A Family Doctor's Tale - TACHYCARDIA

DOC I HAVE TACHYCARDIA


Tachycardia is a symptom defined as heart rate above 100 per minute.

Causes of Tachycardia:

1.Abnormality of the sinus or atrial node in the heart may be continuous or paroxymal in nature

2.Abnormalities of the ventricular conducting system: a.ischemic heart disease b.congenital heart disease

3.Underlying systemic disease:

a.fever

b.anemia

c.thyrotoxicosis

4.Medicines:

a.ephedrine or pseudoephedrine

b.asthmatic drugs like ventolin or bricanyl

c.anticholinergic drugs like atropine, buscopan

5.Psychosomatic like anxiety, emotional upsets, panic attacks

Symptoms:

.palpitations

2.breathlessness

3.fainting

4.polyuria

Signs:

1.heart beat above 100 per minute

2.abnormal heart rhythm

3.ECG will determine

a.location of stimulus of fast heart beat

b.abnormal rhythm -flutter or fibrillation

Treatment of Tachycardia is:


1. Atrial tachycardia can be slowed by carotid sinus massage or Valsalva maneuver

2. Paroxysmal atrial Tachycardia can be terminated by vagal stimulation maneuvers (Valsalva or carotid sinus pressure).

3.Acute atrial attacks if not improved after vagal massage can be treated with: a.digoxin

b.beta blockers such as propanolol or atenolol

c.calcium channel blockers like nefidipine

d.anti-cholinesterase like edrophonium

e.alpha blockers

4.Persistent atrial tachycardia can be treated with a.quinidine, b.beta blockers or c.digoxin or dilatrend

5.Ventricular tachycardia is more dangerous usually associated with coronary heart disease or infarction may be treated with:

a.lidocaine 1-2mg per kg stat followed by infusion of 2-4 mg per kg per min

b.Electo-cardioversion

c.radiofrequency ablation

6. Treat underlying conditions such as thyrotoxicosis

7. No smoking, alcohol or caffiene intake

8.No strenuous exertion or stress

Prognosis:

1.atrial tachycardia may occur in normal young adults and may not indicate heart disease

2.Ventricular tachycardia may herald more serious illness such as life threatening arrthythmia or infarction