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Sinus Tachycardia

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KEY FEATURES

ESSENTIALS OF DIAGNOSIS

  • Heart rate 100–160 bpm

  • Each QRS is preceded by a P wave identical to the P wave of normal sinus rhythm

  • Physiologic response to exercise or adrenergic response to disease

GENERAL CONSIDERATIONS

  • Common causes:

    • – Blood loss

    • – Volume depletion

    • – Hyperthyroidism

    • – Fever

    • – Sepsis

    • – Pulmonary embolism

    • – Hypotension

  • Heart rate achieved is proportional to the intensity of the stimulus

  • Rate changes result from a shift of pacemaker activity within sinus node

  • Carotid sinus massage or Valsalva maneuver may temporarily slow the heart rate, and the rate returns to baseline upon cessation of the maneuver

  • Common in infancy and early childhood

  • Thyroid medication excess, alcohol, nicotine, and caffeine may cause sinus tachycardia

  • Sinus tachycardia after heart transplantation carries adverse prognosis

  • Persistent sinus tachycardia may be a manifestation of heart failure

  • May be appropriate response to stimuli, or inappropriate without any provocation

CLINICAL PRESENTATION

SYMPTOMS AND SIGNS

  • Palpitations

  • Depends on precipitating cause

PHYSICAL EXAM FINDINGS

  • Other than tachycardia, findings depend on underlying precipitating cause

DIFFERENTIAL DIAGNOSIS

  • Sinus node reentry

  • Atrial tachycardia

DIAGNOSTIC EVALUATION

LABORATORY TESTS

  • Thyroid-stimulating hormone

  • CBC, basic metabolic panel

  • Depending on clinical suspicion

ELECTROCARDIOGRAPHY

  • ECG

IMAGING STUDIES

  • If heart failure is suspected, then echocardiogram to evaluate left ventricular function

DIAGNOSTIC PROCEDURES

  • None required

TREATMENT

CARDIOLOGY REFERRAL

  • Generally not required

HOSPITALIZATION CRITERIA

  • Depends on underlying precipitating cause

MEDICATIONS

  • Treat underlying cause

THERAPEUTIC PROCEDURES

  • None required

SURGERY

  • None required

MONITORING

  • Depends on precipitating cause

DIET AND ACTIVITY

  • General healthy lifestyle

ONGOING MANAGEMENT

HOSPITAL DISCHARGE CRITERIA

  • Depends on underlying clinical illness

FOLLOW-UP

  • Depends on precipitating cause

COMPLICATIONS

  • Usually none

  • If tachycardia is inappropriate and persistent, it may lead to cardiomyopathy

PROGNOSIS

  • Depends on precipitating cause

  • Tachycardia resolves with the cure of the inciting condition

RESOURCES

PRACTICE GUIDELINES

  • Management:

    • – Identify a secondary cause and treat

    • – Beta blockade is very useful for emotional stress and anxiety-related tachycardia

REFERENCES

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Sheldon  RS, Grubb  BP 2nd, Olshansky  B,  et ...

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