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.)

Action stat!

After detecting 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. Perform electrocardiography (ECG) to assess cardiac rhythm. Insert an I.V. catheter for fluid, blood product, and drug administration, and gather emergency resuscitation equipment.

History and physical examination

If the patient's condition permits, take a focused history. Find out if he has had palpitations in the past. If so, how were they treated? Explore associated symptoms. Is the patient 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. Also, obtain an alcohol and drug history, including prescription, over-the-counter, and illicit drugs.

Inspect the patient's skin for pallor or cyanosis. Assess pulses, noting peripheral edema. Finally, auscultate the heart and lungs for abnormal sounds or rhythms.

Medical causes

Acute respiratory distress syndrome (ARDS).Besides tachycardia, ARDS causes crackles, rhonchi, dyspnea, tachypnea, nasal flaring, and grunting respirations. Other findings include cyanosis, anxiety, 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. Some patients report an enhanced sense of taste, smell, and hearing.

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 characteristics of 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.

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 the second heart sound; 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 sign (a murmur 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 are exertional dyspnea, angina, dizziness, and syncope. Aortic stenosis 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, decreased LOC, and pale, cool, clammy skin.

Cardiac contusion.Cardiac 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, pericardial friction rub, chest pain, hypotension, narrowed pulse pressure, and hepatomegaly.

Cardiogenic shock.With cardiogenic shock, tachycardia is accompanied by a weak, thready pulse; narrowing pulse pressure; hypotension; tachypnea; cold, pale, clammy, and cyanotic skin; oliguria; restlessness; and altered LOC.

Cholera.Cholera causes abrupt watery diarrhea and vomiting, which leads to severe fluid and electrolyte loss, causing 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.Life-threatening diabetic ketoacidosis commonly produces tachycardia and a thready pulse. Its cardinal sign, however, is Kussmaul's respirations—abnormally rapid, deep breathing. Other signs and symptoms of acidosis include fruity breath odor, orthostatic hypotension, generalized weakness, anorexia, nausea, vomiting, and abdominal pain. The patient's LOC may vary from lethargy to coma.

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 (HHNS).With HHNS, 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 accompanies 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 decreased LOC.

Hypovolemia.Tachycardia occurs 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 decreased LOC.

Neurogenic shock.Tachycardia or bradycardia may accompany tachypnea, apprehension, oliguria, variable body temperature, 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.

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.

Thyrotoxicosis.Tachycardia is a classic feature of thyrotoxicosis—a thyroid disorder. Others 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; his 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; 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's cardiovascular status and vital signs closely.

▪ Administer medications or fluids to control heart rate.

▪ Prepare the patient for diagnostic tests, such as a thyroid panel, electrolyte and hemoglobin levels, hematocrit, pulmonary function studies, 12-lead ECG, if appropriate, an ambulatory ECG.

Patient teaching

▪ Educate the patient about the possibility of the tachyarrhythmia recurring.

▪ Explain that an antiarrhythmic and an internal defibrillator or ablation therapy may be indicated for symptomatic tachycardia.

▪ Discuss the underlying cause of the tachycardia and its treatments.

▪ Explain medications, their proper dosage and administration, and possible adverse effects.

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Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Palpitations: Introduction (review 510 causes)
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More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

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