TACHYCARDIA

TACHYCARDIA: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the Following Questions:

1. Is there a positive alcohol or drug history? It is well known that alcohol can cause a myocardiopathy. Atropine, caffeine, and many other substances can cause a tachycardia.
2. Is the heart rate below 160 and/or reduced by carotid sinus massage? This finding would help confirm the diagnosis of sinus tachycardia and lead to a consideration of fever, thyrotoxicosis, shock, anemia, myocardial infarction, and other disorders as the cause of the tachycardia.
3. Is there fever? The presence of fever and tachycardia should make one suspect acute infectious diseases, rheumatic fever, and thyroid storm.
4. Is there a tremor, neck mass, or systolic hypertension? These findings suggest thyrotoxicosis.
5. Is there chest pain? The presence of chest pain should make one suspect myocardial infarction, pulmonary embolism, and acute pericarditis.
6. Is there pallor or sweating? The presence of pallor or sweating should make one think of anemia and shock.
7. Are there crepitant rales, an enlarged liver, or peripheral edema? These findings suggest congestive heart failure.
8. Is there hypotension? The presence of hypotension should make one think that there may be a pathologic tachycardia such as supraventricular tachycardia, auricular flutter, or auricular fibrillation. Auricular fibrillation is especially likely to be associated with significant hypotension.
9. Is the rate irregular? The presence of an irregular heart rate should make one suspect auricular fibrillation, or alternating flutter and fibrillation.

DIAGNOSTIC WORKUP

Routine diagnostic tests should include a CBC, sedimentation rate, urinalysis, chemistry panel, toxicology screen, thyroid profile, ANA titer, VDRL test, chest x-ray, and EKG. If there is fever, then an ASO titer and CRP, febrile agglutinins, and serial blood cultures should be done.

If a myocardial infarction is suspected, serial EKGs and cardiac enzymes need to be ordered. If a pulmonary embolism or infarction is suspected, arterial blood gases and lung scans need to be ordered, and, ultimately, pulmonary angiography may need to be done.

If congestive heart failure is suspected, a venous pressure and circulation time and possibly pulmonary function studies may be done. Echocardiography may be done to determine the LVEF.

If the tachycardia is paroxysmal, 24-hr Holter monitoring or admission to the hospital for ambulatory telemetry and observation may be necessary. A cardiologist should be consulted. Ultimately, a psychiatrist may need to be consulted also.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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• Back to disease: Tachycardia: Introduction
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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