Sinus tachycardia: Difference between revisions

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VisualWikitext

Revision as of 17:09, 20 August 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Synonyms and keywords: Sinus tach; sinus tachy

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Sinus tachycardia from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Treatment

Case Studies

Case#1

Related Chapters

Sinus bradycardia

References

Hammill S. C. Electrocardiographic diagnoses: Criteria and definitions of abnormalities, Chapter 18, MAYO Clinic, Concise Textbook of Cardiology, 3rd edition, 2007 ISBN 0-8493-9057-5

Template:WikiDoc Sources

@@ Line 6: / Line 6: @@
 {{SK}} Sinus tach; sinus tachy
-==Overview==
+==[[Sinus tachycardia overview|Overview]]==
-Sinus [[tachycardia]] is a rhythm with elevated rate of impulses originating from the [[sinoatrial node]], defined as a rate greater than 100 beats/min in an average adult. The normal heart rate in the average adult ranges from 60–100 beats/min. Note that the normal heart rate varies with age, with infants having normal heart rate of 110–150 bpm to the elderly, who have slower normals.
-==Causes==
+==[[Sinus tachycardia historical perspective|Historical Perspective]]==
-Sinus tachycardia is usually a response to normal physiological situations, such as [[exercise]] and an increased [[sympathetic nervous system|sympathetic]] tone with increased [[catecholamine]] release—stress, fright, flight, anger. Other causes include:
-*[[Fever]]
-*[[Anxiety]]
-*[[Dehydration]]
-*[[Malignant hyperthermia]]
-*[[Hypovolemia]] with [[hypotension]] and [[Shock (medical)|shock]]
-*[[Anemia]]
-*[[Heart failure]]
-*[[Hyperthyroidism]]
-*[[Pheochromocytoma]]
-*[[Sepsis]]
-*[[Pulmonary embolism]]
-*Acute coronary ischemia and [[myocardial infarction]]
-*Chronic pulmonary disease
-*[[Hypoxia (medical)|Hypoxia]]
-*Intake of [[nicotine]], [[caffeine]], or illicit drugs
-*[[Hyperdynamic Circulation]]
-==Differentiating Sinus Tachycardia from other Disorders==
+==[[Sinus tachycardia classification|Classification]]==
-Usually apparent on the EKG, but if heart rate is above 140 bpm the [[P wave]] may be difficult to distinguish from the previous [[T wave]] and one may confuse it with a [[paroxysmal supraventricular tachycardia]] or [[atrial flutter]] with a 2:1 block. Ways to distinguish the three are:
-* Vagal maneuvers (such as carotid sinus massage or [[Valsalva maneuver]]) to slow the rate and identification of [[P wave]]s
-* Administer AV blockers (e.g., [[adenosine]], [[verapamil]]) to identify [[atrial flutter]] with 2:1 block
-===Postural orthostatic tachycardia syndrome (POTS)===
+==[[Sinus tachycardia pathophysiology|Pathophysiology]]==
-[[Postural orthostatic tachycardia syndrome]] (POTS) usually occurs in women with no known heart problems. This syndrome is characterized by normal resting heart rate but exaggerated postural sinus tachycardia with or without [[orthostatic hypotension]].
-==Diagnosis==
+==[[Sinus tachycardia causes|Causes]]==
-===Symptoms===
-Sinus tachycardia is often asymptomatic. If the heart rate is too high, [[cardiac output]] may fall due to the markedly reduced ventricular filling time. Rapid rates, though they may be compensating for [[ischemia]] elsewhere, increase myocardial oxygen demand and reduce coronary blood flow, thus precipitating ischemia or [[valvular disease]]. Sinus tachycardia accompanying a [[myocardial infarction]] may be indicative of [[cardiogenic shock]].
-===Electrocardiogram===
+==[[Sinus tachycardia differential diagnosis|Differentiating Sinus tachycardia from other Diseases]]==
-* Rate:  Greater than 100.
-* Rhythm:  Regular.
-*[[P waves]]:  Upright, consistent, and normal in morphology (if no atrial disease)
-*[[PR interval]]:  Between 0.12–0.20 seconds and shortens with increasing heart rate
-*[[QRS complex]]: Less than 0.12 seconds, consistent, and normal in morphology
-*Pathophysiology: [[Sinus tachycardia]] is considered "appropriate" when a reasonable stimulus such as [[fever]], [[anemia]], fright, stress, or physical activity, provokes the tachycardia. This is in distinction to [[Inappropriate sinus tachycardia]] where no such stiumulus exists.
-===EKG Examples===
+==[[Sinus tachycardia epidemiology and demographics|Epidemiology and Demographics]]==
-----
-Shown below is an EKG example of sinus tachycardia with a heart rate of 125/min. The rhythm is regular.
-[[Image:Sinustachycardia.jpg|center|500px]]
-Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:Sinustachycardia.jpg
-----
-Shown below is an EKG example of 12 lead EKG showing sinus tachycardia. The heart rate is 150 bpm
-[[Image:R7.htm32.jpg|center|500px]]
-Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page
-----
-==Treatment==
+==[[Sinus tachycardia risk factors|Risk Factors]]==
-Not required for physiologic sinus tachycardia. Underlying causes are treated if present.
-[[Acute myocardial infarction]]: [[Sinus tachycardia]] can present in more than a third of the patients with AMI but this usually decreases over time. Patients with sustained [[sinus tachycardia]] reflects a larger infarct that are more anterior with prominent left ventricular dysfunction, associated with high mortality and morbidity. Tachycardia in the presence of AMI can reduce coronary blood flow and increase myocardial oxygen demand, aggravating the situation. [[Beta blockers]] can be used to slow the rate, but most patients are usually already treated with [[beta blockers]] as a routine regimen for AMI.
+==[[Sinus tachycardia natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
-Practically, many studies showed that there is no need for any treatment.
+==Diagnosis==
+[[Sinus tachycardia history and symptoms| History and Symptoms]] | [[Sinus tachycardia physical examination | Physical Examination]] | [[Sinus tachycardia laboratory findings|Laboratory Findings]] | [[Sinus tachycardia CT|CT]] | [[Sinus tachycardia other imaging findings|Other Imaging Findings]] | [[Sinus tachycardia other diagnostic studies|Other Diagnostic Studies]]
-'''''IST and POTS'''''. [[Beta blockers]] are useful if the cause is sympathetic overactivity. If the cause is due to decreased vagal activity, it is usually hard to treat and one may consider [[radiofrequency catheter ablation]].
+==Treatment==
+[[Sinus tachycardia medical therapy|Medical Therapy]] |  [[Sinus tachycardia surgery|Surgery]] | [[Sinus tachycardia primary prevention|Primary Prevention]] |[[Sinus tachycardia secondary prevention|Secondary Prevention]] | [[Sinus tachycardia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] |[[Sinus tachycardia future or investigational therapies|Future or Investigational Therapies]]
+==Case Studies==
+[[Sinus tachycardia case study one|Case#1]]
 ==Related Chapters==
 *[[Sinus bradycardia]]
@@ Line 75: / Line 39: @@
 {{Electrocardiography}}
 [[Category:Electrophysiology]]

v t e Electrocardiography
Overview	History of the EKG • EKG interpretation basics • Normal sinus rhythm
EKG Complexes	P wave • QRS complex • ST Segment • T wave • T wave alternans • Tombstone T wave • U wave Osborn wave • H wave • K wave • Delta wave NSSTW changes
EKG Intervals	PR Interval • QRS Interval • ST Interval • QT Interval
Conduction System & Bradycardia	Cardiac pacemaker • SA node • AV node• Bundle of His • Purkinje fibers • Sinus bradycardia • First Degree AV Block • Second Degree AV Block • Complete or Third-Degree AV Block • Concealed conduction • AV Junctional Rhythms • LBBB • LAHB • LPHB • RBBB • Trifascicular block
Atrial Arrhythmias	Sinus tachycardia • Premature Atrial Contractions (PACs) • Ectopic Atrial Rhythm • Paroxysmal Atrial Tachycardia (PAT) • Paroxysmal Atrial Tachycardia (PAT) with Block • Multifocal Atrial Tachycardia (MAT) • Atrial Flutter • Atrial Fibrillation • Wandering atrial pacemaker
Ventricular Arrhythmias	Differential Diagnosis of Tachycardia with a Wide QRS Complex • Accelerated Idioventricular Rhythm • Ventricular Parasystole • Premature Ventricular Contractions (PVCs) • Ventricular tachycardia • Ventricular Fibrillation • Sudden cardiac death
EKG Abnormalities in Disease States	Hypertrophy & Dilatation • Right atrial enlargement • Left atrial enlargement • Biatrial enlargement • Left Ventricular Hypertrophy • Right Ventricular Hypertrophy • Biventricular Hypertrophy • Acute myocardial infarction • NSTEMI • STEMI • Tombstone ST elevation • Right ventricular myocardial infarction • Atrial infarction Pre-excitation Syndromes • Wolff-Parkinson-White Syndrome • Lown Ganong Levine Syndrome • Mahaim Type Preexcitation Cardiomyopathies • Arrhythmogenic Right Ventricular Dysplasia • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy Drug Effects on the EKG • Adenosine • β-blockers • Digitalis • Quinidine • Procainamide • Disopyramide • Lidocaine • Tocainide and Mexiletine • Phenytoin • Encainide, Flecainide and Propafenone • Amiodarone • Bretylium • Ca Channel Blockers • Phenothiazines • Tricyclic Antidepressants • Lithium Congenital Heart Disease • Dextrocardia • Atrial Septal Defect • Ventricular Septal Defect • Tetralogy of Fallot • Conjoined Twins or Siamese Twins • Congenital heart block Electrolyte Disturbances • Hyperkalemia • Hypokalemia • Hypercalcemia • Hypocalcemia • Nonspecific Changes Other Heart Diseases • Pericarditis • Myocarditis • Tamponade • Heart Transplantation • Sick Sinus Syndrome • Long QT Syndrome Inherited Disease • Brugada Syndrome Systemic Diseases • CNS Disease • Cardiac Tumors Heart Transplantation • EKG Changes in patient with Heart Transplantation Exogenous Effects • Hypothermia • Chest Trauma • Insect Bites • Electric Injuries
Technical Issues and Potential Errors in Interpretation	Artifacts • Lead Placement Errors • The EKG in a Patient with a Pacemaker • EKG in athletes

Sinus tachycardia: Difference between revisions

Revision as of 17:09, 20 August 2013

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