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| Image = Tachycardia 0001.jpg| | | Image = Tachycardia 0001.jpg| |
| Caption = Rhythm strip showing a run of [[ventricular tachycardia]] (VT)| | | Caption = Rhythm strip showing a run of [[ventricular tachycardia]] (VT)| |
| DiseasesDB = |
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| ICD10 = {{ICD10|R|00|0|r|00}} |
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| ICD9 = {{ICD9|785.0}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| MeshID = D013610 |
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| }} | | }} |
| {{SI}} | | {{Tachycardia}} |
| {{CMG}}; '''Associate Editor-In-Chief:''' {{MUT}} | | {{CMG}}; '''Associate Editor-In-Chief:''' {{MUT}} |
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| ==Overview== | | ==[[Tachycardia overview|Overview]]== |
| '''Tachycardia''' is a form of [[cardiac arrhythmia]] which refers to a rapid beating of the [[heart]]. By convention the term refers to [[heart rate]]s greater than 100 beats per minute in the [[adult]] patient. Tachycardia may be a perfectly normal physiological response to stress. However, depending on the mechanism of the tachycardia and the health status of the patient, tachycardia may be harmful, and require medical treatment. In extreme cases, tachycardia can be life threatening.
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| Tachycardia can be harmful in three ways. Firstly, if the heart is pumping too fast for an extended period of time it will change the balance of oxygen and carbon dioxide in the hemoglobin in the blood; this is normal during exercise but when resting this is quite dangerous. Second, when the heart beats too rapidly, it may pump blood less efficiently. Thirdly, the faster the heart beats, the more [[oxygen]] and nutrients the heart requires. This may leave patients feeling out of breath or cause [[angina pectoris|angina]]. This can be especially problematic for patients suffering from [[ischemic heart disease]]. | | ==[[Tachycardia classification|Classification]]== |
| | {{familytree/start |summary=Tachycardia}} |
| | {{familytree | | | | | | | | | | | | A01 | | | A01=Tachycardia}} |
| | {{familytree | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | }} |
| | {{familytree | | | | | B01 | | | | | | | | | | | | B02 | | B01= '''[[SVT|Narrow complex tachycardia (SVT)]]'''| B02= '''[[Wide complex tachycardia]]''' }} |
| | {{familytree | | | |,|-|^|-|-|-|.| | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | }} |
| | {{familytree | | | C01 | | | | C02 | | C03 | | C04 | | C05 | | C06 | | C01= '''<u>The origin of the impulse:</u><br>Atria'''| C02= '''<u>The origin of the impulse:</u><br>AV junction'''| C03='''<u>The origin of the impulse:</u><br>Atria or AV junction''' | C04= '''<u>The origin of the impulse:</u><br>AV junction'''| C05= '''<u>The origin of the impulse:</u><br>Atria, AV junction or ventricles<br><br> Presence of an [[accessory pathway]]'''| C06= '''<u>The origin of the impulse:</u><br>Pacemaker'''}} |
| | {{familytree | |,|-|^|-|.| | | |!| | | |!| | | |!| | | |!| | | |!| | }} |
| | {{familytree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | D01= [[Atrial fibrillation]] <br> [[Atrial flutter]] <br> [[Ectopic Atrial Rhythm|Ectopic atrial rhythm]] <br> [[Multifocal Atrial Tachycardia (MAT)|Multifocal atrial tachycardia (MAT)]] <br> [[Paroxysmal Atrial Tachycardia (PAT) with Block|Paroxysmal atrial tachycardia (PAT) with block]] <br> [[Premature Atrial Contractions (PACs)|Premature atrial contractions (PAC)]] <br> [[Sinus Tachycardia|Sinus tachycardia]] <br> [[Wandering atrial pacemaker]]<br> [[Sick sinus syndrome]]| D02= [[AVNRT]] <br><br> [[AVRT]] ([[accessory pathway]]):<br>- [[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White syndrome (WPW)]]<br>- [[Lown-Ganong-Levine syndrome|Lown-Ganong-Levine syndrome (LGL)]]|D03=[[Accelerated junctional rhythm]]| D04= '''[[Wide complex tachycardias|SVTAC]]'''<br>'''([[Wide complex tachycardias|SVT with aberrant conduction]]):<br><br>'''[[Left Bundle Branch Block|Left bundle branch block]] <br> [[LAHB|Left anterior hemi-block]] <br> [[Left posterior fascicular block electrocardiogram|Lefo posterior hemi-block]] <br> [[Right Bundle Branch Block|Right bundle branch block]] <br> [[Trifascicular block]]| D05= [[Ventricular tachycardia]] <br> [[Ventricular fibrillation electrocardiogram|Ventricular fibrillation]] <br> [[Ventricular Parasystole|Ventricular parasystole]] | D06= [[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White syndrome (WPW)]]<br>[[Lown-Ganong-Levine syndrome|Lown-Ganong-Levine syndrome (LGL)]]| D07= [[Pacemaker-mediated tachycardia]] <br> [[Runaway pacemaker syndrome]]<br> [[Sensor induced tachycardia]]}} |
| | {{familytree/end}} |
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| ==Classification== | | ==[[Tachycardia pathophysiology|Pathophysiology]]== |
| The 12 lead [[electrocardiogram|ECG]] can help distinguish between the various types of tachycardias, generally distinguished by their site of pacemaker origin:
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| *[[Sinus tachycardia]], which originates from the Sino-atrial (SA) node, near the base of the [[superior vena cava]]
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| *[[Ventricular tachycardia]], any tachycardia which originates in the [[ventricles]].
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| *[[Supraventricular tachycardia]] (SVT), which is a tachycardia paced from the Atria or the AV node. SVT rhythms include:
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| **[[Atrial fibrillation]]
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| **AVNRT or [[AV nodal reentrant tachycardia]]
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| **AVRT or [[AV reentrant tachycardia]]
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| **[[Junctional tachycardia]]
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| It is sometimes useful to classify tachycardias as either narrow complex tachycardias (often referred to as supraventricular tachycardias) or wide complex tachycardias. "Narrow" and "wide" refer to the width of the QRS complex on the [[ECG]]. Narrow complex tachycardias tend to originate in the atria, while wide complex tachycardias tend to originate in the ventricles. Tachycardias can be further classified as either regular or irregular.
| | ==[[Tachycardia causes|Causes]]== |
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| ==Pathophysiology== | | ==[[Tachycardia risk factors|Risk Factors]]== |
| ===Haemodynamic responses===
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| The body contains several feedback mechanisms to maintain adequate blood flow and [[blood pressure]]. If blood pressure decreases, the heart beats faster in an attempt to raise it. This is called [[reflex]] tachycardia.
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| This can happen in response to a decrease in [[blood volume]] (through [[dehydration]] or [[bleeding]]), or an unexpected change in [[blood flow]].
| | ==[[Tachycardia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ===Sinus tachycardia=== | | ==Diagnosis== |
| The most common type of tachycardia is [[sinus tachycardia]], which is the body's normal reaction to stress, including fever, dehydration, or blood loss (shock). It is a technical [[supraventricular tachycardia|narrow complex tachycardia]]. In the absence of heart disease, it tends to have a narrow QRS complex on the ECG. Treatment is generally directed at identifying the underlying cause.
| | [[Tachycardia history and symptoms| History and Symptoms]] | [[Tachycardia physical examination |Physical Examination]] | [[Tachycardia laboratory findings|Laboratory Findings]] | [[Tachycardia electrocardiogram|Electrocardiogram]] | [[Tachycardia chest x ray|Chest X Ray]] | [[Tachycardia echocardiography|Echocardiography]] | [[Tachycardia MRI|MRI]] |[[Tachycardia other imaging findings|Other Imaging Findings]] | [[Tachycardia other diagnostic studies|Other Diagnostic Studies]] |
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| ===Ventricular tachycardia=== | | ==Treatment== |
| {{main|Ventricular tachycardia}}
| | [[Tachycardia medical therapy|Medical Therapy]] | [[Tachycardia surgery|Surgery]] | [[Tachycardia primary prevention|Primary Prevention]] | [[Tachycardia secondary prevention|Secondary Prevention]] | [[Tachycardia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Tachycardia future or investigational therapies|Future or Investigational Therapies]] |
| Ventricular tachycardia (VT or V-tach) is a potentially life-threatening cardiac arrhythmia that originates in the ventricles. It is usually a regular, wide complex tachycardia with a rate between 120 and 250 beats per minute. Ventricular tachycardia has the potential of degrading to the more serious [[ventricular fibrillation]]. Ventricular tachycardia is a common, and often lethal, complication of a [[myocardial infarction]] (heart attack).
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| '''Exercise-induced ventricular tachycardia''' is a phenomenon related to [[cardiac arrest|sudden death]]s, especially in patients with severe heart disease ([[ischaemia]], acquired [[valvular heart disease|valvular heart]] and [[congenital heart disease]]) accompanied with left [[ventricular]] [[dysfunction]].<ref>{{cite web |url=http://www.medinet.hochiminhcity.gov.vn/medic/nckh/nhthat/e_nhthat.htm |title=Ventricular tachycardia and ST segment elevation during Exercise |accessdate=2007-07-21 |format= |work=}}</ref> A case of a death from exercise-induced VT was the death on a basketball court of Hank Gathers, the Loyola Marymount basketball]] star, in March 1990.<ref>{{cite web |url=http://query.nytimes.com/gst/fullpage.html?res=9C0CE1DC103DF93AA15750C0A966958260&sec=health&pagewanted=print |title=Basketball; As a Lawsuit Looms on Death of Gathers, Many Major Questions Remain Unanswered - New York Times |accessdate=2007-07-21 |format= |work=}}</ref>
| | ==Case Studies== |
| | [[Tachycardia case study one|Case #1]] |
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| Both of these rhythms normally last for only a few seconds to minutes'' ([[paroxysmal tachycardia]])'', but if VT persists it is extremely dangerous, often leading to [[ventricular fibrillation]].
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| ===SVT Rhythms===
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| {{main|Supraventricular tachycardia}}
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| ====Atrial fibrillation====
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| [[Atrial fibrillation]] is one of the most common cardiac arrhythmias. It is generally an irregular, narrow complex rhythm. However, it may show wide QRS complexes on the ECG if a [[bundle branch block]] is present. At high rates, the QRS complex may also become wide due to the [[Ashman phenomenon]]. It may be difficult to determine the rhythm's regularity when the rate exceeds 150 beats per minute. Depending on the patient's health and other variables such as medications taken for rate control, atrial fibrillation may cause heart rates that span from 50 to 250 beats per minute (or even higher if an [[Wolff-Parkinson-White syndrome|accessory pathway]] is present). However, new onset atrial fibrillation tends to present with rates between 100 and 150 beats per minute.
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| ====AV nodal reentrant tachycardia (AVNRT)====
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| [[AV nodal reentrant tachycardia]] is the most common reentrant tachycardia. It is a regular [[supraventricular tachycardia|narrow complex tachycardia]] that usually responds well to [[vagal maneuvers]] or the drug [[adenosine]]. However, unstable patients sometimes require synchronized [[cardioversion]]. Definitive care may include [[catheter ablation]].
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| ====AV reentrant tachycardia====
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| AV reentrant tachycardia (AVRT) requires an [[Wolff-Parkinson-White syndrome|accessory pathway]] for its maintenance. AVRT may involve orthodromic conduction (where the impulse travels down the AV node to the ventricles and back up to the atria through the accessory pathway) or antidromic conduction (which the impulse travels down the accessory pathway and back up to the atria through the AV node). Orthodromic conduction usually results in a narrow complex tachycardia, and antidromic conduction usually results in a wide complex tachycardia that often mimics [[ventricular tachycardia]]. Most antiarrhythmics are contraindicated in the emergency treatment of AVRT, because they may paradoxically increase conduction across the accessory pathway.
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| ====Junctional tachycardia====
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| Junctional tachycardia is an automatic tachycardia originating in the AV junction. It tends to be a regular, narrow complex tachycardia and may be a sign of digitalis toxicity.
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| ===Causes===
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| ===Common Causes===
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| The most common cause of the latter is [[orthostatic hypotension]] (also called [[postural hypotension]]), a sudden drop of blood pressure that occurs with a change in body position (e.g., going from lying down to standing up). When tachycardia occurs for this reason, it is called [[postural orthostatic tachycardia syndrome]] (POTS).
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| [[Fever]], [[hyperventilation]] and [[infection]] leading to [[sepsis]] are also common causes of tachycardia, primarily due to increase in [[metabolic]] demands and compensatory increase in heart rate.
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| An increase in [[sympathetic nervous system]] stimulation causes the heart rate to increase, both by the direct action of [[sympathetic nerve]] fibers on the heart and by causing the [[endocrine]] system to release [[hormone]]s such as [[epinephrine|epinephrine (adrenaline)]], which have a similar effect. Increased sympathetic stimulation is usually due to physical or psychological stress (the so-called "[[fight or flight]]" response), but can also be induced by [[stimulant]]s such as [[amphetamines]].
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| [[Endocrine disorders]] such as [[pheochromocytoma]] can cause epinephrine release and tachycardia independent of the nervous system. [[Hyperthyroidism]] is also known to cause tachycardia.
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| ===Causes by Organ System===
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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |
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| [[Arrhythmogenic right ventricular dysplasia]],
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| [[AV Nodal Reentrant Tachycardia]],
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| [[AV-dissociation]],
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| [[Bradycardia-tachycardia syndrome]],
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| [[Cardiac amyloidosis]],
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| [[Cardiac arrhythmia]],
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| [[Cardiac tamponade]],
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| [[Cardiogenic shock]],
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| [[Congestive Heart Failure]],
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| [[Ebstein's Anomaly of the Tricuspid Valve]],
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| [[Inappropriate Sinus Tachycardia]],
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| [[Inferior vena cava syndrome]],
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| [[Multifocal atrial tachycardia]],
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| [[Nonparoxysmal Junctional Tachycardia]],
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| [[Paroxysmal supraventricular tachycardia]],
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| [[Polymorphic ventricular tachycardia]],
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| [[Premature ventricular contractions]],
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| [[Pulseless ventricular tachycardia]],
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| [[Torsade de pointes]],
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| [[Wolff-Parkinson-White syndrome]],
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|
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"|
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| [[3-Quinuclidinyl benzilate]],
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| [[Arsenic Poisoning]],
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| [[Bothrops]],
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| [[Caffeine]],
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| [[Carbon monoxide poisoning]],
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| [[Cardiac effects of insect bites]],
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| [[Hydroxyethyl starch]],
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| [[Mercury poisoning]],
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| [[Methadone withdrawl]],
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| [[Scombroid]],
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|
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"|
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| [[Amlodipine]],
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| [[Amphetamine]],
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| [[Anticholinergic]],
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| [[Antipsychotic]],
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| [[Atropine]],
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| [[Abciximab (patient information)]],
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| [[Benzatropine]],
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| [[Biperiden]],
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| [[Bupropion]],
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| [[Caspofungin]],
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| [[Clofarabine]],
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| [[Clomipramine]],
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| [[Clonidine]],
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| [[Daptomycin]],
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| [[Desflurane]],
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| [[Desoxyn]],
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| [[Diethylcathinone]],
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| [[Diflunisal]],
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| [[Digoxin]],
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| [[Diltiazem]],
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| [[Dimenhydrinate]],
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| [[Diphenhydramine]],
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| [[Doxapram]],
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| [[Doxepin]],
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| [[Ephedrine]],
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| [[Epinephrine]],
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| [[Ethcathinone]],
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| [[Iloprost]],
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| [[Imipramine]],
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| [[Isoproterenol]],
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| [[Isosorbide mononitrate]],
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| [[Levomepromazine]],
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| [[Levomethamphetamine]],
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| [[Levosimendan]],
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| [[Lomotil]],
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| [[Maprotiline]],
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| [[Methcathinone]],
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| [[Methylphenidate]],
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| [[Metoclopramide]],
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| [[Milnacipran]],
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| [[Minoxidil]],
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| [[Modafinil]],
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| [[Motofen]],
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| [[Nalbuphine]],
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| [[Nalmefene]],
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| [[Nialamide]],
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| [[Neuromuscular-blocking drugs]],
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| [[Olanzapine]],
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| [[Opioid]],
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| [[Paliperidone]],
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| [[Papaverine]],
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| [[Phentermine]],
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| [[Pipradrol]],
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| [[Procainamide (patient information)]],
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| [[Procyclidine hydrochloride]],
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| [[Propantheline]],
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| [[Pseudoephedrine]],
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| [[Sumatriptan]],
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| [[Terbutaline]],
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| [[Tizanidine]],
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| [[Trazodone]],
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| [[Tuaminoheptane]],
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| [[Vardenafil]],
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| [[Zopiclone withdrawl]],
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|
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"|
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| [[Graves' Disease]],
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| [[Toxic multinodular goitre]],
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|
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"|
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| [[Accessory pancreas]],
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| [[Gastroenteritis]],
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| [[Megacolon]],
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| [[Peritonitis]],
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| [[Retroperitoneal hematoma]],
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| [[Ulcerative colitis]],
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|
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"|
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| [[Brugada syndrome]],
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| [[Catecholaminergic polymorphic ventricular tachycardia]],
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| [[Costello syndrome]],
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|
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"|
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| [[Ruptured spleen]],
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| [[Sickle-cell disease]],
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|
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"|
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| [[Blood transfusion]],
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"|
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| [[Clostridium Difficile]],
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| [[Cotton fever]],
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| [[Ebola]],
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| [[Lassa fever]],
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| [[Malaria]],
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| [[Scarlet fever]],
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| [[Tuberculosis]],
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"|
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| [[Autonomic neuropathy]],
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| [[Dysautonomia]],
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|
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"|
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| [[Adams Nance syndrome]],
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| [[Acute Porphyria]],
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| [[Beriberi Heart Disease]],
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| [[Betel nut]],
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| [[Foods containing tyramine]],
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| [[Hypoglycemia]],
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| [[Hypomagnesemia]],
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| [[Metabolic acidosis]],
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|
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"|
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| [[Aortocaval compression syndrome]],
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| [[Fetal distress]],
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| [[Omphalitis]],
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|
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| [[Insulinoma]],
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|
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"|
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| [[Aconitum]],
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| [[Benzylpiperazine]],
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| [[Bupropion]],
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| [[Cocaine]],
| |
| [[Diflunisal]],
| |
| [[Imipramine]],
| |
| [[Lomotil]],
| |
| [[Long-term effects of alcohol]],
| |
| [[Procainamide]],
| |
| [[Procyclidine hydrochloride]],
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| [[Xanthine]],
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|
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Pulmonary'''
| |
| |bgcolor="Beige"|
| |
| [[Acute Chest Syndrome]],
| |
| [[Asthma]],
| |
| [[Community-acquired pneumonia]],
| |
| [[Hemothorax]],
| |
|
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Renal / Electrolyte'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Rheum / Immune / Allergy'''
| |
| |bgcolor="Beige"| [[Kawasaki disease]],
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|
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Sexual'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Trauma'''
| |
| |bgcolor="Beige"|
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| [[Commotio cordis]],
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|
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|
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
| |
| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"|
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| [[Chronic fatigue syndrome]],
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| [[Dipping tobacco]],
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| [[Hyperthermia]],
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| [[Malignant hyperthermia]],
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| [[Pheochromocytoma]],
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| [[Postural orthostatic tachycardia syndrome]],
| |
| |-
| |
| |}
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|
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| ===Causes in Alphabetical Order===
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|
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| {{MultiCol}}
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| *[[3-Quinuclidinyl benzilate]]
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| *[[Abciximab (patient information)]]
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| *[[Accessory pancreas]]
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| *[[Aconitum]]
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| *[[Acute Chest Syndrome]]
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| *[[Acute Porphyria]]
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| *[[Adams Nance syndrome]]
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| *[[Alcohol Withdrawal]]
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| *[[Amanita phalloides]]
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| *[[Amlodipine]]
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| *[[Amphetamine]]
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| *[[Anticholinergic]]
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| *[[Antipsychotic]]
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| *[[Aortocaval compression syndrome]]
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| *[[Arrhythmogenic right ventricular dysplasia]]
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| *[[Arsenic Poisoning]]
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| *[[Ashman phenomenon]]
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| *[[Asthma]]
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| *[[Atropine]]
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| *[[Autonomic neuropathy]]
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| *[[AV Nodal Reentrant Tachycardia]]
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| *[[AV-dissociation]]
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| *[[AVNRT]]
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| *[[Benzatropine]]
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| *[[Benzylpiperazine]]
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| *[[Beriberi Heart Disease]]
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| *[[Betel nut]]
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| *[[Biperiden]]
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| *[[Blood transfusion]]
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| *[[Bothrops]]
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| *[[Bradycardia-tachycardia syndrome]]
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| *[[Brugada syndrome]]
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| *[[Bupropion]]
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| *[[Caffeine]]
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| *[[Carbon monoxide poisoning]]
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| *[[Cardiac amyloidosis]]
| |
| *[[Cardiac arrhythmia]]
| |
| *[[Cardiac effects of insect bites]]
| |
| *[[Cardiac tamponade]]
| |
| *[[Cardiogenic shock]]
| |
| *[[Cardiovascular Effects of Cocaine]]
| |
| *[[Caspofungin]]
| |
| *[[Catecholaminergic polymorphic ventricular tachycardia]]
| |
| *[[Chlorprothixene]]
| |
| *[[Chronic fatigue syndrome]]
| |
| *[[Clofarabine]]
| |
| *[[Clomipramine]]
| |
| *[[Clonidine]]
| |
| *[[Clostridium Difficile]]
| |
| *[[Commotio cordis]]
| |
| *[[Community-acquired pneumonia]]
| |
| *[[Congestive Heart Failure]]
| |
| *[[Costello syndrome]]
| |
| *[[Cotton fever]]
| |
| *[[Daptomycin]]
| |
| *[[Desflurane]]
| |
| *[[Desoxyn]]
| |
| *[[Diethylcathinone]]
| |
| *[[Diflunisal]]
| |
| *[[Digoxin]]
| |
| *[[Diltiazem]]
| |
| *[[Dimenhydrinate]]
| |
| *[[Diphenhydramine]]
| |
| *[[Dipping tobacco]]
| |
| *[[Dosulepin hydrochloride]]
| |
| *[[Doxapram]]
| |
| *[[Doxepin]]
| |
| *[[Dysautonomia]]
| |
| *[[Ebola]]
| |
| *[[Ebstein's Anomaly of the Tricuspid Valve]]
| |
| *[[Ephedrine]]
| |
| *[[Epinephrine]]
| |
| *[[Ethcathinone]]
| |
| *[[Fetal distress]]
| |
| *[[Foods containing tyramine]]
| |
| *[[Gastroenteritis]]
| |
| *[[Graves' Disease]]
| |
| *[[Hemothorax]]
| |
| *[[Hydroxyethyl starch]]
| |
| *[[Hyperthermia]]
| |
| *[[Hyperthyroidism]]
| |
| {{ColBreak}}
| |
| *[[Hypoglycemia]]
| |
| *[[Hypomagnesemia]]
| |
| *[[Iloprost]]
| |
| *[[Imipramine]]
| |
| *[[Inappropriate Sinus Tachycardia]]
| |
| *[[Inferior vena cava syndrome]]
| |
| *[[Insulinoma]]
| |
| *[[Isoproterenol]]
| |
| *[[Isosorbide mononitrate]]
| |
| *[[Kawasaki disease]]
| |
| *[[Lassa fever]]
| |
| *[[Levomepromazine]]
| |
| *[[Levomethamphetamine]]
| |
| *[[Levosimendan]]
| |
| *[[Lomotil]]
| |
| *[[Long-term effects of alcohol]]
| |
| *[[Malaria]]
| |
| *[[Malignant hyperthermia]]
| |
| *[[Maprotiline]]
| |
| *[[Megacolon]]
| |
| *[[Mercury poisoning]]
| |
| *[[Metabolic acidosis]]
| |
| *[[Methadone withdrawl]]
| |
| *[[Methcathinone]]
| |
| *[[Methylphenidate]]
| |
| *[[Metoclopramide]]
| |
| *[[Milnacipran]]
| |
| *[[Minoxidil]]
| |
| *[[Modafinil]]
| |
| *[[Motofen]]
| |
| *[[Multifocal atrial tachycardia]]
| |
| *[[Nalbuphine]]
| |
| *[[Nalmefene]]
| |
| *[[Neuromuscular-blocking drugs]]
| |
| *[[Nialamide]]
| |
| *[[Nonparoxysmal Junctional Tachycardia]]
| |
| *[[Olanzapine]]
| |
| *[[Omphalitis]]
| |
| *[[Opioid]]
| |
| *[[Paliperidone]]
| |
| *[[Palytoxin]]
| |
| *[[Papaverine]]
| |
| *[[Paroxysmal supraventricular tachycardia]]
| |
| *[[Peritonitis]]
| |
| *[[Phentermine]]
| |
| *[[Pheochromocytoma]]
| |
| *[[Pipradrol]]
| |
| *[[Polymorphic ventricular tachycardia]]
| |
| *[[Porphyria]]
| |
| *[[Postural orthostatic tachycardia syndrome]]
| |
| *[[Premature ventricular contractions]]
| |
| *[[Procainamide (patient information)]]
| |
| *[[Procyclidine hydrochloride]]
| |
| *[[Propantheline]]
| |
| *[[Pseudoephedrine]]
| |
| *[[Pulseless ventricular tachycardia]]
| |
| *[[Retroperitoneal hematoma]]
| |
| *[[Ruptured spleen]]
| |
| *[[Scarlet fever]]
| |
| *[[Scombroid]]
| |
| *[[Scopolamine]]
| |
| *[[Sepsis]]
| |
| *[[Serotonin syndrome]]
| |
| *[[Sick sinus syndrome]]
| |
| *[[Sickle-cell disease]]
| |
| *[[Sumatriptan]]
| |
| *[[Supraventricular Tachycardias]]
| |
| *[[Terbutaline]]
| |
| *[[Tizanidine]]
| |
| *[[Torsade de pointes]]
| |
| *[[Toxic multinodular goitre]]
| |
| *[[Toxidrome]]
| |
| *[[Trazodone]]
| |
| *[[Tuaminoheptane]]
| |
| *[[Tuberculosis]]
| |
| *[[Ulcerative colitis]]
| |
| *[[Vardenafil]]
| |
| *[[White coat hypertension]]
| |
| *[[Wide Complex Tachycardias]]
| |
| *[[Wolff-Parkinson-White syndrome]]
| |
| *[[Xanthine]]
| |
| *[[Zopiclone withdrawl]]
| |
| {{EndMultiCol}}
| |
|
| |
| ==Treatments==
| |
| Treatment of tachycardia is usually directed at chemical conversion (with [[antiarrythmics]]), electrical conversion (giving external shocks to convert the heart to a normal rhythm) or use of drugs to simply control heart rate (for example as in [[atrial fibrillation]]).
| |
|
| |
| The treatment modality used depends on the type of tachycardia and the hemodynamic stability of the patient. If the tachycardia originates from the sinus node (sinus tachycardia), treatment of the underlying cause of sinus tachycardia is usually sufficient. On the other hand, if the tachycardia is of a potentially lethal origin (ie: ventricular tachycardia) treatment with anti arrhythmic agents or with electrical cardioversion may be required. Below is a brief discussion of some of the main tachyarrhythmias and their treatments.
| |
|
| |
| The electrocardiac management of atrial fibrillation and atrial flutter is either through medications or electrical cardioversion. Pharmacologic management of these arrhythmias typically involves diltiazem or verapamil as well as beta-blocking agents such as atenolol. The decision to use electrical cardioversion depends heavily on the hemodynamic stability of the presenting patient; in general those patients who are unable to sustain their systemic functions are electrically converted although conversion to a normal sinus rhythm can be performed with amiodarone. An interesting type of atrial fibrillation which must be carefully managed is when it appears in combination with Wolff-parkinson White. In this case, calcium channel blockers, beta-blockers and digoxin must be avoided to prevent precipitation of ventricular tachycardia. Here, procainamide or quinidine are often used. Of note: patients who have been in atrial fibrillation for more than 48 hours should not be converted to normal sinus rhythm unless they have been anti-coagulated to an INR of 2-3 for at least 4 weeks.
| |
|
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| In the case of narrow complex tachycardias (juntional, atrial or paroxysmal), the treatment in general is to first give the patient adenosine (to slow conduction through the AV node) and then perform vagal maneuvers to slow the rhythm. If this does not convert the patient, amiodarone, calcium channel blockers or beta-blockers are commonly employed to stabilize the patient. Again as in atrial fibrillation, if a patient is unstable, the decision to electrially cardiovert him/her should be made.
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|
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| With wide complex tachyarrhythmias or ventricular tachyarrhythmias, in general most are highly unstable and cause the patient significant distress and would be electrically converted. However one notable exception is monomorphic ventricular tachycardia which patients may tolerate but can be treated pharmacologically with amiodarone or lidocaine.
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|
| |
| Above all, the treatment modality is tailored to the individual, and varies based on the mechanism of the tachycardia (where it is originating from within the heart), on the duration of the tachycardia, how well the individual is tolerating the fast heart rate, the likelihood of recurrence once the rhythm is terminated, and any co-morbid conditions the individual is suffering from.
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|
| |
| ==ACC / AHA Guidelines- Recommendations for Permanent Pacemakers That Automatically Detect and Pace to Terminate Tachycardias (DO NOT EDIT) <ref name="Epstein"> Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 2820–2840. PMID 18483207 </ref>==
| |
| {{cquote|
| |
| ===Class IIa===
| |
| 1. Permanent [[pacemaker|pacing]] is reasonable for symptomatic recurrent [[SVT]] that is reproducibly terminated by pacing when [[catheter ablation]] and/or drugs fail to control the [[arrhythmia]] or produce intolerable side effects. ''(Level of Evidence: C)''
| |
|
| |
| ===Class III===
| |
| 1. Permanent [[pacemaker|pacing]] is not indicated in the presence of an accessory pathway that has the capacity for rapid anterograde conduction. ''(Level of Evidence: C)''}}
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|
| |
| ==ACC / AHA Guidelines- Recommendations for Permanent Pacemakers That Automatically Detect and Pace to Terminate Tachycardias (DO NOT EDIT) <ref name="Epstein"> Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 2820–2840. PMID 18483207 </ref>==
| |
| {{cquote|
| |
| ===Class I===
| |
| 1. Permanent [[pacemaker|pacing]] is indicated for sustained pause-dependent [[VT]], with or without [[QT prolongation]]. ''(Level of Evidence: C)''
| |
|
| |
| ===Class IIa===
| |
| 1. Permanent [[pacemaker|pacing]] is reasonable for high-risk patients with congenital [[long-QT syndrome]]. ''(Level of Evidence: C)''
| |
|
| |
| ===Class IIb===
| |
| 1. Permanent [[pacemaker|pacing]] may be considered for prevention of symptomatic, drug-refractory, recurrent [[AF]] in patients with coexisting [[SND]]. ''(Level of Evidence: B)''
| |
|
| |
| ===Class III===
| |
| 1. Permanent [[pacemaker|pacing]] is not indicated for frequent or complex ventricular ectopic activity without sustained [[VT]] in the absence of the [[long-QT syndrome]]. ''(Level of Evidence: C)''
| |
|
| |
| 2. Permanent [[pacemaker|pacing]] is not indicated for [[torsade de pointes]] [[VT]] due to reversible causes. ''(Level of Evidence: A)''}}
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|
| |
| ==Sources==
| |
| * The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities <ref name="Epstein"> Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 2820–2840. PMID 18483207 </ref>
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|
| |
| ==References==
| |
| {{Reflist|2}}
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|
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|
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| {{Symptoms and signs}}
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| {{Electrocardiography}} | | {{Electrocardiography}} |
| {{Circulatory system pathology}} | | {{Circulatory system pathology}} |
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| [[cs:Tachykardie]]
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| [[de:Tachykardie]]
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| [[es:Taquicardia]] | | [[es:Taquicardia]] |
| [[et:Tahhükardia]]
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| [[fr:Tachycardie]] | | [[fr:Tachycardie]] |
| [[ko:빠른맥]]
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| [[it:Tachicardia]]
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| [[nl:Tachycardie]]
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| [[ja:頻脈]] | | [[ja:頻脈]] |
| [[pt:Taquicardia]] | | [[pt:Taquicardia]] |
| [[ru:Тахикардия]] | | [[ru:Тахикардия]] |
| [[fi:Takykardia]]
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| [[sv:Takykardi]]
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| [[pl:Tachykardia]] | | [[pl:Tachykardia]] |
| [[tr:Taşikardi]] | | [[tr:Taşikardi]] |
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |
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| | [[Category:Medical signs]] |
| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| | [[Category:Arrhythmia]] |
| | [[Category:Electrophysiology]] |
