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    R00

    Tachycardia (R00): sinus, supraventricular and ventricular tachycardias, diagnosis and treatment.

    Tachycardia (ICD-10 R00, R00.0) is a heart rate faster than 100 beats per minute at rest. A rise in heart rate is normal during exercise, stress, fever or illness (sinus tachycardia). In tachyarrhythmias, however, an abnormal electrical mechanism in the atria, the AV node or the ventricles drives the heart rapidly. Some tachycardias cause no symptoms; others reduce the heart's pumping, cause fainting, worsen heart failure or, in the case of ventricular tachycardia and fibrillation, lead to sudden cardiac death.

    ICD-10 R00.0ArrhythmiaPalpitations
    Definition> 100 beats/min at rest
    Narrow QRSusually supraventricular
    Wide QRStreat as ventricular until proven otherwise
    Unstable patientelectrical cardioversion
    Rhythm strips: sinus tachycardia with P waves, supraventricular tachycardia with narrow QRS complexes and no visible P waves, and ventricular tachycardia with wide QRS complexes Sinus tachycardia ≈ 120/min, P waves present Supraventricular tachycardia ≈ 180/min, narrow QRS Ventricular tachycardia ≈ 170/min, wide QRS
    Figure 1. Top: sinus tachycardia (about 120/min, P waves present). Middle: supraventricular tachycardia (about 180/min, narrow QRS, P waves hidden). Bottom: ventricular tachycardia (about 170/min, wide QRS).

    Types

    • Sinus tachycardia: a normal response to exercise, fever, pain, anxiety, dehydration, anaemia, low blood pressure, hyperthyroidism, pulmonary embolism, stimulants and some medicines
    • Supraventricular tachycardias: AV nodal re-entrant tachycardia, AV re-entrant tachycardia (WPW), atrial tachycardia, atrial flutter, atrial fibrillation
    • Ventricular tachycardia and ventricular fibrillation: usually with structural heart disease (old myocardial infarction, cardiomyopathy) or inherited channelopathies; life-threatening

    Diagnosis and treatment

    A 12-lead ECG during the tachycardia is the key test; Holter or event recorders capture intermittent episodes, and echocardiography looks for structural heart disease. Sinus tachycardia is treated by treating its cause. Regular narrow-complex tachycardia is first treated with vagal manoeuvres (for example the modified Valsalva manoeuvre), then adenosine; recurrent episodes can be cured by catheter ablation. Any unstable tachycardia (low blood pressure, chest pain, heart failure, confusion) requires urgent electrical cardioversion. Patients at risk of ventricular arrhythmias may need an implantable cardioverter-defibrillator.

    Call emergency services

    for a fast heartbeat with chest pain, breathlessness, fainting, confusion or a pulse that remains very fast at rest.

    References

    1. Brugada J, Katritsis DG, Arbelo E, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. Eur Heart J. 2020;41(5):655–720. doi:10.1093/eurheartj/ehz467
    2. Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022;43(40):3997–4126. doi:10.1093/eurheartj/ehac262

    This article is for general information and does not replace a consultation with a doctor. Diagnosis and treatment must be decided by a physician on the basis of symptoms, examination and tests.

    Published on 23 March 2019