Tachycardia
Tachycardia: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses
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.)
Emergency Actions
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.
History
If the patient’s condition permits, take a focused history. Find out if he has had palpitations before. 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.
Physical assessment
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
Besides tachycardia, acute respiratory distress syndrome (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.
Alcohol withdrawal syndrome
Tachycardia along with tachypnea, profuse diaphoresis, fever, insomnia, anorexia, and anxiety can occur in patients experiencing alcohol withdrawal. 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, a 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; cold, clammy skin; dry mouth; nausea; and light-headedness. The symptoms dissipate as anxiety resolves.
Aortic insufficiency
With aortic insufficiency, tachycardia is accompanied by 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, however, 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 a cardiac arrhythmia. 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
The result of blunt chest trauma, cardiac contusion may cause tachycardia, substernal pain, dyspnea, hypotension, 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
Although many features of cardiogenic shock also appear in other types of shock, they’re usually more profound in this type. Accompanying tachycardia are weak, thready pulse; narrowing pulse pressure; hypotension; tachypnea; cold, pale, clammy, and cyanotic skin; oliguria; restlessness; and altered LOC.
Chronic obstructive pulmonary disease
Although the clinical picture varies widely with chronic obstructive pulmonary disease (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
Diabetic ketoacidosis is a life-threatening disorder that commonly produces tachycardia and a thready pulse. Its cardinal sign, however, is Kussmaul’s respirations — abnormally rapid, deep breathing. Other signs and symptoms of diabetic ketoacidosis 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, chills, diaphoresis, headache, and weakness. 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
With hyperosmolar hyperglycemic nonketotic syndrome (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 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 decreased LOC.
Hypovolemia
Tachycardia may occur with hypovolemia. Associated findings include hypotension, decreased urine output, fatigue, muscle weakness, 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, increasingly rapid and thready. He may also develop hypotension, narrowed pulse pressure, oliguria, subnormal body temperature, and decreased LOC.
Hypoxemia
With hypoxemia, tachycardia may accompany tachypnea, dyspnea, and cyanosis. Confusion, restlessness, and disorientation may progress to coma and syncope. Incoordination may also occur.
Myocardial infarction
Myocardial infarction 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, decreased LOC, and warm, dry skin. Depending on the cause of shock, there also may be motor weakness of the limbs and diaphragm.
Orthostatic hypotension
Tachycardia accompanies the characteristic signs and symptoms of orthostatic hypotension, which include dizziness, syncope, pallor, blurred vision, diaphoresis, and nausea. Other signs and symptoms include dim vision, spots before the eyes and, possibly, signs of dehydration.
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; his blood pressure is normal or slightly decreased. Eventually, he may display anxiety; restlessness; thirst; oliguria or anuria; cool, clammy, cyanotic skin; rapid, thready pulse; and severe hypotension. His LOC may decrease progressively, perhaps culminating in a coma.
Thyrotoxicosis
Tachycardia is a classic feature of thyrotoxicosis. 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.
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.
Special considerations
Continue to 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.
Pediatric pointers
When examining a child for tachycardia, recognize that normal heart rates for children are higher than those for adults. (See Normal pediatric heart rates.) In children, tachycardia may result from many of the adult causes previously described.
Patient counseling
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.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
More About Tachycardia
More Medical Textbooks Online about Tachycardia
Review other book chapters online related to Tachycardia:
Medical Books Excerpts
- MURMURS
- "Differential Diagnosis in Primary Care" (2007)
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- Murmurs
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- Murmurs
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Palpitations
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Tachycardia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Palpitations
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- Tachycardia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- Murmurs
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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- Palpitations
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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- Tachycardia
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (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)
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- Murmurs
- "Nursing: Interpreting Signs and Symptoms" (2007)
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- MURMURS
- "Differential Diagnosis in Primary Care" (2007)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Heart Murmurs (Asymptomatic) (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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