beats alternate between two directions.
Treatment
Treatment depends on the cause. If too much digoxin is the problem, doctors treat the toxicity. If body salts are out of balance, doctors correct those levels. For inherited rhythm problems, treatment often includes beta blockers, and sometimes an implantable cardioverter defibrillator, a small chest device that shocks the heart back into a normal rhythm.
When to see a doctor
Anyone with a racing heartbeat, fainting, chest pain, or trouble breathing should get medical help right away. People taking digoxin who feel sick, confused, or notice vision changes should contact a doctor promptly.
How a direct primary care or concierge doctor fits in
A direct primary care doctor is paid a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can order EKGs, monitor medicines like digoxin, and refer to a cardiologist or electrophysiologist when needed.
Common questions
Is bidirectional tachycardia the same as a heart attack?
No. A heart attack happens when blood flow to part of the heart muscle is blocked. Bidirectional tachycardia is a problem with the heart's electrical signals, though both are emergencies that need prompt care.
Can bidirectional tachycardia go away on its own?
Episodes may stop on their own, but the underlying cause usually needs treatment. This rhythm can return or become dangerous, so it should always be evaluated by a doctor.
Can children have bidirectional tachycardia?
Yes. When it appears in children or young adults, it is often linked to an inherited rhythm condition. Genetic testing and family screening may be recommended in those cases.
Is it safe to exercise with this condition?
It depends on the cause. People with inherited forms are often advised to avoid intense or competitive exercise, and a cardiologist can help set safe limits for each person.
Sources
- NIH Genetic and Rare Diseases Information Center - Catecholaminergic polymorphic ventricular tachycardia
- MedlinePlus Genetics - Catecholaminergic polymorphic ventricular tachycardia
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
