Sinus tachycardia question

[everthesame, LPN, LVN]

Last night I admitted a patient whose pulse was always above 120, usually above 130. She went on to explain that 110's to 120's is her normal and her physician isn't worried about it. She did explain she does tend to tire easily and is always "shaky" but she has always felt this way. Her EKG showed sinus tach. Our hospitalist wasn't doing anything to treat the tachycardia at this point and seemed think the rapid heart rate was more related to the infection she was admitted for.

I don't have a lot of cardiology experience, but if this woman's story is true wouldn't years of persistant tachycardia cause heart damage? BTW, the physician who told her not to worry about it is her OB-GYN and she has never had any sort of work up.

[nrsang97, BSN, RN]

Sounds like the pt needs a good cardio workup. She could have hyperthyroid with the feeling shaky,tired. Can you suggest to the doc to have her thyroid levels checked? Also could be simply related to the infection especially if febrile.

[ebear, BSN, RN]

Could you suggest cardio and endocrine workups? I'm wondering about that if she's hanging around 120-130 "all the time".

[everthesame, LPN, LVN]

She claims she has had a resting HR in the 110's-120's for at least the last 10 years. She did have labs drawn in the ER before she was admitted to the floor. Her TSH and cardiac enzymes were normal. She also wasn't anemic or dehydrated. She is in her late 30's and seems otherwise healthy. I just wonder if all these years of tachycardia wouldn't put her at risk for CHF down the road and why not start her on something to slow her heart rate down now before any damage is done. The hospitalist did say that if she's still tachy after the infection starts to resolve he was going to order a cardiology consult. I go back to work Wednesday noc will have to find out if she got a cardiology consult.

[lil' girl, LPN]

Sinus tachycardia occurs in pts. with healthy hearts as a physiologic response to strenuous exercise, anxiety or/and fear, pain, fever, hyperthyroidism, hemmorrhage, shock or hypoxemia. As long as the rhythm is regular there is no treatment unless symptomatic you would then treat the underlying disease.

[Tweety, BSN, RN]

Sinus tachycardia occurs in pts. with healthy hearts as a physiologic response to strenuous exercise anxiety or/and fear, pain, fever, hyperthyroidism, hemmorrhage, shock or hypoxemia. As long as the rhythm is regular there is no treatment unless symptomatic you would then treat the underlying disease.[/quote']

Yep, you treat the underlying cause, in this case the MD thinks it's sepsis. If her PMD is aware of the patient's condition, she needs to continue to follow up. No nned for a million dollar workup if she's already had one.

[jmgrn65, RN]

My heart at rest was also 120s, I was put on a beta blocker. It is too much work on the heart and will eventually catch up. If they don't treat it in the hospital recommend that she folluw up with her primary care doc and not the ob.