inappropriate sinus tach

Nurses General Nursing

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Specializes in Acute Care.

What would cause someone to have sinus tach even after being put on a beta blocker? It almost seems like the B-blocker is almost not even effective at all. Resting HR on 100mg Toprol has been 95-110s, with moderate exertion HR has been 120s-180s. With higher HRs, pt has palpitations, occassional dizziness, "feels like heart is beating in my throat"

Pt is young but overweight, significant cardiac family hx, pre-HTN tx with Cozaar 50mg. Cardiology has been consulted, echo & 24hr Holter were WNL other than some episodes of tachycardia. No episodes of SVT or VT seen.

Just curious is anyone else is familiat with this?

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Was he tested for T3 and T4?

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Specializes in Acute Care.

I dont know specifically about T3 or T4 but the TSH was WNL.

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Specializes in Home Health.

Is the pt African-American? A significant portion of African-Americans do not respond to B-blockers, but respond well to calcium channel blockers.

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Specializes in Oncology.

My mom's resting HR is around 140-150 without her meds...she also has random episodes of SVT with no apparent cause. She had tried quite a few different beta blockers (including atenolol and metoprolol) and it wasn't until they put her on propranolol did she have significant results. Her resting is still 90s-100's but she experiences far less SVT episodes and overall her HR is way better controlled.

Maybe the pt needs a different beta blocker? Unfortunatly mom now has more respiratory/asthma issues likely r/t the propranolol but least her HR isn't so crazy!

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Specializes in Acute Care.

No, pt is in late 20s, caucasian female.

Pt also has hx of "mild asthma" - she said she doesn't take any meds for it - inhalers cause her more tachycardia.

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Specializes in Public Health, TB.

Accessory pathway like a WPW? Are there delta waves? Beta blockers are contraindicated in duel pathways because they slow the normal pathway and the faster one takes off.

Definitely needs cardiology consult.

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Specializes in Med/Surg, ICU, ER, Peds ER-CPEN.

what is pt's coffee/soda/tea intake? I did this to myself inadvertantly by overdoing it on coffee and coca cola, I thought my intake was "normal" since I didn't drink any during the day, even on toprol XL I stayed in the high 90's so add excessive caffiene to the mix and 120's were nothing, I didn't become symptomatic until around 140. Diet & exercise and my resting HR is comming down. I'm 5'7" 119lbs so weight wasn't a factor either.

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Cardiology consult, different Beta blockers, starting a calcium channel blocker, looking into what "cardiac history" the family has, ruling out other reasons why they'd be tachy is where I would expect to start. and of course could stand to loose a few pounds.

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Specializes in CVICU.

How's her H&H? I had similar symptoms when I was anemic. After 3 months of taking 1000mg of iron a day and an endometrial ablation, I'm right as rain. Barely a PVC at all and only tachy with exertion/exercise. Overweight could also cause the tachycardia d/t the extra stress on the heart. Did she have an echo? What did that say? If none of those turn up a reason, she'd likely benefit from an EP study.

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