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inappropriate sinus tach

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?

Was he tested for T3 and T4?


Specializes in Acute Care.

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


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.


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!


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.

nursej22, MSN, RN

Specializes in med/surg,CV.

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.

ZooMommyRN, ADN, RN

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.

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.


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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