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Is it really sinus tachycardia?

Mugmon M - J Community Hosp Intern Med Perspect (2011)

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Union Memorial Hospital, Baltimore, MD, USA.

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A 56-year-old male with a history of hypertension and coronary disease was admitted after complaining of mild shortness of breath and palpitations... He also had what was felt to have been either atrial flutter or AV nodal re-entrant tachycardia (AVNRT), which reverted to sinus rhythm with a dose of adenosine, followed by 3 months of amiodarone... The chest X-ray showed no cardiomegaly or vascular congestion and possible left basilar atelectasis... Echocardiography revealed mild concentric left ventricular hypertrophy and some evidence of reduced diastolic compliance, but no pericardial effusion or other abnormalities... Initial diagnostic measures were directed toward the usual causes of sinus tachycardia, such as anemia, dehydration, fever, pulmonary issues (pneumonia, pulmonary embolism), and thyroid disease... The relatively high hematocrit suggested dehydration and he was given intravenous fluids, but no significant heart rate drop was noted... The rate dropped abruptly from 125 to <60, suggesting that the initial rhythm was sinoatrial re-entrant tachycardia (SANRT) rather than sinus tachycardia... In SANRT, a re-entry circuit is localized to the SA node... This results in a P-wave that has normal morphology, occurring before a regular, narrow QRS complex... The only way it is possible to distinguish it from sinus tachycardia would be an observation of an abrupt onset or termination, which also occurs in other re-entry tachycardias, especially typical AV nodal re-entrant tachycardia (AVNRT)... One study demonstrated SANRT in <2% of 379 patients undergoing diagnostic electrophysiologic study... However, one author found a nearly 17% incidence in patients being studied, almost all of whom had concomitant organic heart disease... Other supraventricular tachyarrhythmias, such as atrial flutter and AVNRT, would demonstrate P-wave morphologies that differ from normal... Because of the relatively low frequency of the arrhythmia, no large pharmacologic studies are available and therapy is usually empiric and includes beta blockers, amiodarone, verapamil, and/or digitalis... Radiofrequency ablation can also be effective and may allow freedom from antiarrhythmic agents.

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Sinus rhythm replaces what was initially considered to be sinus tachycardia.
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Figure 0002: Sinus rhythm replaces what was initially considered to be sinus tachycardia.

Mentions: A follow-up electrocardiogram (Fig. 2) revealed sinus bradycardia, the only apparent difference from the admission tracing being the rate. The P-wave axis changed slightly but still was in the normal range.


Is it really sinus tachycardia?

Mugmon M - J Community Hosp Intern Med Perspect (2011)

Sinus rhythm replaces what was initially considered to be sinus tachycardia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3714029&req=5

Figure 0002: Sinus rhythm replaces what was initially considered to be sinus tachycardia.
Mentions: A follow-up electrocardiogram (Fig. 2) revealed sinus bradycardia, the only apparent difference from the admission tracing being the rate. The P-wave axis changed slightly but still was in the normal range.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Union Memorial Hospital, Baltimore, MD, USA.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 56-year-old male with a history of hypertension and coronary disease was admitted after complaining of mild shortness of breath and palpitations... He also had what was felt to have been either atrial flutter or AV nodal re-entrant tachycardia (AVNRT), which reverted to sinus rhythm with a dose of adenosine, followed by 3 months of amiodarone... The chest X-ray showed no cardiomegaly or vascular congestion and possible left basilar atelectasis... Echocardiography revealed mild concentric left ventricular hypertrophy and some evidence of reduced diastolic compliance, but no pericardial effusion or other abnormalities... Initial diagnostic measures were directed toward the usual causes of sinus tachycardia, such as anemia, dehydration, fever, pulmonary issues (pneumonia, pulmonary embolism), and thyroid disease... The relatively high hematocrit suggested dehydration and he was given intravenous fluids, but no significant heart rate drop was noted... The rate dropped abruptly from 125 to <60, suggesting that the initial rhythm was sinoatrial re-entrant tachycardia (SANRT) rather than sinus tachycardia... In SANRT, a re-entry circuit is localized to the SA node... This results in a P-wave that has normal morphology, occurring before a regular, narrow QRS complex... The only way it is possible to distinguish it from sinus tachycardia would be an observation of an abrupt onset or termination, which also occurs in other re-entry tachycardias, especially typical AV nodal re-entrant tachycardia (AVNRT)... One study demonstrated SANRT in <2% of 379 patients undergoing diagnostic electrophysiologic study... However, one author found a nearly 17% incidence in patients being studied, almost all of whom had concomitant organic heart disease... Other supraventricular tachyarrhythmias, such as atrial flutter and AVNRT, would demonstrate P-wave morphologies that differ from normal... Because of the relatively low frequency of the arrhythmia, no large pharmacologic studies are available and therapy is usually empiric and includes beta blockers, amiodarone, verapamil, and/or digitalis... Radiofrequency ablation can also be effective and may allow freedom from antiarrhythmic agents.

No MeSH data available.


Related in: MedlinePlus