Sinus tachycardia: Difference between revisions
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**In pediatric patients it varies by age until age 8 or 9 (see [[Pediatric vital signs|pediatric vital signs]])
**In pediatric patients it varies by age until age 8 or 9 (see [[Pediatric vital signs|pediatric vital signs]])
*Usually seen as a secondary response to a primary medical condition
*Usually seen as a secondary response to a primary medical condition
{{Sinus tach DDX}}


==Clinical Features==
==Clinical Features==
 
*Tachycardia
*+/- [[Palpitations]]


==Differential Diagnosis==
==Differential Diagnosis==
[[File:Tachycardia.png|thumb|Algorithm for the Evaluation of Sinus Tachycardia]]
{{Tachycardia (narrow) DDX}}
*Emotional or psychiatric causes
{{Tachycardia (wide) DDX}}
**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]]


==Evaluation==
==Evaluation==
[[File:Tachycardia.png|thumb|Algorithm for the Evaluation of Sinus Tachycardia]]
===Workup===
*[[ECG]]
*History and physical exam
*History and physical exam
**Look for intoxication/withdrawal, infection, dehydration, bleeding, or a psychiatric/emotional state  
**Look for intoxication/withdrawal, infection, dehydration, bleeding, or a psychiatric/emotional state  
*Consider orthostatic vital signs
*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:
* If history and physical are unable to explain the tachycardia, limited labs and imaging studies may be indicated:
**CBC
**CBC
**BMP
**BMP
**UTox
**[[Utox]]
**Urine pregnancy
**Urine pregnancy
*Consider:
*Consider:
**Empiric treatment for anxiety or pain (e.g. [[benzodiazepine]] or [[NSAID]])
**Empiric treatment for [[anxiety]] or [[analgesia|pain]] (e.g. [[benzodiazepine]] or [[NSAID]])
**[[Urinalysis]]  
**[[Urinalysis]]  
**TSH
**TSH
**Troponin
**[[Troponin]]
**CXR
**[[CXR]]
**Workup for [[PE]] (e.g. [[D-dimer]] or CTA)
**Consider workup for [[PE]] (e.g. [[D-dimer]] or CTA)
 
===Diagnosis===
[[File:Sinustachy.jpg|thumb|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==
==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.
**[[IVF|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. 
**[[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==
==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==
==See Also==
 
*[[ECG (Main)]]


==External Links==
==External Links==

Revision as of 19:12, 27 February 2021

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

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

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