Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Heart rates > 100 bpm at rest or with minimal exertion Mean heart rate > 90 bpm over 24 hours P waves identical or nearly identical to sinus P wave Chronic duration of symptoms Exclusion of other causes of sinus tachycardia +++ GENERAL CONSIDERATIONS ++ Frequently seen in young female health care workers May occur transiently after ablation of other supraventricular arrhythmias The arrhythmia is nonparoxysmal and not associated with an underlying cardiac pathologic process Alteration in autonomic tone with increase in sympathetic output or reduction in parasympathetic tone is likely to be the primary abnormality Primary problem of the sinus node itself and beta-adrenergic hypersensitivity suggested in some studies May cause tachycardia cardiomyopathy if untreated +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Chest pain Palpitations Dyspnea Near syncope +++ PHYSICAL EXAM FINDINGS ++ Tachycardia +++ DIFFERENTIAL DIAGNOSIS ++ Appropriate sinus tachycardia Sinus node reentry Atrial tachycardia Postural orthostatic tachycardia syndrome (POTS) +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ Serum thyroid-stimulating hormone CBC, basic metabolic panel +++ ELECTROCARDIOGRAPHY ++ ECG to document rhythm disorder +++ IMAGING STUDIES ++ Echocardiogram if there are features of heart failure +++ DIAGNOSTIC PROCEDURES ++ Electrophysiologic study may be necessary to establish mechanism of arrhythmia and determine suitability for ablation +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ Electrophysiology referral is required if heart rate cannot be controlled with adequate doses of beta blockers +++ HOSPITALIZATION CRITERIA ++ Usually not required except in tachycardia cardiomyopathy +++ MEDICATIONS ++ High doses of beta blockers (atenolol 100–200 mg/day) or propranolol 320 mg/day Rate-lowering calcium channel blockers +++ THERAPEUTIC PROCEDURES ++ Radiofrequency modification of sinoatrial node (high recurrence rate of 20–30%) Intracoronary ethanol ablation may be tried in selected patients +++ SURGERY ++ Surgery rarely done Surgical exclusion of right atrium Intraoperative cryoablation +++ MONITORING ++ Monitor heart rate and symptoms of cardiomyopathy +++ DIET AND ACTIVITY ++ General healthy lifestyle +++ ONGOING MANAGEMENT +++ HOSPITAL DISCHARGE CRITERIA ++ After control of heart failure +++ FOLLOW-UP ++ Frequent follow-up may be needed to titrate medications Follow-up 2–4 weeks after radiofrequency ablation +++ COMPLICATIONS ++ Cardiomyopathy Complications of radiofrequency ablation include: – Need for a pacemaker – Superior vena cava ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. 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 Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.