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Supraventricular rhythms
Published in Andrew R Houghton, Making Sense of the ECG, 2019
Persistent ‘sinus tachycardia’ should lead to suspicion that the diagnosis may be incorrect – both atrial flutter and atrial tachycardia can, on casual inspection, be mistaken for sinus tachycardia. However, persistent ‘inappropriate’ sinus tachycardia is recognized as a clinical entity, referring to a persistent increase in daytime resting heart rate (>100/min) which is out of proportion to any clinical factors, and with an excessive increase in heart rate on physical activity. On ambulatory ECG monitoring, the overall average heart rate is typically >90/min. P wave morphology is normal. The condition is poorly understood, but it may result from enhanced automaticity within the SA node or from autonomic dysfunction. Inappropriate sinus tachycardia can be treated with rate-controlling drugs (such as beta blockers) or, in severe symptomatic cases, electrophysiological modification/ablation of the SA node. Careful exclusion of any underlying physiological factors (e.g. hyperthyroidism) is essential.
Recognition of common arrhythmias
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Nicholas P. Kerr, Rajesh N. Subbiah
Sinus tachycardia is defined as sinus rhythm at a rate greater than 100 bpm. Causes include pain, fever, hypovolaemia, hypoxia, anaemia, anxiety, decompensated heart failure, pulmonary embolism, hyperthyroidism and medications (e.g. beta-adrenoreceptor agonists). Management always involves identifying and treating reversible causes. Some patients have a rare condition called inappropriate sinus tachycardia. It typically affects young women and is defined as a resting heart rate of greater than 100 bpm, with a mean heart rate greater than 90 bpm over 24 hours. It is often associated with highly symptomatic palpitations. Reversible causes of sinus tachycardia and atrial tachycardia must be excluded. Beta-blockers, calcium channel blockers or ivabradine may be used to treat inappropriate sinus tachycardia, but sinus node modification by catheter ablation should generally be avoided.
Supraventricular rhythms
Published in Andrew R Houghton, David Gray, Making Sense of the ECG, 2014
Persistent ‘sinus tachycardia’ should lead to suspicion that the diagnosis may be incorrect – both atrial flutter and atrial tachycardia can, on casual inspection, be mistaken for sinus tachycardia. However, persistent ‘inappropriate’ sinus tachycardia is recognized as a clinical entity, referring to a persistent increase in daytime resting heart rate (>100/min) which is out of proportion to any clinical factors, and with an excessive increase in heart rate on physical activity. P wave morphology is normal. The condition is poorly understood, but it may result from enhanced automaticity within the SA node or from autonomic dysfunction. Inappropriate sinus tachycardia can be treated with rate-controlling drugs (such as beta blockers) or, in severe symptomatic cases, electrophysiological modification/ablation of the SA node. Careful exclusion of any underlying physiological factors (e.g. hyperthyroidism) is essential.
Duchenne muscular dystrophy: an overview to the cardiologist
Published in Expert Review of Cardiovascular Therapy, 2020
Fabio de Souza, Caroline Bittar Braune, Ana Paula Cassetta Dos Santos Nucera
The current guidelines published in 2018 by the DMD Care Considerations Working Group recommends cardiological evaluation since DMD diagnosis to identify incipient signs of heart disease. Follow-up should be annual for asymptomatic patients, becoming more frequent after the onset of symptoms or changes in imaging examinations [20]. Electrocardiographic evaluation is mandatory and irreplaceable for the cardiological evaluation of DMD patients. Changes on a traditional electrocardiogram include sinus tachycardia, short PR interval, increased amplitude of R waves in right precordial leads, electrical signs of right ventricular hypertrophy, and Q waves in left lateral and precordial leads (D1, aVL, V5, V6). Q waves are narrow and deep, differing from those found in patients with ischemic disease. Inappropriate sinus tachycardia is the most described finding [21]. It is also important to note that RSr’ pattern and high R waves in V1 can be common findings in children, with no association to heart disease [22,23]. However, the presence of left bundle branch block was associated with mortality in adult MV-dependent patients [24]. Significant arrhythmias in the 24-h Holter monitoring, including unsustainable atrial and ventricular tachycardia, were rare in patients with EF > 35%, with low clinical applicability in patients with preserved EF [25].
Summary of 2019 ESC Guidelines on chronic coronary syndromes, acute pulmonary embolism, supraventricular tachycardia and dislipidaemias
Published in Acta Cardiologica, 2021
Marc J. Claeys, Yves Vandekerckhove, Bernard Cosyns, Philippe Van de Borne, Patrizio Lancellotti
Inappropriate sinus tachycardia:first evaluation and treatment of reversible underlying causes (IC).beta blockers and/or Ivabradine should be considered (IIa).catheter ablation and calcium antagonists are not mentioned.
Postural orthostatic tachycardia syndrome: pathophysiology, management, and experimental therapies
Published in Expert Opinion on Investigational Drugs, 2022
Bharat Narasimhan, Devika Aggarwal, Priyanka Satish, Bharat Kantharia, Wilbert S. Aronow
POTS is an autonomic disorder, characterized by chronic orthostatic intolerance (>6 months) with an increase in heart rate by ≥30 bpm within 10 minutes of assuming an upright posture without associated orthostatic hypotension or other clear explanations for the tachycardia [2,3]. This is a distinct entity from other similar conditions including, neurocardiogenic syncope, and inappropriate sinus tachycardia.