Sinus tachycardia

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Sinus tachycardia
ECG Sinus Tachycardia 125 bpm.jpg
ECG of a 29-year-old female with sinus tachycardia with a heart rate of 125 bpm
Specialty Cardiology

Sinus tachycardia is a sinus rhythm of the heart, with an increased rate of electrical discharge from the sinoatrial node, resulting in a tachycardia, a heart rate that is higher than the upper limit of normal (90-100 beats per minute for adult humans). [1]

Contents

The normal resting heart rate is 60–90 bpm in an average adult. [2] Normal heart rates vary with age and level of fitness, from infants having faster heart rates (110-150 bpm) and the elderly having slower heart rates. [3] Sinus tachycardia is a normal response to physical exercise or other stress, when the heart rate increases to meet the body's higher demand for energy and oxygen, but sinus tachycardia can also be caused by a health problem. [4]

An elite athlete's heart recorded during a maximum effort workout maintaining over 180 bpm for 10 minutes.

Signs and symptoms

Tachycardia is often asymptomatic. It is often a resulting symptom of a primary disease state and can be an indication of the severity of a disease. [5] If the heart rate is too high, cardiac output may fall due to the markedly reduced ventricular filling time. [6] Rapid rates, though they may be compensating for ischemia elsewhere, increase myocardial oxygen demand and reduce coronary blood flow, thus precipitating an ischemic heart or valvular disease. [5] Sinus tachycardia accompanying a myocardial infarction may be indicative of cardiogenic shock.[ citation needed ]

Cause

Sinus tachycardia is usually a response to physiological stress, such as exercise, or an increased sympathetic tone with increased catecholamine release, such as stress, fright, flight, and anger. [5] Other causes include:

Diagnosis

A 12 lead ECG showing sinus tachycardia Sinustachy.JPG
A 12 lead ECG showing sinus tachycardia

Sinus tachycardia is usually apparent on an ECG, but if the 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:[ citation needed ]

Heart sounds should also be listened to. [13]

ECG characteristics

Inappropriate sinus tachycardia

In inappropriate sinus tachycardia (also known as chronic nonparoxysmal sinus tachycardia), patients have an elevated resting heart rate and/or exaggerated heart rate in response to exercise. These patients have no apparent heart disease or other causes of sinus tachycardia. IST is thought to be due to abnormal autonomic control.[ citation needed ] IST is a diagnosis of exclusion. [14]

Postural orthostatic tachycardia syndrome

Usually, in women with no heart problems, this syndrome is characterized by normal resting heart rate but exaggerated postural sinus tachycardia with or without orthostatic hypotension.[ citation needed ]

Metabolic myopathy

Upon exertion, sinus tachycardia can be seen in some inborn errors of metabolism that result in metabolic myopathies, such as McArdle Disease (GSD-V) [9] [12] and Hereditary myopathy with lactic acidosis (Larsson–Linderholm syndrome). [4] [15] Metabolic myopathies interfere with the muscle's ability to create energy. This energy shortage in muscle cells causes an inappropriate rapid heart rate response to exercise. The heart tries to compensate for the energy shortage by increasing heart rate to maximize delivery of oxygen and other blood borne fuels to the muscle cells. [9] [4]

In one such category of metabolic myopathies, muscle glycogenoses (muscle GSDs), individuals are unable to create energy from muscle glycogen, and depending on the muscle GSD, may not be able to utilize blood glucose within the muscle cell either. [9] As skeletal muscle relies predominantly on glycogenolysis for the first few minutes as it transitions from rest to activity, as well as throughout high-intensity aerobic activity and all anaerobic activity, individuals with glycogenoses experience during exercise: sinus tachycardia, tachypnea, muscle fatigue and pain, during the aforementioned activities and time frames. [9] [10] Notable in McArdle Disease (GSD-V) is the phenomenon of second wind where after approximately 6–10 minutes of aerobic exercise, such as walking without an incline, the heart rate drops as blood borne fuels, predominantly from free fatty acids, produce energy via oxidative phosphorylation. [9] [10] [16]

Rare diseases, such as McArdle disease, are often misdiagnosed. [9] The inappropriate rapid heart rate response to exercise may be misdiagnosed as inappropriate sinus tachycardia (which is a diagnosis of exclusion).

Treatment

Treatment for physiologic sinus tachycardia involves treating the underlying causes of the tachycardia response. Beta blockers may be used to decrease tachycardia in patients with certain conditions, such as ischemic heart disease and rate-related angina. In patients with inappropriate sinus tachycardia, careful titration of beta-blockers, salt loading, and hydration typically reduce symptoms. Patients who are unresponsive to such treatment can undergo catheter ablation to potentially repair the sinus node. [3]

Acute myocardial infarction (AMI)

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.[ citation needed ]

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.[ citation needed ]

Notes

    See also

    Related Research Articles

    <span class="mw-page-title-main">Bradycardia</span> Heart rate below the normal range

    Bradycardia, also called bradyarrhythmia, is a resting heart rate under 60 beats per minute (BPM). While bradycardia can result from various pathologic processes, it is commonly a physiologic response to cardiovascular conditioning or due to asymptomatic type 1 atrioventricular block.

    Kocher–Debré–Semelaigne syndrome (KDSS) is hypothyroidism in infancy or childhood characterised by lower extremity or generalized muscular hypertrophy, myxoedema, short stature, and cognitive impairment.

    <span class="mw-page-title-main">Tachycardia</span> Heart rate exceeding normal resting rate

    Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal or abnormal.

    <span class="mw-page-title-main">Glycogen storage disease type V</span> Human disease caused by deficiency of a muscle enzyme

    Glycogen storage disease type V, also known as McArdle's disease, is a metabolic disorder, one of the metabolic myopathies, more specifically a muscle glycogen storage disease, caused by a deficiency of myophosphorylase. Its incidence is reported as one in 100,000, roughly the same as glycogen storage disease type I.

    <span class="mw-page-title-main">Glycogen storage disease</span> Medical condition

    A glycogen storage disease is a metabolic disorder caused by a deficiency of an enzyme or transport protein affecting glycogen synthesis, glycogen breakdown, or glucose breakdown, typically in muscles and/or liver cells.

    <span class="mw-page-title-main">Sinus node dysfunction</span> Medical condition

    Sinus node dysfunction (SND), also known as sick sinus syndrome (SSS), is a group of abnormal heart rhythms (arrhythmias) usually caused by a malfunction of the sinus node, the heart's primary pacemaker. Tachycardia-bradycardia syndrome is a variant of sick sinus syndrome in which the arrhythmia alternates between fast and slow heart rates.

    <span class="mw-page-title-main">Palpitations</span> Perceived cardiac abnormality in which ones heartbeat can be felt

    Palpitations are perceived abnormalities of the heartbeat characterized by awareness of cardiac muscle contractions in the chest, which is further characterized by the hard, fast and/or irregular beatings of the heart.

    Alkalosis is the result of a process reducing hydrogen ion concentration of arterial blood plasma (alkalemia). In contrast to acidemia, alkalemia occurs when the serum pH is higher than normal. Alkalosis is usually divided into the categories of respiratory alkalosis and metabolic alkalosis or a combined respiratory/metabolic alkalosis.

    <span class="mw-page-title-main">Phosphoglucomutase</span> Metabolic enzyme

    Phosphoglucomutase is an enzyme that transfers a phosphate group on an α-D-glucose monomer from the 1 to the 6 position in the forward direction or the 6 to the 1 position in the reverse direction.

    Muscle fatigue is when muscles that were initially generating a normal amount of force, then experience a declining ability to generate force. It can be a result of vigorous exercise, but abnormal fatigue may be caused by barriers to or interference with the different stages of muscle contraction. There are two main causes of muscle fatigue: the limitations of a nerve’s ability to generate a sustained signal ; and the reduced ability of the muscle fiber to contract.

    <span class="mw-page-title-main">Postural orthostatic tachycardia syndrome</span> Abnormally high heart rate after a postural change

    Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon sitting up or standing. POTS is a disorder of the autonomic nervous system that can lead to a variety of symptoms, including lightheadedness, brain fog, blurred vision, weakness, fatigue, headaches, heart palpitations, exercise intolerance, nausea, diminished concentration, tremulousness (shaking), syncope (fainting), coldness or pain in the extremities, numbness or tingling in the extremities, chest pain, and shortness of breath. Other conditions associated with POTS include myalgic encephalomyelitis/chronic fatigue syndrome, migraine headaches, Ehlers–Danlos syndrome, asthma, autoimmune disease, vasovagal syncope, and mast cell activation syndrome. POTS symptoms may be treated with lifestyle changes such as increasing fluid, electrolyte, and salt intake, wearing compression stockings, gentle and slow postural changes, avoiding prolonged bedrest, medication, and physical therapy.

    <span class="mw-page-title-main">Exercise intolerance</span> Inability to perform physical exercise at normal levels

    Exercise intolerance is a condition of inability or decreased ability to perform physical exercise at the normally expected level or duration for people of that age, size, sex, and muscle mass. It also includes experiences of unusually severe post-exercise pain, fatigue, nausea, vomiting or other negative effects. Exercise intolerance is not a disease or syndrome in and of itself, but can result from various disorders.

    <span class="mw-page-title-main">Hitting the wall</span> Sudden fatigue during endurance sports

    In endurance sports such as road cycling and long-distance running, hitting the wall or the bonk is a condition of sudden fatigue and loss of energy which is caused by the depletion of glycogen stores in the liver and muscles. Milder instances can be remedied by brief rest and the ingestion of food or drinks containing carbohydrates. Otherwise, it can be remedied by attaining second wind by either resting for approximately 10 minutes or by slowing down considerably and increasing speed slowly over a period of 10 minutes. Ten minutes is approximately the time that it takes for free fatty acids to sufficiently produce ATP in response to increased demand.

    <span class="mw-page-title-main">Inappropriate sinus tachycardia</span> Syndrome where the sinus heart rate is inexplicably faster than expected

    Inappropriate sinus tachycardia (IST) is defined as sinus tachycardia that is not caused by identifiable medical ailments, a physiological reaction, or pharmaceuticals (a diagnosis of exclusion) and is accompanied by symptoms, frequently invalidating and affecting quality of life. IST symptoms include palpitations, chest discomfort, exhaustion, shortness of breath, presyncope, and syncope.

    Second wind is a phenomenon in endurance sports, such as marathons or road running, whereby an athlete who is out of breath and too tired to continue, finds the strength to press on at top performance with less exertion. The feeling may be similar to that of a "runner's high", the most obvious difference being that the runner's high occurs after the race is over. In muscle glycogenoses, an inborn error of carbohydrate metabolism impairs either the formation or utilization of muscle glycogen. As such, those with muscle glycogenoses do not need to do prolonged exercise to experience "hitting the wall". Instead, signs of exercise intolerance, such as an inappropriate rapid heart rate response to exercise, are experienced from the beginning of an activity, and some muscle GSDs can achieve second wind within about 10 minutes from the beginning of the aerobic activity, such as walking. (See below in pathology).

    <span class="mw-page-title-main">Inborn errors of carbohydrate metabolism</span> Medical condition

    Inborn errors of carbohydrate metabolism are inborn error of metabolism that affect the catabolism and anabolism of carbohydrates.

    <span class="mw-page-title-main">Syncope (medicine)</span> Transient loss of consciousness and postural tone

    Syncope, commonly known as fainting or passing out, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery. It is caused by a decrease in blood flow to the brain, typically from low blood pressure. There are sometimes symptoms before the loss of consciousness such as lightheadedness, sweating, pale skin, blurred vision, nausea, vomiting, or feeling warm. Syncope may also be associated with a short episode of muscle twitching. Psychiatric causes can also be determined when a patient experiences fear, anxiety, or panic; particularly before a stressful event, usually medical in nature. When consciousness and muscle strength are not completely lost, it is called presyncope. It is recommended that presyncope be treated the same as syncope.

    <span class="mw-page-title-main">Metabolic myopathy</span> Muscular diseases caused by defects in metabolic processes

    Metabolic myopathies are myopathies that result from defects in biochemical metabolism that primarily affect muscle. They are generally genetic defects that interfere with the ability to create energy, causing a low ATP reservoir within the muscle cell.

    <span class="mw-page-title-main">Arrhythmia</span> Group of medical conditions characterized by irregular heartbeat

    Arrhythmias, also known as cardiac arrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults – is called tachycardia, and a resting heart rate that is too slow – below 60 beats per minute – is called bradycardia. Some types of arrhythmias have no symptoms. Symptoms, when present, may include palpitations or feeling a pause between heartbeats. In more serious cases, there may be lightheadedness, passing out, shortness of breath, chest pain, or decreased level of consciousness. While most cases of arrhythmia are not serious, some predispose a person to complications such as stroke or heart failure. Others may result in sudden death.

    Hoffmann syndrome is a rare form of hypothyroid myopathy and is not to be confused with Werdnig-Hoffmann disease.

    References

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