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'''For patient information, click [[Inappropriate sinus tachycardia (patient information)|here]]'''
{{Inappropriate sinus tachycardia}}
{{Inappropriate sinus tachycardia}}
 
{{CMG}}  
{{CMG}}


{{SK}} IST; chronic nonparoxysmal sinus tachycardia
{{SK}} IST; chronic nonparoxysmal sinus tachycardia


==Overview==
== [[Inappropriate sinus tachycardia overview|Overview]] ==


==Historical Perspective==
== [[Inappropriate sinus tachycardia historical perspective|Historical Perspective]] ==


==Pathophysiology==
== [[Inappropriate sinus tachycardia pathophysiology|Pathophysiology]] ==


==Epidemiology and Demographics==
== [[Inappropriate sinus tachycardia causes|Causes]] ==


==Differentiating Inappropriate Sinus Tachycardia from other Medical Conditions==
== [[Inappropriate sinus tachycardia differential diagnosis|Differentiating Inappropriate Sinus Tachycardia from other Diseases]] ==


==Differentiating Inappropriate Sinus Tachycardia from other Supraventricular Arrhythmias==
== [[Inappropriate sinus tachycardia epidemiology and demographics|Epidemiology and Demographics]] ==


==Diagnosis==
== Diagnosis ==
===Diagnostic Criteria===
No formal diagnostic criteria exist. A diagnosis of Inappropriate sinus tachycardia is primarily a diagnosis of exclusion and the following must be observed:
*Exclusion of all other causes of [[sinus tachycardia]]
*Common forms of [[supraventricular tachycardia]] (SVT) must be excluded
*Normal [[P wave]] morphology
*A resting [[sinus tachycardia]] is usually (but not always) present
*A nocturnal reduction in [[heart rate]] from over 100 beats per minute to 80 - 90 beats per minute
*There is an inappropriate [[heart rate]] response on exertion so that the heart rate accelerates to 140 - 150 beats per minute with minimal exertion.
*The mean [[heart rate]] during 24 hrs of monitoring is > 95 bpm
*Symptoms are documented to be due to [[tachycardia]]
*[[Hypotension]] may occasionally be observed
*[[Syncope]] ([[fainting]]) is occasionally reported


=== Symptoms ===
[[Inappropriate sinus tachycardia diagnostic criteria|Diagnostic Criteria]] | [[Inappropriate sinus tachycardia history and symptoms|History and Symptoms]] | [[Inappropriate sinus tachycardia electrocardiogram|Electrocardiogram]]
Symptoms reported by patients vary in frequency and severity. Symptoms associated with Inappropriate sinus tachycardia include:
*[[Blurred vision]]
*Frequent [[palpitations]]
*[[Dyspnea]] ([[shortness of breath]]) and [[palpitations]] on exertion
*[[Pre-syncope]] (feeling as if about to [[faint]])
*[[Fatigue]]
*[[Dizziness]]
*[[Exercise intolerance]]
*Occasional [[paresthesia]] and [[cramping]]
*Symptoms associated with [[autonomic nervous system]] disturbance, including GI disturbance
*[[Orthostatic hypotension]] with a [[drop in blood pressure on standing]]


== Treatment ==
== Treatment ==
Treatments in the form of [[pharmacological]] therapy or [[catheter ablation]] are available, although it is currently difficult to treat successfully.
===Beta-blockers===
In so far as the pathophysiology of IST involves abnormal sensitivity to [[adrenaline]], [[betaa-blockers]] can be helpful.
===Calcium Channel Blockers===
Although [[calcium channel blockers]] slow conduction through the [[AV node]], they have been marginally effective in the treatment of IST.


===Ivabradine===
[[Inappropriate sinus tachycardia treatment guidelines|ACC/AHA/ESC Treatment Guidelines]] | [[Inappropriate sinus tachycardia medical therapy|Medical Therapy]] | [[Inappropriate sinus tachycardia surgery|Surgery]]
A new selective sinus node inhibitor [[Ivabradine]] is also being used to treat IST.


===Treatments Related to Dysautonomia and POTS===
==Case Studies==
In so far as the underlying pathophysiology may involve a [[dysautonomia]] and features of [[Postural orthostatic tachycardia syndrome]] ([[POTS]]), some therapies more commonly used to treat these disorders have been tried:
[[Inappropriate sinus tachycardia case study one|Case #1]]
====[[Fludrocortisone]] ([[Florinef]])====
[[POTS]] and [[dysautonomia]] have been associated with decreases in blood volume, and this drug promotes sodium retention.
====[[Midodrine]]====
Midodrine increases vasoconstriction, and prevents falls in blood pressure.
====[[Serotonin-reuptake inhibitors]] ([[SSRI]]s)====
SSRIs have proven effective in treating some patients with [[dysautonomia]].


===Catheter Ablation===
==Related Chapters==
Invasive treatments include forms of [[Catheter ablation]] has gained favor among electrophysiologists in the treatment of IST.
====Sinus Node Modification====
This procedure involves selective ablation of the [[sinus node]]. The rhythm reoccurs in 80% of cases.
 
====Complete Sinus Node Ablation====
This procedure requires implantation of a Permanent [[Artificial pacemaker]])
 
====AV Node Ablation====
In cases resistant to sinus node ablation, AV node ablation with creation of an [[iatrogenic]]  [[complete heart block]], may be neccessary.  This procedure requires implantation of a permanent [[artificial pacemaker]].
 
== See also ==
*[[Supraventricular tachycardia]]
*[[Supraventricular tachycardia]]
*[[Sinus tachycardia]]
*[[Sinus tachycardia]]
*[[Postural orthostatic tachycardia syndrome]]
*[[Postural orthostatic tachycardia syndrome]]
*[[Dysautonomia]]
*[[Dysautonomia]]
==References==
{{Reflist|2}}




Latest revision as of 20:03, 23 August 2013

For patient information, click here

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Overview

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Pathophysiology

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Differentiating Inappropriate Sinus Tachycardia from other Medical Conditions

Epidemiology and Demographics

Diagnosis

Diagnostic Criteria

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Electrocardiogram

Treatment

ACC/AHA/ESC Treatment Guidelines

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: IST; chronic nonparoxysmal sinus tachycardia

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Inappropriate Sinus Tachycardia from other Diseases

Epidemiology and Demographics

Diagnosis

Diagnostic Criteria | History and Symptoms | Electrocardiogram

Treatment

ACC/AHA/ESC Treatment Guidelines | Medical Therapy | Surgery

Case Studies

Case #1

Related Chapters



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