Sinus tachycardia: Difference between revisions

Revision as of 22:32, 5 March 2019

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

Algorithm for the Evaluation of Sinus Tachycardia

Emotional or psychiatric causes
- Pain, anger, or anxiety
Response to fever (about 10 bpm per degree C > 37.0)
SIRS (from infection or other causes)
Dehydration/Hypovolemia
Anemia
Drug/alcohol intoxication (particularly sympathomimetic or anticholinergic drugs, but may also be seen in aspirin, theophylline, or other ingestions)
Drug/alcohol withdrawal
Anion gap acidosis
Hyperthyroidism
PE
CHF
Cardiac tamponade
Myocardial contusion
Cardiac valvular disease
Hyper or hypoglycemia
Myocardial infarction
Pheochromocytoma

History and physical exam
- Look for intoxication/withdrawal, infection, dehydration, bleeding, or a psychiatric/emotional state
Consider orthostatic vital signs
ECG to rule out other arrhythmias that may present with an elevated heart rate
- Look for regular rate and presence of p-waves to support diagnosis of sinus tachycardia
If history and physical are unable to explain the tachycardia, limited labs and imaging studies may be indicated:
- CBC
- BMP
- UTox
- Urine pregnancy
Consider:
- Empiric treatment for anxiety or pain (e.g. benzodiazepine or NSAID)
- Urinalysis
- TSH
- Troponin
- CXR
- Workup for PE (e.g. D-dimer or CTA)

Tailored to specific cause of sinus tachycardia:
- Fluids for dehydration
- Blood for hemorrhage
- Thombolytics for PE
- Antibiotics and fluids for sepsis
- Benzodiazepines for alcohol withdrawal
- Supportive care for intoxication
If no cause identified, treat with caution
- Beta blockers or other anti-dysrhythmics 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

Authors:

@@ Line 49: / Line 49: @@
 ==Management==
-*Management should be tailored to the specific cause of sinus tachycardia. This may range from fluids for mild dehydration to admission to the ICU for severe sepsis.
+*Tailored to specific cause of sinus tachycardia:
-*If no cause can be found, treatment is not usually indicated. Be extremely cautious if treating unexplained sinus tachycardia with beta blockers or other anti-arrhythmics, as the patient may require the elevated heart rate to maintain an appropriate cardiac output.
+**Fluids for dehydration
-*Unexplained tachycardia should be thoroughly worked up. If no etiology can be found and no serious pathology is suspected, discharge can be considered with close follow up and strict return precautions.
+**Blood for hemorrhage
+**Thombolytics for [[PE]]
+**Antibiotics and fluids for sepsis
+**Benzodiazepines for alcohol withdrawal
+**Supportive care for intoxication
+*If no cause identified, treat with caution
+**Beta blockers or other anti-dysrhythmics 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==