Sinus tachycardia

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

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

Evaluation

Algorithm for the Evaluation of Sinus Tachycardia

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

Sinus tachycardia on 12-lead ECG
  • 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