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ULY CLINIC

29 Oktoba 2026, 11:47:32

Tachycardia

Tachycardia is defined as a heart rate exceeding 100 beats per minute. It is easily detected by counting the apical, carotid, or radial pulse. Patients often report palpitations or a “racing” heart. While commonly triggered by emotional or physical stress (exercise, anxiety, pain, or fever) or stimulants (caffeine, tobacco), tachycardia may also indicate serious, life-threatening disorders such as cardiogenic, hypovolemic, or septic shock. Other causes include cardiovascular, respiratory, metabolic disorders, drugs, and medical interventions.

Pathophysiology

Increased heart rate to maintain oxygen delivery: Tachycardia reflects the heart’s attempt to deliver more oxygen to tissues by increasing cardiac output.
Overstimulation of cardiac conduction system: Enhanced activity in the sinoatrial node, atria, atrioventricular node, or ventricles can cause rapid heartbeats.
Reduced ventricular filling time: Elevated heart rate decreases stroke volume, which may reduce overall cardiac output and tissue perfusion.
Myocardial oxygen imbalance: Tachycardia increases oxygen demand while shortening diastole, which can worsen ischemia.

History and Physical Examination

History

Onset, duration, and triggers (exercise, stress, fever, stimulants).
Symptoms: palpitations, dizziness, syncope, fatigue, dyspnea, chest pain.
Medical history: cardiac, pulmonary, thyroid disorders; diabetes; trauma.
Medication and substance history: prescription, OTC, illicit drugs, alcohol, caffeine.

Physical Examination

Vital signs: pulse rate, blood pressure, respiratory rate, temperature.
Skin: pallor, cyanosis, clamminess.
Cardiovascular: pulse quality, peripheral edema, jugular vein distension.
Auscultation: heart rhythm abnormalities, murmurs, gallops; lung sounds.
Level of consciousness (LOC) and mental status.

Medical causes

Cause	Onset	Key Features	Associated Signs	Pathophysiology	Management
Acute Respiratory Distress Syndrome (ARDS)	Acute	Tachycardia, dyspnea	Crackles, rhonchi, cyanosis, decreased LOC	Hypoxemia triggers sympathetic response	Oxygen therapy, mechanical ventilation, treat underlying cause
Adrenocortical insufficiency	Gradual	Weak pulse, fatigue, tachycardia	Abdominal pain, nausea, hypotension, bronze skin, syncope	Cortisol deficiency → hypotension, reduced vascular tone	Corticosteroid replacement, fluid support, monitor electrolytes
Anaphylactic shock	Sudden	Tachycardia, hypotension	Urticaria, pruritus, dyspnea, stridor, angioedema	Massive histamine release → vasodilation, increased heart rate	Epinephrine, oxygen, IV fluids, airway support
Anemia	Gradual	Bounding pulse, tachycardia	Pallor, fatigue, dyspnea, bleeding tendencies	Reduced oxygen-carrying capacity → compensatory tachycardia	Treat underlying cause (iron, B12, blood transfusion)
Aortic insufficiency	Gradual	“Water-hammer” pulse, tachycardia	Diastolic murmur, dyspnea, angina, pallor	Regurgitant flow → increased stroke volume and heart rate	Surgical repair/replacement, medical therapy for heart failure
Aortic stenosis	Gradual	Tachycardia, weak pulse	Crescendo-decrescendo systolic murmur, exertional dyspnea, syncope	Obstructed outflow → compensatory tachycardia	Valve replacement, symptom management
Cardiac arrhythmias	Variable	Irregular heart rhythm, tachycardia	Hypotension, dizziness, palpitations, fatigue	Abnormal conduction → rapid ventricular response	Antiarrhythmic drugs, cardioversion, pacemaker if indicated
Cardiac contusion	Acute	Tachycardia, chest pain	Dyspnea, palpitations, sternal ecchymosis	Myocardial injury from blunt trauma	Supportive care, monitor cardiac function, ECG
Cardiac tamponade	Acute	Tachycardia, paradoxical pulse	Hypotension, distended jugular veins, muffled heart sounds	Pericardial fluid → impaired ventricular filling	Pericardiocentesis, surgical intervention
Cardiogenic shock	Acute	Weak, thready pulse, tachycardia	Hypotension, cyanosis, oliguria, altered LOC	Reduced cardiac output → tissue hypoperfusion	Oxygen, IV fluids, inotropes, treat underlying cause
Cholera	Acute	Tachycardia, dehydration	Watery diarrhea, vomiting, hypotension, muscle cramps	Fluid/electrolyte loss → hypovolemia	Aggressive fluid/electrolyte replacement, antibiotics if indicated
COPD	Chronic	Tachycardia	Dyspnea, cough, cyanosis, accessory muscle use	Chronic hypoxemia → sympathetic stimulation	Bronchodilators, oxygen, pulmonary rehab
Diabetic ketoacidosis (DKA)	Acute	Tachycardia, thready pulse	Kussmaul respirations, fruity breath, nausea, vomiting, LOC changes	Acidosis → sympathetic activation	IV fluids, insulin therapy, electrolyte correction
Heart failure	Chronic	Tachycardia	Dyspnea, fatigue, orthopnea, peripheral edema	Compensatory response to low cardiac output	Diuretics, ACE inhibitors, beta-blockers, lifestyle management
Hyperosmolar hyperglycemic nonketotic syndrome	Acute	Tachycardia	Hypotension, severe dehydration, seizures	Extreme hyperglycemia → osmotic diuresis, hypovolemia	IV fluids, insulin, electrolyte correction
Hypertensive crisis	Acute	Tachycardia	Pulmonary edema, chest pain, headache, seizures	Extreme BP → sympathetic overactivity	Rapid BP control, ICU monitoring
Hypoglycemia	Acute	Tachycardia, nervousness	Sweating, weakness, blurred vision, altered LOC	Low glucose → sympathetic activation	Rapid glucose administration, monitor blood sugar
Hypovolemia / Hypovolemic shock	Acute	Tachycardia, thready pulse	Hypotension, pallor, oliguria, syncope	Decreased circulating volume → compensatory tachycardia	IV fluids, blood transfusion if needed
Neurogenic shock	Acute	Tachycardia/bradycardia	Warm, dry skin, hypotension, decreased LOC	Loss of sympathetic tone → variable HR	Supportive care, fluids, vasopressors
Orthostatic hypotension	Acute	Tachycardia upon standing	Dizziness, syncope, pallor, blurred vision	Rapid positional change → compensatory HR increase	Slow positional changes, treat underlying cause
Pneumothorax	Acute	Tachycardia	Dyspnea, unilateral chest pain, cyanosis	Lung collapse → hypoxia and sympathetic activation	Needle decompression or chest tube insertion
Pulmonary embolism	Acute	Tachycardia	Sudden dyspnea, chest pain, cyanosis	Obstruction → right heart strain → sympathetic activation	Anticoagulation, thrombolysis if indicated
Thyrotoxicosis	Gradual	Tachycardia, bounding pulse	Heat intolerance, weight loss, tremors, palpitations	Excess thyroid hormones → increased metabolism and sympathetic activity	Antithyroid drugs, beta-blockers, definitive therapy

Other causes

Diagnostic procedures: Cardiac catheterization, electrophysiologic studies.
Drugs and stimulants: Sympathomimetics, atropine, thyroid drugs, beta-agonists, hydralazine, nitrates, caffeine, alcohol.
Surgery and pacemakers: Post-cardiac surgery or device-related irritation/malfunction.

Emergency interventions

Assess airway, breathing, circulation (ABCs).
Obtain vital signs and level of consciousness.
Initiate oxygen therapy and cardiac monitoring.
Insert IV line for fluids, medications, or blood products.
Prepare resuscitation equipment; be ready for antiarrhythmic therapy or cardioversion if indicated.

Special considerations

Monitor ECG, electrolytes, thyroid function, hemoglobin, hematocrit.
Prepare for ambulatory ECG or electrophysiologic studies if recurrent episodes occur.
Educate the patient on recurrence risk, antiarrhythmic therapy, internal defibrillator, or ablation therapy.

Patient counseling

Discuss possible recurrence and triggers.
Advise on medication adherence, lifestyle modifications, and monitoring for warning signs (syncope, palpitations, chest pain).
Educate about when to seek emergency care.

Pediatric pointers

Recognize that normal heart rates are higher in children, so tachycardia thresholds vary by age.
Pediatric tachycardia may arise from fever, dehydration, infection, congenital heart disease, or anxiety, in addition to adult causes.

References

Berkowitz CD. Berkowitz’s Pediatrics: A Primary Care Approach. 4th ed. American Academy of Pediatrics; 2012.
Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. Mosby Elsevier; 2008.
Colyar MR. Well-Child Assessment for Primary Care Providers. F.A. Davis; 2003.
Lehne RA. Pharmacology for Nursing Care. 7th ed. Saunders Elsevier; 2010.
McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Mosby Elsevier; 2010.
Sommers MS, Brunner LS. Pocket Diseases. F.A. Davis; 2012.
Berkowitz CD. Berkowitz’s Pediatrics: A Primary Care Approach. 4th ed. American Academy of Pediatrics; 2012.
Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis, MO: Mosby Elsevier; 2008.
Colyar MR. Well-child Assessment for Primary Care Providers. Philadelphia, PA: F.A. Davis; 2003.
Lehne RA. Pharmacology for Nursing Care. 7th ed. St. Louis, MO: Saunders Elsevier; 2010.
McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Maryland Heights, MO: Mosby Elsevier; 2010.
Sommers MS, Brunner LS. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.

Disclaimer: The information on this website is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional for medical concerns or emergencies.