Tachycardia
Easily detected by counting the apical, carotid, or radial pulse, tachycardia is a heart rate greater than 100 beats/minute. The patient with tachycardia usually complains of palpitations or of a “racing” heart. This common sign normally occurs in response to emotional or physical stress, such as excitement, exercise, pain, anxiety, and fever. It may also result from the use of stimulants, such as caffeine and tobacco. However, tachycardia may be an early sign of a life-threatening disorder, such as cardiogenic, hypovolemic, or septic shock. It may also result from a cardiovascular, respiratory, or metabolic disorder or from the effects of certain drugs, tests, or treatments. (See What happens in tachycardia.)
Act Now: After detecting tachycardia, first perform electrocardiography (ECG) to examine for reduced cardiac output, which may initiate or result from tachycardia. Take the patient’s other vital signs and determine his level of consciousness (LOC). If the patient has increased or decreased blood pressure and is drowsy or confused, administer oxygen and begin cardiac monitoring. Insert an I.V. line for fluid, blood product, and drug administration, and gather emergency resuscitation equipment.
Assessment
History
If the patient’s condition permits, obtain his medical history. Has he had palpitations before? If so, what treatment was he given? Explore associated symptoms: Is he dizzy or short of breath? Is he weak or fatigued? Is he experiencing episodes of syncope or chest pain? Next, ask about a history of trauma, diabetes, or cardiac, pulmonary, or thyroid disorders. Obtain a drug history, including prescription, over-the-counter, and illegal drugs, and ask whether the patient uses alcohol.
Physical examination
Inspect the patient’s skin for pallor, dehydration, or cyanosis. Assess pulses, noting peripheral edema. Assess the patient’s blood pressure. Finally, auscultate the heart and lungs for abnormal sounds or rhythms.
Pediatric pointers
When examining a child for tachycardia, remember that the normal heart rate for a child is higher than an adult’s heart rate. (See Normal pediatric vital signs, pages 292 and 293.) In a child, tachycardia may result from many of the adult causes described above.
Medical causes
See Tachycardia: Causes and associated findings, pages 288 to 291.
Acute respiratory distress syndrome (ARDS)
Besides tachycardia, ARDS causes crackles, rhonchi, dyspnea, tachypnea, nasal flaring, and grunting respirations. Other findings include cyanosis, anxiety, a decreased LOC, and abnormal chest X-ray findings.
Adrenocortical insufficiency
With adrenocortical insufficiency, tachycardia commonly occurs with a weak pulse as well as progressive weakness and fatigue, which may become so severe that the patient requires bed rest. Other signs and symptoms include abdominal pain, nausea and vomiting, altered bowel habits, weight loss, orthostatic hypotension, irritability, bronze skin, decreased libido, and syncope. The patient may report an enhanced sense of taste, smell, and hearing.
Alcohol withdrawal syndrome
Tachycardia can occur with tachypnea, profuse diaphoresis, fever, insomnia, anorexia, and anxiety. The patient is characteristically anxious, irritable, and prone to visual and tactile hallucinations.
Anaphylactic shock
With life-threatening anaphylactic shock, tachycardia and hypotension develop within minutes after exposure to an allergen, such as penicillin or an insect sting. Typically, the patient is visibly anxious and has severe pruritus, perhaps with urticaria and a pounding headache. Other findings may include flushed and clammy skin, cough, dyspnea, nausea, abdominal cramps, seizures, stridor, change or loss of voice associated with laryngeal edema, and urinary urgency and incontinence.
Anemia
Tachycardia and bounding pulse are characteristic with anemia. Associated signs and symptoms include fatigue, pallor, dyspnea and, possibly, bleeding tendencies. Auscultation may reveal an atrial gallop, a systolic bruit over the carotid arteries, and crackles.
Anxiety
A fight-or-flight response produces tachycardia, tachypnea, chest pain, nausea, and light-headedness. The symptoms dissipate as anxiety resolves.
Aortic insufficiency
Accompanying tachycardia with aortic insufficiency are a “water-hammer” bounding pulse and a large, diffuse apical heave. With severe insufficiency, widened pulse pressure occurs. Auscultation reveals a hallmark diastolic murmur that starts with S
2; is decrescendo, high-pitched, and blowing; and is heard best at the left sternal border of the second and third intercostal spaces. An atrial or ventricular gallop, an early systolic murmur, an Austin Flint murmur (apical diastolic rumble), or Duroziez’s murmur (heard over the femoral artery during systole and diastole) may also be heard. Other findings include angina, dyspnea, palpitations, strong and abrupt carotid pulsations, pallor, and signs of heart failure, such as crackles and jugular vein distention.
Aortic stenosis
Typically, aortic stenosis causes tachycardia; a weak, thready pulse; and an atrial gallop. Its chief features, however, are exertional dyspnea, angina, dizziness, and syncope. This valvular disorder also causes a harsh, crescendo-decrescendo systolic ejection murmur that’s loudest at the right sternal border of the second intercostal space. Other findings include palpitations, crackles, and fatigue.
Cardiac arrhythmias
Tachycardia may occur with an irregular heart rhythm. The patient may be hypotensive and report dizziness, palpitations, weakness, and fatigue. Depending on his heart rate, he may also exhibit tachypnea, a decreased LOC, and pale, cool, clammy skin.
Cardiac contusion
The result of blunt chest trauma, this contusion may cause tachycardia, substernal pain, dyspnea, and palpitations. Assessment may detect sternal ecchymoses and a pericardial friction rub.
Cardiac tamponade
With life-threatening cardiac tamponade, tachycardia is commonly accompanied by paradoxical pulse, dyspnea, and tachypnea. The patient is visibly anxious and restless and has cyanotic, clammy skin and distended jugular veins. He may develop muffled heart sounds, a pericardial friction rub, chest pain, hypotension, narrowed pulse pressure, and hepatomegaly.
Cardiogenic shock
Although many features of cardiogenic shock appear in other types of shock, they’re usually more profound in this type. Tachycardia is accompanied by narrowing pulse pressure, hypotension, tachypnea, oliguria, restlessness, and an altered LOC. The patient will also exhibit a weak, thready pulse and cold, pale, clammy, and cyanotic skin.
Cholera
Signs of cholera, an infectious disorder, include abrupt watery diarrhea and vomiting. Severe fluid and electrolyte loss leads to tachycardia, thirst, weakness, muscle cramps, decreased skin turgor, oliguria, and hypotension. Without treatment, death can occur within hours.
Chronic obstructive pulmonary disease (COPD)
Although the clinical picture varies widely with COPD, tachycardia is a common sign. Other characteristic findings include cough, tachypnea, dyspnea, pursed-lip breathing, accessory muscle use, cyanosis, diminished breath sounds, rhonchi, crackles, and wheezing. Clubbing and barrel chest are usually late findings.
Diabetic ketoacidosis (DKA)
A life-threatening disorder, DKA commonly produces tachycardia and a thready pulse. Its cardinal sign, however, is Kussmaul’s respirations — abnormally rapid, deep breathing. Other signs and symptoms of DKA include fruity breath odor, orthostatic hypotension, generalized weakness, anorexia, nausea, vomiting, and abdominal pain. The patient’s LOC may vary from lethargy to coma.
Febrile illness
Fever can cause tachycardia. Related findings reflect the specific disorder.
Heart failure
Especially common with left-sided heart failure, tachycardia may be accompanied by a ventricular gallop, fatigue, dyspnea (exertional and paroxysmal nocturnal), orthopnea, and leg edema. Eventually, the patient develops widespread signs and symptoms, such as palpitations, narrowed pulse pressure, hypotension, tachypnea, crackles, dependent edema, weight gain, slowed mental response, diaphoresis, pallor and, possibly, oliguria. Late signs include hemoptysis, cyanosis, and marked hepatomegaly and pitting edema.
Hyperosmolar hyperglycemic nonketotic syndrome
A rapidly deteriorating LOC is commonly accompanied by tachycardia, hypotension, tachypnea, seizures, oliguria, and severe dehydration with poor skin turgor and dry mucous membranes.
Hypertensive crisis
Life-threatening hypertensive crisis is characterized by tachycardia, tachypnea, diastolic blood pressure that exceeds 120 mm Hg, and systolic blood pressure that may exceed 200 mm Hg. Typically, the patient develops pulmonary edema with jugular vein distention, dyspnea, and pink, frothy sputum. Related findings include chest pain, severe headache, drowsiness, confusion, anxiety, tinnitus, epistaxis, muscle twitching, seizures, nausea, and vomiting. Focal neurologic signs, such as paresthesia, may also occur.
Hypoglycemia
A common sign of hypoglycemia, tachycardia is accompanied by hypothermia, nervousness, trembling, fatigue, malaise, weakness, headache, hunger, nausea, diaphoresis, and moist, clammy skin. Central nervous system effects include blurred or double vision, motor weakness, hemiplegia, seizures, and a decreased LOC.
Hyponatremia
Tachycardia, although rare, is a possible effect of hyponatremia, an electrolyte imbalance. Other effects include orthostatic hypotension, headache, muscle twitching and weakness, fatigue, oliguria or anuria, poor skin turgor, thirst, irritability, seizures, nausea and vomiting, and a decreased LOC that may progress to coma. Severe hyponatremia may cause cyanosis and signs of vasomotor collapse such as a thready pulse.
Hypovolemia
Tachycardia may occur with hypovolemia. Associated findings include hypotension, decreased skin turgor, sunken eyeballs, thirst, syncope, and dry skin and tongue.
Hypovolemic shock
Mild tachycardia, an early sign of life-threatening hypovolemic shock, may be accompanied by tachypnea, restlessness, thirst, and pale, cool skin. As shock progresses, the patient’s skin becomes clammy and his pulse becomes increasingly rapid and thready. He may also develop hypotension, narrowed pulse pressure, oliguria, subnormal body temperature, and a decreased LOC.
Hypoxemia
Tachycardia may accompany tachypnea, dyspnea, and cyanosis. Confusion, syncope, and incoordination may also occur.
Myocardial infarction (MI)
A life-threatening disorder, an MI may cause tachycardia or bradycardia. Its classic symptom, however, is crushing substernal chest pain that may radiate to the left arm, jaw, neck, or shoulder. Auscultation may reveal an atrial gallop, a new murmur, and crackles. Other signs and symptoms include pallor, clammy skin, dyspnea, diaphoresis, nausea and vomiting, anxiety, restlessness, and increased or decreased blood pressure.
Neurogenic shock
Tachycardia or bradycardia may accompany tachypnea, apprehension, oliguria, variable body temperature, a decreased LOC, and warm, dry skin.
Orthostatic hypotension
Tachycardia accompanies the characteristic signs and symptoms of orthostatic hypotension, which include dizziness, syncope, pallor, blurred vision, diaphoresis, and nausea.
Pheochromocytoma
Characterized by sustained or paroxysmal hypertension, pheochromocytoma is a rare tumor that may also cause tachycardia and palpitations. Other findings include headache; chest and abdominal pain; diaphoresis; pale or flushed, warm skin; paresthesia; tremors; nausea; vomiting; insomnia; and extreme anxiety — possibly even panic.
Pneumothorax
Life-threatening pneumothorax causes tachycardia and other signs and symptoms of distress, such as severe dyspnea and chest pain, tachypnea, and cyanosis. Related findings include dry cough, subcutaneous crepitation, absent or decreased breath sounds, cessation of normal chest movement on the affected side, and decreased vocal fremitus.
Pulmonary embolism
With pulmonary embolism, tachycardia is usually preceded by sudden dyspnea, angina, or pleuritic chest pain. Common associated signs and symptoms include weak peripheral pulses, cyanosis, tachypnea, low-grade fever, restlessness, diaphoresis, and a dry cough or a cough with blood-tinged sputum.
Septic shock
Initially, septic shock produces chills, sudden fever, tachycardia, tachypnea and, possibly, nausea, vomiting, and diarrhea. The patient’s skin is flushed, warm, and dry and his blood pressure is normal or slightly decreased. Eventually, he may display a rapid, thready pulse accompanied by anxiety, restlessness, thirst, oliguria or anuria, severe hypotension, and cool, clammy, cyanotic skin. His LOC may decrease progressively, perhaps culminating in a coma.
Thyrotoxicosis
Tachycardia is a classic feature of thyrotoxicosis, a thyroid disorder. Other signs and symptoms include an enlarged thyroid, nervousness, heat intolerance, weight loss despite increased appetite, diaphoresis, diarrhea, tremors, and palpitations. Although also considered characteristic, exophthalmos is sometimes absent.
Because thyrotoxicosis affects virtually every body system, its associated features are diverse and numerous. Some examples include full and bounding pulse, widened pulse pressure, dyspnea, anorexia, nausea, vomiting, altered bowel habits, hepatomegaly, and muscle weakness, fatigue, and atrophy. The patient’s skin is smooth, warm, and flushed; the hair is fine and soft and may gray prematurely or fall out. The female patient may have a reduced libido and oligomenorrhea or amenorrhea; the male patient may exhibit a reduced libido and gynecomastia.
Other causes
Diagnostic tests
Cardiac catheterization and electrophysiologic studies may induce transient tachycardia.
Drugs and alcohol
Various drugs affect the nervous system, circulatory system, or heart muscle, resulting in tachycardia. Examples of these include sympathomimetics; phenothiazines; anticholinergics, such as atropine; thyroid drugs; vasodilators, such as hydralazine and nifedipine; acetylcholinesterase inhibitors, such as captopril; nitrates, such as nitroglycerin; alpha-adrenergic blockers, such as phentolamine; and beta-adrenergic bronchodilators such as albuterol. Excessive caffeine intake and alcohol intoxication may also cause tachycardia.
Surgery and pacemakers
Cardiac surgery and pacemaker malfunction or wire irritation may cause tachycardia.
Nursing considerations
Monitor the patient closely. Explain ordered diagnostic tests, such as a thyroid panel, electrolyte and hemoglobin levels, hematocrit, pulmonary function studies, and 12-lead ECG. If appropriate, prepare him for an ambulatory ECG.
Patient teaching
Provide information about the possibility of the tachyarrhythmia recurring. Teach the patient to take his pulse and monitor his blood pressure at home. Explain the importance of following the medication regimen as prescribed, such as thyroid medication or antiarrhythmics. Explain dietary limitations such as caffeine and alcohol.
Explain that an antiarrhythmic and an internal defibrillator or ablation therapy may be indicated for symptomatic tachycardia.
Pictures
Book Source Details
- Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Atrial fibrillation
Read excerpts from these other book chapters related to Atrial fibrillation:
Medical Books Excerpts
- MURMURS
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Murmurs
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Bradycardia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Murmurs
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Palpitations
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Tachycardia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Bradycardia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Palpitations
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Tachycardia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Bradycardia
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Murmurs
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Palpitations
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Tachycardia
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Bradycardia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Murmurs
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Tachycardia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Murmurs
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- MURMURS
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2008 Williams & Wilkins.
More About Causes of Atrial fibrillation
» Next page: Pulsus paradoxus [Paradoxical pulse] (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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