Evaluation of tachycardia

fever or other signs of infection; weight loss and/or agitation (suggestive of hyperthyroidism); causes of anxiety or stress; fatigue or malaise (suggestive of anemia); drug use history; medication use, and dosage changes; orthostatic symptoms (volume depletion); if palpitations are felt, they have a gradual onset and gradual resolution; postural orthostatic tachycardia syndrome (POTS) is characterized by an exaggerated heart rate and orthostatic symptoms in response to postural change, in the absence of orthostatic hypotension and cardiac causes of sinus tachycardia

regular tachycardic pulse; skin pallor (anemia); lid lag, warm smooth skin (hyperthyroidism); hypotension or orthostasis (volume depletion); normal cardiac exam

often asymptomatic but history can include irregular palpitations, malaise, fatigue, chest pain, or dyspnea; may have history of alcohol misuse, use of stimulants or illicit stimulants, use of omega-3-acid ethyl esters in patients treated for hypertriglyceridemia, hyperthyroidism, pulmonary embolism, heart failure, lung disease, hypertension, or diabetes

normal physical exam in the absence of other concomitant pathologies, except for the presence of an irregularly irregular pulse; signs of heart failure, lung disease, hyperthyroidism, hypertension, or diabetes may be found

history can include palpitations, shortness of breath, fatigue, chest pain, dizziness, and stroke; due to rapidity of ventricular response, cerebral hypoperfusion can result in presyncope; may be asymptomatic; may have history of hypertension, coronary heart disease, rheumatic valvular disease, alcohol misuse, hyperthyroidism, or recent cardiothoracic surgery

normal physical exam in the absence of other concomitant pathologies, except for the presence of an irregularly irregular pulse; signs of heart failure, lung disease, hyperthyroidism, hypertension, or diabetes may be found

palpitations, dyspnea, fatigue, chest discomfort, or worsening exercise tolerance, or symptoms of heart failure; history of congenital heart disease; previous heart surgery; structural heart disease

normal physical exam except for a rapid pulse (usually regular, but can be irregular with AV block); suggestive of heart failure: jugular venous distension, lung crackles, and lower-extremity edema; hypotension in the context of rapid atrial flutter may provoke more urgent cardioversion

sudden-onset palpitations, dizziness, dyspnea, lightheadedness, or chest pressure or tightness; may have symptoms of infection or hyperthyroidism; may be on digoxin; may have taken stimulants

normal physical exam except for a rapid pulse (if the rhythm is occurring at that time); no orthostatic hypotension

episodic tachycardia with abrupt onset and termination; can be associated with symptoms of chest discomfort, dyspnea, dizziness, or anxiety; in the differentiation between narrow-complex regular tachycardias, a sensation of a regular rapid pounding in the neck is highly suggestive of AV node reentry

normal physical exam except for a rapid regular pulse

episodic tachycardia with abrupt onset and termination; can be associated with symptoms of chest discomfort, dyspnea, dizziness, syncope, or anxiety

normal physical exam except for a rapid regular pulse; suggestive of secondary cardiomyopathy: S3 gallop, right ventricular (RV) heave, laterally displaced point of maximal impulse, and other signs of heart failure (elevated jugular venous pressure, lung crackles, lower-extremity edema)

patients may report palpitations and malaise; history of pulmonary disease is highly suggestive of multifocal atrial tachycardia (MAT)

rapid irregular pulse; signs of pulmonary disease or hypoxia

postoperative junctional ectopic tachycardia (JET) is commonly seen following cardiac surgery and may at times lead to hemodynamic compromise due to the loss of A-V synchrony; congenital JET usually presents within the first 4 weeks of life and manifests with symptoms of heart failure; the tachycardia usually has a gradual onset or "warm up" pattern

often a regular rapid pulse; intermittent cannon A waves can be seen with atrioventricular dissociation in either type of JET; congenital JET can have physical signs of congestive heart failure due to tachycardia-mediated cardiomyopathy within the first 4 weeks of life

history of significant coronary artery disease or structural heart disease; symptoms are abrupt in onset or termination, and can be mild (such as dizziness, diaphoresis, dyspnea, palpitations) or more severe, including syncope, angina, or cardiogenic shock

rapid regular pulse, often with variable intensity depending on the degree of atrioventricular (AV) dissociation; during hemodynamically tolerated slow VT, cannon A waves, resulting from AV dissociation, are highly suggestive of ventricular tachyarrhythmia; examine for signs of heart failure (right ventricular heave, laterally displaced point of maximal impulse, elevated jugular vein pressure, S3 gallop, lung crackles, peripheral edema, ascites), which may predispose the patient to VT

symptoms are abrupt in onset or termination; intermittent palpitations can be associated with dizziness, diaphoresis, or dyspnea; may be triggered by emotional stress or exercise; symptoms suggestive of ischemic heart disease

rapid regular pulse, often with variable intensity depending on the degree of AV dissociation; during hemodynamically tolerated slow VT, cannon A waves, resulting from AV dissociation, are highly suggestive of ventricular tachyarrhythmia

often seen, but not limited to, patients with associated ischemic heart disease and ongoing ischemia; associated with rapid hemodynamic collapse and syncope; may have recent history of progressive angina, previous cardiac arrest, severe valvular disease, or depressed left ventricular systolic function

pulse absent; dramatic hemodynamic collapse and loss of consciousness

dizziness, diaphoresis, dyspnea, palpitations, syncope, and angina; a family history of juvenile sudden death or stress-induced syncope should raise suspicion for catecholaminergic polymorphic VT

peripheral pulses may have variable intensity depending on degree of AV dissociation; often associated with severe hypotension; cannon A waves, also resulting from AV dissociation, are highly suggestive of ventricular tachyarrhythmia

intermittent palpitations that can be associated with dizziness, diaphoresis, or dyspnea; may be triggered by emotional stress, exercise, caffeine intake, and menstrual variation; attention to symptoms that suggest ischemic heart disease; often seen in postoperative states or after a acute coronary event followed by reperfusion

peripheral pulses are regular and may have variable intensity depending on degree of AV dissociation; cannon A waves are also due to AV dissociation and are highly suggestive of ventricular tachyarrhythmia

rarely symptomatic, though patients may report intermittent rapid palpitations with abrupt onset or termination

normal physical exam, though the patient may have a rapid regular pulse

often asymptomatic; symptoms can include palpitations, fatigue, exercise intolerance, anxiety, or panic attacks; no history suggestive of hyperthyroidism, infection, anemia, volume depletion

normal physical exam except for a rapid pulse; specific attention to rule out causes of secondary sinus tachycardia such as hyperthyroidism, infection, anemia, volume depletion (test for orthostatic hypotension)

asymptomatic, though may present with palpitations or symptoms secondary to tachycardia-mediated cardiomyopathy, including malaise, edema, and dyspnea

normal physical exam, may have a rapid regular pulse; evaluate for impaired left ventricular systolic function, which may suggest a tachycardia-mediated cardiomyopathy with S3 gallop, right ventricular heave, laterally displaced point of maximal impulse, or other signs of heart failure (elevated jugular venous pressure, lower-extremity edema)

may report intermittent palpitations, syncope, seizures, or cardiac arrest; may have family history of juvenile sudden death and/or a history of using QT-prolonging medication; etiology usually secondary to either congenital or acquired QT interval prolongation

variable peripheral pulse intensity and cannon A waves, resulting from AV dissociation, though often no pulse is palpable given hemodynamic compromise; sensorineural deafness is associated with Jervell and Lange-Nielsen syndrome (autosomal recessive long-QT syndrome); neurologic exam may show focal deficits or other causes for increased intracranial pressure

assessment is time-critical, as delay in treatment may be fatal; digitalis toxicity or history of syncope in patient; history of sudden death in family members

rapid regular pulse, if palpable, due to hypotension; signs of hypoperfusion may be present, including changes in mental status

gradual onset and termination; symptoms consistent with acute myocardial infarction or history of angina; increased risk after thrombolytics or percutaneous coronary intervention for cardiac ischemia; history of digitalis use should be investigated, as accelerated idioventricular rhythm (AIVR) can suggest digitalis toxicity

bradycardia or mild tachycardia is possible with possible irregular rhythm (intermittent sinus capture); patient may be hypotensive given the lack of atrioventricular synchrony, and there may be evidence of AV dissociation (cannon A waves or carotid pulse intensity variation)

symptoms of orthostatic intolerance include: palpitations, lightheadedness, blurred vision, exercise intolerance (which may also be a non-orthostatic feature of POTS), presyncope and syncope, tremor, generalized weakness, fatigue (which may also be a non-orthostatic feature of POTS); non-orthostatic symptoms include: dyspnea, gastrointestinal symptoms, exercise intolerance, fatigue, headache, sleep disturbance, cognitive impairment, chest pain, bladder disturbance; may be symptoms of associated comorbidities, such as those of Ehlers-Danlos syndrome and autoimmune diseases, particularly Hashimotos thyroiditis and celiac disease

irregular heart rate, tachycardia, increased respiratory rate, generalized weakness; may be signs of associated comorbidities, such as those of Ehlers-Danlos syndrome and autoimmune diseases, particularly Hashimotos thyroiditis and celiac disease