Sinus tachycardia: what it is and how to treat it

Sinus tachycardia is the most common heart rhythm disturbance found in clinical practice

The medical term sinus tachycardia encompasses a heterogeneous group of disorders including:

  • sinus tachycardia secondary to psychophysical stress
  • sinus tachycardia secondary to other pathologies,
  • orthostatic sinus tachycardia (Postural Orthostatic Tachycardia Syndrome – POTS), characterised by the presence of sinus tachycardia when standing upright
  • inappropriate sinus tachycardia, where there is an alteration of the physiological regulatory mechanisms of the chronotropic response.

The clinical and symptomatological overlap of these disorders sometimes makes a correct differential diagnosis difficult.

FIRST AID: VISIT THE DMC DINAS MEDICAL CONSULTANTS BOOTH AT EMERGENCY EXPO

Postural Orthostatic Tachycardia

Postural Orthostatic Tachycardia is characterised by an intolerance to standing that manifests with changes in posture.

After changing from supine to upright position, there is an increase in frequency of 30 bpm over baseline or heart rate of 120 bpm for at least 10 minutes, without associated orthostatic hypotension.

The condition can then be diagnosed with the Tilt Up Test.

Inappropriate sinus tachycardia

Inappropriate sinus tachycardia is a syndrome in which the sinus heart rate is higher than it should be: the resting heart rate can exceed 100 bpm and minimal physical exertion increases it rapidly and significantly.

Patients have daytime heart rates above 100 bpm, unrelated to physiological increased demand, with 24-hour averages around 90 bpm, and heart rates that normalise at night.

In inappropriate sinus tachycardia, the acceleration of the heart rate for minimal effort is excessive and its recovery is very slow and does not reduce to normal levels.

The origin of the rhythm is always the physiological one, i.e. from the sinoatrial node, and therefore on the electrocardiogram the P waves have morphology and axis superimposed on those of the normal sinus rhythm.

DEFIBRILLATORS: VISIT THE PROGETTI MEDICAL EQUIPMENT SOLUTIONS BOOTH AT EMERGENCY EXPO

What are the symptoms of sinus tachycardia?

It occurs most frequently in the female sex, generally between the second and fifth decades.

The symptom pattern is varied and the mode of presentation may be constant or intermittent.

Among the most frequent symptoms are

  • palpitations,
  • dyspnoea,
  • easy fatigability,
  • exercise intolerance,
  • headache,
  • lipotimia,
  • syncope,
  • thoracoalgias,
  • myalgias,
  • anxiety,
  • stress,
  • depression.

Usually the diagnosis is not accidental, but patients come to the doctor’s observation due to the appearance of one or more symptoms.

CARDIOPROTECTION AND CARDIOPULMONARY RESUSCITATION? VISIT THE EMD112 BOOTH AT EMERGENCY EXPO NOW TO LEARN MORE

Diagnosis: what tests should be performed?

Instrumental tests such as: electrocardiogram, cardiac Holter (preferably 12-lead), echocardiogram, and some haematochemical and hormonal tests are essential for a correct diagnosis.

The diagnosis of IST is a diagnosis by exclusion and can therefore only be made in the presence of a prolonged and recurrent sinus tachycardia that cannot be explained in any other way.

Before a diagnosis of Inappropriate Sinus Tachycardia is made, other conditions such as postural orthostatic tachycardia and appropriate-secondary sinus tachycardia must be excluded in association with other causes, including those listed below anticholinergics, catecholamines, alcohol, anaemia, antiasthiacs, meta-amphetamines, cocaine, caffeine, marijuana, dehydration, fever, anxiety, panic attacks, pain, myocardial ischaemia, pulmonary embolism, valvulopathies, physical activity, pneumothorax, pericarditis, myocarditis, hyperthyroidism, hyperglycaemia, hypovolaemia, anaemia, hyperpyrexia, infections, hypoxaemia, pheochromocytoma.

THE IMPORTANCE OF TRAINING IN RESCUE: VISIT THE SQUICCIARINI RESCUE BOOTH AND FIND OUT HOW TO BE PREPARED FOR AN EMERGENCY

Treatment: how is sinus tachycardia treated?

Inappropriate sinus tachycardia is treated with lifestyle changes and increased aerobic physical activity, combined with:

  • Beta-blocking drugs (particularly metoprolol and atenolol) which are effective in reducing the frequency, although they are sometimes not tolerated due to the onset of arterial hypotension.
  • Ivabradine, an If-current antagonist, is effective in significantly reducing heart rate without any influence on blood pressure and improved exercise endurance.

The use of calcium antagonists is controversial and their efficacy is questionable.

Finally, let us mention transcatheter ablation: some patients do not respond to single or multi-drug therapy. In these patients it is useful to perform transcatheter ablation of sinus tachycardia.

The interventional procedure is aimed at modulating the activity of the sinoatrial node, which thus reduces its intrinsic frequency.

Read Also

Emergency Live Even More…Live: Download The New Free App Of Your Newspaper For IOS And Android

Diseases Of The Heart: Postural Orthostatic Tachycardia (POTS)

Supraventricular Tachycardia: Definition, Diagnosis, Treatment, And Prognosis

Identifying Tachycardias: What It Is, What It Causes And How To Intervene On A Tachycardia

Who Can Use The Defibrillator? Some Information For Citizens

Defibrillator Maintenance: What To Do To Comply

Defibrillators: What Is The Right Position For AED Pads?

When To Use The Defibrillator? Let’s Discover The Shockable Rhythms

What Is The Difference Between Pacemaker And Subcutaneous Defibrillator?

What Is An Implantable Defibrillator (ICD)?

What Is A Cardioverter? Implantable Defibrillator Overview

Paediatric Pacemaker: Functions And Peculiarities

Cardiac Arrest: Why Is Airway Management Important During CPR?

Tachycardia: Is There A Risk Of Arrhythmia? What Differences Exist Between The Two?

Do You Have Episodes Of Sudden Tachycardia? You May Suffer From Wolff-Parkinson-White Syndrome (WPW)

Transient Tachypnoea Of The Newborn: Overview Of Neonatal Wet Lung Syndrome

Paediatric Toxicological Emergencies: Medical Intervention In Cases Of Paediatric Poisoning

Valvulopathies: Examining Heart Valve Problems

What Is The Difference Between Pacemaker And Subcutaneous Defibrillator?

Heart Disease: What Is Cardiomyopathy?

Inflammations Of The Heart: Myocarditis, Infective Endocarditis And Pericarditis

Heart Murmurs: What It Is And When To Be Concerned

Broken Heart Syndrome Is On The Rise: We Know Takotsubo Cardiomyopathy

Cardiomyopathies: What They Are And What Are The Treatments

Alcoholic And Arrhythmogenic Right Ventricular Cardiomyopathy

Difference Between Spontaneous, Electrical And Pharmacological Cardioversion

What Is Takotsubo Cardiomyopathy (Broken Heart Syndrome)?

Dilated Cardiomyopathy: What It Is, What Causes It And How It Is Treated

Heart Pacemaker: How Does It Work?

Basic Airway Assessment: An Overview

Assessment Of Abdominal Trauma: Inspection, Auscultation And Palpation Of The Patient

Pain Assessment: Which Parameters And Scales To Use When Rescuing And Treating A Patient

Airway Management After A Road Accident: An Overview

Tracheal Intubation: When, How And Why To Create An Artificial Airway For The Patient

What Is Traumatic Brain Injury (TBI)?

Acute Abdomen: Meaning, History, Diagnosis And Treatment

First Aid Tips For Teachers

Poison Mushroom Poisoning: What To Do? How Does Poisoning Manifest Itself?

Chest Trauma: Clinical Aspects, Therapy, Airway And Ventilatory Assistance

The Quick And Dirty Guide To Pediatric Assessment

EMS: Pediatric SVT (Supraventricular Tachycardia) Vs Sinus Tachycardia

Source

Medicitalia

You might also like