Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Heart rate 100–180 bpm P-wave morphology different from sinus P waves Initiated by an ectopic beat Abrupt onset with increase in heart rate +++ GENERAL CONSIDERATIONS ++ Episodes may be brief and self-terminating or chronic and persistent Structural heart disease is common, particularly coronary artery disease (including acute myocardial infarction), valvular heart disease, and cardiomyopathy Concomitant atrial flutter or fibrillation is not uncommon Continuous tachycardia may cause tachycardia cardiomyopathy May be associated with digoxin toxicity +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Palpitations Dyspnea Dizziness Chest pain +++ PHYSICAL EXAM FINDINGS ++ Tachycardia If the tachycardia is incessant, features of cardiomyopathy may be noted +++ DIFFERENTIAL DIAGNOSIS ++ Reentrant atrial tachycardia Atypical atrioventricular (AV) nodal reentrant tachycardia AV reentrant tachycardia with slowly conducting pathway +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ CBC, basic metabolic panel Cardiac biomarkers If the patient has features of congestive heart failure, measurement of brain natriuretic peptide Measurement of serum digoxin level if appropriate +++ ELECTROCARDIOGRAPHY ++ ECG to define rhythm disturbance Ambulatory cardiac monitoring to document frequency and duration of episodes +++ IMAGING STUDIES ++ Echocardiogram to exclude structural heart disease +++ DIAGNOSTIC PROCEDURES ++ Electrophysiology study to determine mechanism of rhythm disturbance +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ All patients require cardiology assessment followed by electrophysiology referral as suggested by cardiologist +++ HOSPITALIZATION CRITERIA ++ Patients with sustained or symptomatic arrhythmia +++ MEDICATIONS ++ Common antiarrhythmic options include amiodarone, flecainide, propafenone, or sotalol Beta blockers and calcium channel blockers are effective to slow the ventricular rate Digoxin is uniformly ineffective Type IA antiarrhythmic drugs are uniformly ineffective Consider adenosine as some atrial tachycardias are adenosine sensitive +++ THERAPEUTIC PROCEDURES ++ Radiofrequency ablation Success rate of ablation varies with the type and focus of the arrhythmia Mapping and ablation of atrial tachycardia often more complex than other supraventricular tachycardias +++ SURGERY ++ Surgical excision and open cryoablation are not performed due to advances in catheter ablation +++ MONITORING ++ Patients managed by pharmacotherapy need ECG monitoring for effectiveness and assessment of side effects +++ DIET AND ACTIVITY ++ No specific change other than healthy lifestyle +++ ONGOING MANAGEMENT +++ HOSPITAL DISCHARGE CRITERIA ++ Twenty-four hours after ablation +++ FOLLOW-UP +... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.