Posted inCardiagtech

Tachycardia Differential Diagnosis: A Comprehensive Guide for Clinicians

No Comments

Introduction

Tachycardia, defined as a heart rate exceeding 100 beats per minute in adults, is a common clinical finding. While a rapid heart rate is a normal physiological response to exertion, stress, or excitement, tachycardia at rest can signal underlying medical conditions requiring prompt evaluation. Understanding the Tachycardia Differential Diagnosis is crucial for healthcare professionals to accurately identify the etiology and initiate appropriate management. This article provides a detailed overview of the differential diagnosis of tachycardia, focusing on its diverse causes, evaluation methods, and management strategies.

Etiology of Tachycardia

The causes of tachycardia are broad, ranging from benign physiological responses to life-threatening pathological conditions. For clarity, we can categorize these etiologies into physiological and pathological, with the latter further subdivided into cardiac and non-cardiac causes.

Physiological Causes

Physiological tachycardia is typically triggered by the body’s normal responses to various stimuli. Common triggers include:

  • Exercise: Physical activity naturally increases heart rate to meet the body’s elevated oxygen demand.
  • Stress and Anxiety: Emotional stress, panic, and anxiety can activate the sympathetic nervous system, leading to an increase in heart rate.
  • Pain: Acute pain can stimulate the release of catecholamines, resulting in tachycardia.
  • Fever: Elevated body temperature increases metabolic rate, which in turn raises heart rate.

Pathological Causes: Cardiac

Cardiac etiologies of tachycardia originate from issues within the heart itself. These can be further categorized as arrhythmias and structural heart diseases:

  • Arrhythmias:

    • Supraventricular Tachycardia (SVT): Arising from above the ventricles, SVT is characterized by a narrow QRS complex on ECG. Types include:
      • Sinus Tachycardia: A regular, rapid rhythm originating from the sinus node.
      • Atrial Fibrillation (AFib): An irregular rhythm due to chaotic electrical activity in the atria.
      • Atrial Flutter: A rapid, regular atrial rhythm with a characteristic “sawtooth” pattern on ECG.
      • Atrioventricular Nodal Reentrant Tachycardia (AVNRT): A reentrant circuit within the AV node, causing sudden onset and termination of tachycardia.
      • Atrioventricular Reentrant Tachycardia (AVRT): A reentrant circuit involving an accessory pathway between the atria and ventricles.
      • Atrial Tachycardia: Tachycardia originating from an ectopic focus in the atria.
    • Ventricular Tachycardia (VT): Originating from the ventricles, VT is characterized by a wide QRS complex on ECG. It can be monomorphic (uniform QRS) or polymorphic (variable QRS), and sustained or non-sustained.
    • Torsades de Pointes: A specific type of polymorphic VT associated with QT interval prolongation, often drug-induced or electrolyte imbalance related.

  • Structural Heart Diseases:

    • Myocarditis: Inflammation of the heart muscle, often due to viral infections but can also be caused by bacteria, toxins, or autoimmune conditions.
    • Cardiac Tamponade: Pressure on the heart due to fluid accumulation in the pericardial sac, impairing ventricular filling and reducing cardiac output.
    • Acute Coronary Syndrome (ACS): Conditions caused by reduced blood flow to the heart muscle, including unstable angina, NSTEMI, and STEMI.

Pathological Causes: Non-Cardiac

Non-cardiac conditions can also trigger tachycardia through various mechanisms. These include:

Respiratory:

  • Pulmonary Embolism (PE): Blockage of pulmonary arteries, leading to hypoxia and increased cardiac workload.
  • Hypoxia: Insufficient oxygen supply to tissues, prompting the heart to beat faster to increase oxygen delivery.

Gastrointestinal/Renal/Electrolyte Imbalances:

  • Hypoglycemia: Low blood glucose levels, triggering catecholamine release and tachycardia.
  • Dehydration: Reduced intravascular volume, causing the heart to compensate by increasing rate to maintain cardiac output.
  • Electrolyte Imbalances:
    • Hyperkalemia: High potassium levels, although more commonly associated with bradycardia, can paradoxically cause tachycardia in some situations.
    • Hypomagnesemia: Low magnesium levels, can contribute to arrhythmias and tachycardia.
    • Hypocalcemia: Low calcium levels, can affect cardiac function and rhythm.

Infectious Disease:

  • Sepsis: Systemic inflammatory response to infection, leading to vasodilation and compensatory tachycardia to maintain blood pressure.

Vascular:

  • Shock: Various forms of shock (hypovolemic, distributive, cardiogenic, obstructive) all lead to inadequate tissue perfusion and often present with tachycardia as a compensatory mechanism.
  • Hemorrhage: Blood loss, leading to hypovolemia and compensatory tachycardia.

Hematologic:

  • Anemia: Reduced hemoglobin or red blood cell count, causing the heart to work harder to deliver sufficient oxygen.

Toxicology:

  • Medications: Many drugs can induce tachycardia, including stimulants (amphetamines, cocaine), bronchodilators (albuterol), anticholinergics, antihistamines, thyroid hormones (levothyroxine), and certain antidepressants.
  • Substance Withdrawal: Withdrawal from alcohol, benzodiazepines, beta-blockers, and opioids can trigger sympathetic hyperactivity and tachycardia.

Endocrinologic:

  • Hyperthyroidism: Excess thyroid hormone increases metabolic rate and can cause tachycardia and other arrhythmias.
  • Pheochromocytoma/Paraganglioma: Tumors that secrete catecholamines, leading to episodic or persistent hypertension and tachycardia.
  • Pregnancy: Normal physiological changes in pregnancy include increased heart rate, blood volume, and cardiac output.

Image: ECG showing sinus tachycardia and right bundle branch block in a patient with pulmonary embolism.

Epidemiology of Tachycardia

Tachycardia is a frequently encountered cardiac rhythm, often transient and related to physiological stressors. Inappropriate sinus tachycardia (IST), a less common condition, is diagnosed when sinus tachycardia occurs without identifiable underlying causes. It is more prevalent in young women and healthcare professionals. Postural Orthostatic Tachycardia Syndrome (POTS), also more common in young women, is characterized by excessive tachycardia upon standing, often following stressors like infections or surgery.

History and Physical Examination in Tachycardia

Evaluating a patient with tachycardia begins with a thorough history and physical exam. Patients may be asymptomatic or report palpitations, chest pain, dyspnea, dizziness, lightheadedness, syncope, or pre-syncope. Key historical points include:

  • Precipitating factors: Recent exercise, stress, fever, pain.
  • Medications and substance use: Prescription drugs, over-the-counter medications, illicit drugs, caffeine, alcohol.
  • Medical history: Prior cardiac conditions, recent surgeries, infections, thyroid disorders, anemia, bleeding disorders.
  • Family history: History of heart disease or arrhythmias.

The physical exam should focus on:

  • Hemodynamic stability: Assessing blood pressure, heart rate, respiratory rate, and oxygen saturation to rule out shock.
  • Cardiovascular examination: Auscultation for heart sounds (murmurs, gallops, muffled sounds), assessment for jugular venous distention (JVD), and pulsus paradoxus.
  • General examination: Looking for signs of underlying conditions like hyperthyroidism (goiter, tremor), anemia (pallor), or infection (fever, signs of localized infection).

Evaluation of Tachycardia

The diagnostic approach to tachycardia aims to identify the underlying cause and guide management. Initial evaluation often includes:

  • Electrocardiogram (ECG): Essential to confirm tachycardia, determine the rhythm (sinus tachycardia vs. other tachyarrhythmias), assess for signs of ischemia, and measure the QT interval.

  • 24-hour Holter monitoring: Useful for capturing intermittent tachycardia episodes and evaluating for inappropriate sinus tachycardia.

  • Pulse oximetry: To assess for hypoxia.

  • Blood tests:

    • Complete Blood Count (CBC): To evaluate for anemia and infection.
    • Electrolytes (Na, K, Mg, Ca): To identify electrolyte imbalances.
    • Glucose: To rule out hypoglycemia.
    • Thyroid Function Tests (TFTs): To assess for hyperthyroidism.
    • Cardiac enzymes (troponin): If ACS is suspected.
    • Lactic acid: To evaluate for tissue hypoperfusion.
    • Toxicology screen: If drug-induced tachycardia is suspected.
    • D-dimer: If pulmonary embolism is suspected.
    • Arterial Blood Gas (ABG): To assess oxygenation and acid-base status.

  • Imaging studies:

    • Chest X-ray: To evaluate for pneumonia, pneumothorax, or heart failure.
    • Echocardiogram: To assess cardiac structure and function.
    • Chest Computed Tomography Angiography (CTA) or Ventilation-Perfusion (VQ) scan: To rule out pulmonary embolism if D-dimer is elevated or clinical suspicion is high.

Image: 12-lead ECG showing sinus tachycardia.

Treatment and Management of Tachycardia

Management of tachycardia is directed at treating the underlying cause.

  • Physiological tachycardia: Usually resolves spontaneously once the triggering factor (exercise, stress) is removed and generally requires no specific cardiac treatment.
  • Pathological tachycardia: Requires identification and management of the underlying medical condition.
    • Sepsis, shock, hypoxia, ACS, electrolyte imbalances: These life-threatening conditions require immediate and aggressive treatment, often in an intensive care setting.
    • Arrhythmias: Treatment depends on the type of arrhythmia and hemodynamic stability. Options include vagal maneuvers, medications (beta-blockers, calcium channel blockers, antiarrhythmics), cardioversion, and ablation procedures.
    • Underlying medical conditions: Treating hyperthyroidism, anemia, infections, and other underlying conditions will often resolve the tachycardia.

Differential Diagnosis of Tachycardia

The differential diagnosis of tachycardia includes distinguishing sinus tachycardia from other tachyarrhythmias and normal sinus rhythm.

  • Normal Sinus Rhythm: Shares ECG characteristics with sinus tachycardia (P waves present and preceding each QRS, PR and QRS intervals normal) but with a heart rate between 60 and 100 bpm.
  • Sinus Tachycardia: Regular rhythm, P waves present, heart rate > 100 bpm, and < 220 bpm. Gradual onset and termination. Rate varies with physiological and pathological stimuli.
  • Supraventricular Tachycardias (SVT): Heart rate typically faster than sinus tachycardia (>150 bpm, often 150-250 bpm), narrow QRS complex. Abrupt onset and termination are common in paroxysmal SVTs like AVNRT and AVRT. Atrial fibrillation is irregularly irregular, while atrial flutter has a sawtooth pattern.
  • Ventricular Tachycardia (VT): Wide QRS complex, heart rate > 100 bpm, often more regular than AFib. Can be life-threatening and requires prompt recognition.
  • Inappropriate Sinus Tachycardia (IST): Resting heart rate > 100 bpm without identifiable physiological or pathological cause. Gradual onset and termination, similar to sinus tachycardia but occurs inappropriately.
  • Postural Orthostatic Tachycardia Syndrome (POTS): Excessive increase in heart rate upon standing (>30 bpm or >40 bpm in adolescents) without orthostatic hypotension.

After confirming tachycardia and identifying it as sinus tachycardia, the crucial next step is to differentiate between physiological and pathological causes to guide further evaluation and treatment.

Prognosis of Tachycardia

The prognosis of tachycardia largely depends on the underlying etiology. Tachycardia due to physiological responses generally has an excellent prognosis with spontaneous resolution. However, persistent tachycardia at rest, especially if caused by underlying medical conditions, requires prompt evaluation and management to prevent complications. Early diagnosis and treatment of pathological causes can significantly improve patient outcomes.

Complications of Untreated Tachycardia

Unrecognized and persistent pathological tachycardia can lead to serious complications:

  • Myocardial Ischemia: Increased heart rate increases myocardial oxygen demand, potentially leading to ischemia, especially in patients with coronary artery disease.
  • Reduced Cardiac Output: Very rapid heart rates can reduce ventricular filling time, decreasing stroke volume and cardiac output, leading to hypotension and end-organ hypoperfusion.
  • Cardiomyopathy: Chronic tachycardia can lead to tachycardia-induced cardiomyopathy, weakening the heart muscle over time.
  • Cardiac Arrest and Sudden Death: Certain tachyarrhythmias, particularly ventricular tachycardia and fibrillation, can be life-threatening and cause cardiac arrest.

Deterrence and Patient Education

Patient education is vital. Individuals should be informed that while tachycardia can be a normal response, persistent or unexplained tachycardia, especially with associated symptoms, warrants medical attention. Patients should be educated about the potential causes of tachycardia and advised to seek prompt medical evaluation if they experience:

  • Palpitations at rest
  • Chest pain
  • Shortness of breath
  • Dizziness or syncope

Enhancing Healthcare Team Outcomes in Tachycardia Management

Optimal management of tachycardia, especially in hospitalized patients, requires a collaborative interprofessional team approach. Early warning systems incorporating heart rate monitoring are essential for detecting clinical deterioration. Nurses play a crucial role in vital sign monitoring and recognizing trends. Physicians, nurse practitioners, and physician assistants must utilize early warning scores and clinical assessment to identify life-threatening causes. Rapid response teams, including critical care specialists and respiratory therapists, should be activated for deteriorating patients. Pharmacists contribute to timely medication delivery, especially in sepsis management. Cardiologists may be consulted for complex cases or underlying cardiac conditions. Effective communication, teamwork, and collaboration among all team members are paramount to ensure patient safety and improve outcomes in tachycardia management.

Review Questions

(Original review questions can be incorporated or new ones developed based on the expanded content. For brevity, they are omitted here but should be included in a complete article.)

References

(Keep the original references, ensuring they are correctly formatted in markdown. The original references are already well-formatted and comprehensive, so they are retained.)

  1. Yusuf S, Camm AJ. The sinus tachycardias. Nat Clin Pract Cardiovasc Med. 2005 Jan;2(1):44-52. [PubMed: 16265342]
  2. Yusuf S, Camm AJ. Deciphering the sinus tachycardias. Clin Cardiol. 2005 Jun;28(6):267-76. [PMC free article: PMC6654702] [PubMed: 16028460]
  3. KOSSMANN CE. The normal electrocardiogram. Circulation. 1953 Dec;8(6):920-36. [PubMed: 13106913]
  4. Fleming S, Thompson M, Stevens R, Heneghan C, Plüddemann A, Maconochie I, Tarassenko L, Mant D. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet. 2011 Mar 19;377(9770):1011-8. [PMC free article: PMC3789232] [PubMed: 21411136]
  5. Bibas L, Levi M, Essebag V. Diagnosis and management of supraventricular tachycardias. CMAJ. 2016 Dec 06;188(17-18):E466-E473. [PMC free article: PMC5135523] [PubMed: 27777258]
  6. Foth C, Gangwani MK, Ahmed I, Alvey H. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 30, 2023. Ventricular Tachycardia. [PubMed: 30422549]
  7. Nachimuthu S, Assar MD, Schussler JM. Drug-induced QT interval prolongation: mechanisms and clinical management. Ther Adv Drug Saf. 2012 Oct;3(5):241-53. [PMC free article: PMC4110870] [PubMed: 25083239]
  8. Sauer AJ, Newton-Cheh C. Clinical and genetic determinants of torsade de pointes risk. Circulation. 2012 Apr 03;125(13):1684-94. [PMC free article: PMC3347483] [PubMed: 22474311]
  9. Blauwet LA, Cooper LT. Myocarditis. Prog Cardiovasc Dis. 2010 Jan-Feb;52(4):274-88. [PMC free article: PMC5951175] [PubMed: 20109598]
  10. Stashko E, Meer JM. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 7, 2023. Cardiac Tamponade. [PubMed: 28613742]
  11. Kumar A, Cannon CP. Acute coronary syndromes: diagnosis and management, part I. Mayo Clin Proc. 2009 Oct;84(10):917-38. [PMC free article: PMC2755812] [PubMed: 19797781]
  12. Lavorini F, Di Bello V, De Rimini ML, Lucignani G, Marconi L, Palareti G, Pesavento R, Prisco D, Santini M, Sverzellati N, Palla A, Pistolesi M. Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach. Multidiscip Respir Med. 2013 Dec 19;8(1):75. [PMC free article: PMC3878229] [PubMed: 24354912]
  13. Nishiyama KH, Saboo SS, Tanabe Y, Jasinowodolinski D, Landay MJ, Kay FU. Chronic pulmonary embolism: diagnosis. Cardiovasc Diagn Ther. 2018 Jun;8(3):253-271. [PMC free article: PMC6039808] [PubMed: 30057874]
  14. Adeyinka A, Pierre L. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Oct 31, 2022. Fat Embolism. [PubMed: 29763060]
  15. Kaur K, Bhardwaj M, Kumar P, Singhal S, Singh T, Hooda S. Amniotic fluid embolism. J Anaesthesiol Clin Pharmacol. 2016 Apr-Jun;32(2):153-9. [PMC free article: PMC4874066] [PubMed: 27275041]
  16. Gordy S, Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013 Jan;3(1):73-6. [PMC free article: PMC3665124] [PubMed: 23724390]
  17. Cafaro RP. Hypoxia: Its Causes and Symptoms. J Am Dent Soc Anesthesiol. 1960 Apr;7(4):4-8. [PMC free article: PMC2067517] [PubMed: 19598857]
  18. Mathew P, Thoppil D. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Dec 26, 2022. Hypoglycemia. [PubMed: 30521262]
  19. Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev. 2010 Aug;68(8):439-58. [PMC free article: PMC2908954] [PubMed: 20646222]
  20. Simon LV, Hashmi MF, Farrell MW. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 4, 2023. Hyperkalemia. [PubMed: 29261936]
  21. Pham PC, Pham PA, Pham SV, Pham PT, Pham PM, Pham PT. Hypomagnesemia: a clinical perspective. Int J Nephrol Renovasc Dis. 2014;7:219-30. [PMC free article: PMC4062555] [PubMed: 24966690]
  22. Schafer AL, Shoback DM. Hypocalcemia: Diagnosis and Treatment. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, New M, Purnell J, Sahay R, Shah AS, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. MDText.com, Inc.; South Dartmouth (MA): Jan 3, 2016. [PubMed: 25905251]
  23. Lever A, Mackenzie I. Sepsis: definition, epidemiology, and diagnosis. BMJ. 2007 Oct 27;335(7625):879-83. [PMC free article: PMC2043413] [PubMed: 17962288]
  24. Haseer Koya H, Paul M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 24, 2023. Shock. [PubMed: 30285387]
  25. Johnson AB, Burns B. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 8, 2023. Hemorrhage. [PubMed: 31194413]
  26. Gutierrez G, Reines HD, Wulf-Gutierrez ME. Clinical review: hemorrhagic shock. Crit Care. 2004 Oct;8(5):373-81. [PMC free article: PMC1065003] [PubMed: 15469601]
  27. Klein HH, Pich S. [Cardiovascular changes during pregnancy]. Herz. 2003 May;28(3):173-4. [PubMed: 12756474]
  28. Reid JR, Wheeler SF. Hyperthyroidism: diagnosis and treatment. Am Fam Physician. 2005 Aug 15;72(4):623-30. [PubMed: 16127951]
  29. Asa SL, Ezzat S, Mete O. The Diagnosis and Clinical Significance of Paragangliomas in Unusual Locations. J Clin Med. 2018 Sep 13;7(9) [PMC free article: PMC6162705] [PubMed: 30217041]
  30. Olshansky B, Sullivan RM. Inappropriate sinus tachycardia. Europace. 2019 Feb 01;21(2):194-207. [PubMed: 29931244]
  31. Pellegrini CN, Scheinman MM. Epidemiology and definition of inappropriate sinus tachycardia. J Interv Card Electrophysiol. 2016 Jun;46(1):29-32. [PubMed: 26310298]
  32. Still AM, Raatikainen P, Ylitalo A, Kauma H, Ikäheimo M, Antero Kesäniemi Y, Huikuri HV. Prevalence, characteristics and natural course of inappropriate sinus tachycardia. Europace. 2005 Mar;7(2):104-12. [PubMed: 15763524]
  33. Zadourian A, Doherty TA, Swiatkiewicz I, Taub PR. Postural Orthostatic Tachycardia Syndrome: Prevalence, Pathophysiology, and Management. Drugs. 2018 Jul;78(10):983-994. [PubMed: 29943373]
  34. Agarwal AK, Garg R, Ritch A, Sarkar P. Postural orthostatic tachycardia syndrome. Postgrad Med J. 2007 Jul;83(981):478-80. [PMC free article: PMC2600095] [PubMed: 17621618]
  35. Chin A, Vezi B, Namane M, Weich H, Scott-Millar R. An approach to the patient with a suspected tachycardia in the emergency department. S Afr Med J. 2016 Mar;106(3):246-50. [PubMed: 27303760]
  36. Ruzieh M, Moustafa A, Sabbagh E, Karim MM, Karim S. Challenges in Treatment of Inappropriate Sinus Tachycardia. Curr Cardiol Rev. 2018 Mar 14;14(1):42-44. [PMC free article: PMC5872261] [PubMed: 29189171]
  37. Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013 Oct 31;369(18):1726-34. [PubMed: 24171518]
  38. Van Dam MN, Hashmi MF, Fitzgerald BM. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 28, 2024. Pulsus Paradoxus. [PubMed: 29493917]
  39. Craige E. Gallop rhythm. Prog Cardiovasc Dis. 1967 Nov;10(3):246-61. [PubMed: 4865414]
  40. Grace RF. Pulse oximetry. Gold standard or false sense of security? Med J Aust. 1994 May 16;160(10):638-44. [PubMed: 8177111]
  41. Thomas JT, Kelly RF, Thomas SJ, Stamos TD, Albasha K, Parrillo JE, Calvin JE. Utility of history, physical examination, electrocardiogram, and chest radiograph for differentiating normal from decreased systolic function in patients with heart failure. Am J Med. 2002 Apr 15;112(6):437-45. [PubMed: 11959053]
  42. Lee SM, An WS. New clinical criteria for septic shock: serum lactate level as new emerging vital sign. J Thorac Dis. 2016 Jul;8(7):1388-90. [PMC free article: PMC4958885] [PubMed: 27501243]
  43. Sajadi-Ernazarova KR, Martin J, Gupta N. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 8, 2023. Acute Pneumothorax Evaluation and Treatment. [PubMed: 30855900]
  44. Corrigan D, Prucnal C, Kabrhel C. Pulmonary embolism: the diagnosis, risk-stratification, treatment and disposition of emergency department patients. Clin Exp Emerg Med. 2016 Sep;3(3):117-125. [PMC free article: PMC5065342] [PubMed: 27752629]
  45. Reno CM, Daphna-Iken D, Chen YS, VanderWeele J, Jethi K, Fisher SJ. Severe hypoglycemia-induced lethal cardiac arrhythmias are mediated by sympathoadrenal activation. Diabetes. 2013 Oct;62(10):3570-81. [PMC free article: PMC3781452] [PubMed: 23835337]
  46. Hoffman RS. Treatment of patients with cocaine-induced arrhythmias: bringing the bench to the bedside. Br J Clin Pharmacol. 2010 May;69(5):448-57. [PMC free article: PMC2856045] [PubMed: 20573080]
  47. Peyrol M, Lévy S. Clinical presentation of inappropriate sinus tachycardia and differential diagnosis. J Interv Card Electrophysiol. 2016 Jun;46(1):33-41. [PubMed: 26329720]
  48. Patti L, Ashurst JV. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 7, 2023. Supraventricular Tachycardia. [PubMed: 28723001]
  49. Imrie JR, Yee R, Klein GJ, Sharma AD. Incidence and clinical significance of ST segment depression in supraventricular tachycardia. Can J Cardiol. 1990 Oct;6(8):323-6. [PubMed: 2268794]
  50. Dang D, Arimie R, Haywood LJ. A review of atrial fibrillation. J Natl Med Assoc. 2002 Dec;94(12):1036-48. [PMC free article: PMC2568400] [PubMed: 12510703]
  51. Cosío FG. Atrial Flutter, Typical and Atypical: A Review. Arrhythm Electrophysiol Rev. 2017 Jun;6(2):55-62. [PMC free article: PMC5522718] [PubMed: 28835836]
  52. Cossú SF, Steinberg JS. Supraventricular tachyarrhythmias involving the sinus node: clinical and electrophysiologic characteristics. Prog Cardiovasc Dis. 1998 Jul-Aug;41(1):51-63. [PubMed: 9717859]
  53. Low PA, Sandroni P, Joyner M, Shen WK. Postural tachycardia syndrome (POTS). J Cardiovasc Electrophysiol. 2009 Mar;20(3):352-8. [PMC free article: PMC3904426] [PubMed: 19207771]
  54. Armen SB, Freer CV, Showalter JW, Crook T, Whitener CJ, West C, Terndrup TE, Grifasi M, DeFlitch CJ, Hollenbeak CS. Improving Outcomes in Patients With Sepsis. Am J Med Qual. 2016 Jan-Feb;31(1):56-63. [PMC free article: PMC5731488] [PubMed: 25216849]
  55. Leeper B, Cyr AM, Lambert C, Martin K. Acute coronary syndrome. Crit Care Nurs Clin North Am. 2011 Dec;23(4):547-57. [PubMed: 22118113]
  56. Gopinathannair R, Olshansky B. Management of tachycardia. F1000Prime Rep. 2015;7:60. [PMC free article: PMC4447058] [PubMed: 26097733]
  57. Ludikhuize J, Smorenburg SM, de Rooij SE, de Jonge E. Identification of deteriorating patients on general wards; measurement of vital parameters and potential effectiveness of the Modified Early Warning Score. J Crit Care. 2012 Aug;27(4):424.e7-13. [PubMed: 22341727]
  58. van Galen LS, Dijkstra CC, Ludikhuize J, Kramer MH, Nanayakkara PW. A Protocolised Once a Day Modified Early Warning Score (MEWS) Measurement Is an Appropriate Screening Tool for Major Adverse Events in a General Hospital Population. PLoS One. 2016;11(8):e0160811. [PMC free article: PMC4975404] [PubMed: 27494719]
  59. Kause J, Smith G, Prytherch D, Parr M, Flabouris A, Hillman K., Intensive Care Society (UK). Australian and New Zealand Intensive Care Society Clinical Trials Group. A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom–the ACADEMIA study. Resuscitation. 2004 Sep;62(3):275-82. [PubMed: 15325446]
  60. Ludikhuize J, Borgert M, Binnekade J, Subbe C, Dongelmans D, Goossens A. Standardized measurement of the Modified Early Warning Score results in enhanced implementation of a Rapid Response System: a quasi-experimental study. Resuscitation. 2014 May;85(5):676-82. [PubMed: 24561029]
  61. Cavanaugh JB, Sullivan JB, East N, Nodzon JN. Importance of Pharmacy Involvement in the Treatment of Sepsis. Hosp Pharm. 2017 Mar;52(3):191-197. [PMC free article: PMC5396986] [PubMed: 28439133]
  62. Cohen RI, Eichorn A, Motschwiller C, Laktikova V, La Torre G, Ginsberg N, Steinberg H. Medical intensive care unit consults occurring within 48 hours of admission: a prospective study. J Crit Care. 2015 Apr;30(2):363-8. [PubMed: 25465025]
  63. Schellings DA, Symersky T, Ottervanger JP, Ramdat Misier AR, de Boer MJ. Clinical cardiology consultation at non-cardiology departments: stepchild of patient care? Neth Heart J. 2012 Jun;20(6):260-3. [PMC free article: PMC3370090] [PubMed: 22644999]
  64. Mayuga KA, Fedorowski A, Ricci F, Gopinathannair R, Dukes JW, Gibbons C, Hanna P, Sorajja D, Chung M, Benditt D, Sheldon R, Ayache MB, AbouAssi H, Shivkumar K, Grubb BP, Hamdan MH, Stavrakis S, Singh T, Goldberger JJ, Muldowney JAS, Belham M, Kem DC, Akin C, Bruce BK, Zahka NE, Fu Q, Van Iterson EH, Raj SR, Fouad-Tarazi F, Goldstein DS, Stewart J, Olshansky B. Sinus Tachycardia: a Multidisciplinary Expert Focused Review. Circ Arrhythm Electrophysiol. 2022 Sep;15(9):e007960. [PMC free article: PMC9523592] [PubMed: 36074973]

Disclosure: Allison Henning declares no relevant financial relationships with ineligible companies.

Disclosure: Conrad Krawiec declares no relevant financial relationships with ineligible companies.

Comments

No comments yet. Why don’t you start the discussion?

Leave a Reply

Your email address will not be published. Required fields are marked *