Sinus tachycardia: Difference between revisions

No edit summary
 
(31 intermediate revisions by 5 users not shown)
Line 1: Line 1:
=Background=
==Background==
* A cardiac abnormality characterized by the presence of a sinus rhythm at a rate that is above the upper limit of normal.
*Sinus rhythm at a rate above the upper limit of normal
** In adults, usually defined as a heart rate >100. In pediatric patients it varies by age. See [https://wikem.org/wiki/Pediatric_vital_signs pediatric vital signs].
**In adults, usually >100 bpm
* Usually a secondary response to another medical condition.
**In pediatric patients it varies by age until age 8 or 9 (see [[Pediatric vital signs|pediatric vital signs]])
=Evaluation=
*Usually seen as a secondary response to a primary medical condition
* History and physical exam, focusing on any evidence of intoxication, infection, dehydration, or a psychiatric/emotional state that may contribute to an elevated heart rate. Orthostatic vital signs should be measured.
 
* EKG should be ordered to rule out other arrhythmias that may present with an elevated heart rate.
{{Sinus tach DDX}}
* If history and physical are unable to explain the tachycardia, limited labs and imaging studies may be indicated.
 
**CBC, BMP, UTox, UA, TSH, troponin, and CXR are often indicated.
==Clinical Features==
**If suspected, a CT of the pulmonary arteries, may be able to diagnose a PE.
*Tachycardia
==Differential Diagnosis==
*+/- [[Palpitations]]
*Emotional or psychiatric causes such as pain, anger, or anxiety
 
*Appropriate response to fever (about 10 bpm per degree C > 37.0)
==Differential Diagnosis==
* SIRS (from infection or other causes)
{{Tachycardia (narrow) DDX}}
*Dehydration
{{Tachycardia (wide) DDX}}
*Anemia
{{Palpitations DDX}}
*Drug/alcohol intoxication (particularly sympathomimetic or anticholinergic drugs, but may also be seen in aspirin, theophylline, or other ingestions)
 
*Drug/alcohol withdrawal
==Evaluation==
*Anion gap acidosis
[[File:Tachycardia.png|thumb|Algorithm for the Evaluation of Sinus Tachycardia]]
*Hyperthyroidism
[[File:Sinustachy.jpg|thumb|Sinus tachycardia on 12-lead [[ECG]]]]
*PE
===Workup===
*CHF
*[[ECG]]
*Cardiac tamponade
*History and physical exam
*Myocardial contusion
**Look for intoxication/withdrawal, infection, dehydration, bleeding, or a psychiatric/emotional state  
*Cardiac valvular disease
*Consider orthostatic vital signs
*Hyper or hypoglycemia
* If history and physical are unable to explain the tachycardia, limited labs and imaging studies may be indicated:
*Myocardial infarction
**CBC
*Pheochromocytoma
**BMP
**[[Utox]]
**Urine pregnancy
*Consider:
**Empiric treatment for [[anxiety]] or [[analgesia|pain]] (e.g. [[benzodiazepine]] or [[NSAID]])
**[[Urinalysis]]
**TSH
**[[Troponin]]
**[[CXR]]
**Consider workup for [[PE]] (e.g. [[D-dimer]] or CTA)
 
===Diagnosis===
*Based on [[ECG]]
**Look for regular rate and presence of p-waves to support diagnosis of sinus tachycardia
 
==Management==
*Tailored to specific cause of sinus tachycardia:
**[[IVF|Fluids]] for dehydration
**[[pRBCs|Blood]] for hemorrhage
**[[Anticoagulation]]/[[thrombolytics]] for [[PE]]
**[[Sepsis antibiotics|Antibiotics]] and fluids for [[sepsis]]
**[[Benzodiazepines]] for [[alcohol withdrawal]]
**Supportive care for intoxication
*If no cause identified, treat with caution
**[[Beta blockers]] or other [[antiarrhythmics]] are '''not''' appropriate for unexplained sinus tachycardia as patient may require elevated heart rate to maintain appropriate cardiac output depending on underlying cause
**May consider discharge with strict return precautions if no clear cause identified and no serious pathology suspected after careful work-up
***Ensure close follow-up and strict return precautions
 
==Disposition==
*Depends on cause of tachycardia:
**Home for pain, fever, or anxiety resolving with appropriate treatment
**Certain withdrawal or intoxication syndromes may require ED observation or admission
**ICU for severe sepsis
**OR for life-threatening hemorrhage
 
==See Also==
*[[ECG (Main)]]
 
==External Links==
 
 
==References==
<references/>


[[Category:Cardiology]]
[[Category:Cardiology]]

Latest revision as of 17:06, 30 July 2025

Background

  • Sinus rhythm at a rate above the upper limit of normal
    • In adults, usually >100 bpm
    • In pediatric patients it varies by age until age 8 or 9 (see pediatric vital signs)
  • Usually seen as a secondary response to a primary medical condition

Causes of sinus tachycardia

Clinical Features

Differential Diagnosis

Narrow-complex tachycardia

Wide-complex tachycardia

Assume any wide-complex tachycardia is ventricular tachycardia until proven otherwise (it is safer to incorrectly assume a ventricular dysrhythmia than supraventricular tachycardia with abberancy)

^Fixed or rate-related

Palpitations

Evaluation

Algorithm for the Evaluation of Sinus Tachycardia
Sinus tachycardia on 12-lead ECG

Workup

  • ECG
  • History and physical exam
    • Look for intoxication/withdrawal, infection, dehydration, bleeding, or a psychiatric/emotional state
  • Consider orthostatic vital signs
  • If history and physical are unable to explain the tachycardia, limited labs and imaging studies may be indicated:
    • CBC
    • BMP
    • Utox
    • Urine pregnancy
  • Consider:

Diagnosis

  • Based on ECG
    • Look for regular rate and presence of p-waves to support diagnosis of sinus tachycardia

Management

  • Tailored to specific cause of sinus tachycardia:
  • If no cause identified, treat with caution
    • Beta blockers or other antiarrhythmics are not appropriate for unexplained sinus tachycardia as patient may require elevated heart rate to maintain appropriate cardiac output depending on underlying cause
    • May consider discharge with strict return precautions if no clear cause identified and no serious pathology suspected after careful work-up
      • Ensure close follow-up and strict return precautions

Disposition

  • Depends on cause of tachycardia:
    • Home for pain, fever, or anxiety resolving with appropriate treatment
    • Certain withdrawal or intoxication syndromes may require ED observation or admission
    • ICU for severe sepsis
    • OR for life-threatening hemorrhage

See Also

External Links

References

Retrieved from "https://www.wikem.org/w/index.php?title=Sinus_tachycardia&oldid=377233"