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| {{SI}} | | __NOTOC__ |
| {{CMG}} | | '''For patient information, click [[Inappropriate sinus tachycardia (patient information)|here]]''' |
| | {{Inappropriate sinus tachycardia}} |
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| {{SK}} IST | | {{SK}} IST; chronic nonparoxysmal sinus tachycardia |
| ==Overview==
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| '''Inappropriate sinus tachycardia''' is an uncommon type of [[cardiac arrhythmia]], within the category of [[supraventricular tachycardia]] ('''[[SVT]]''').
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| ==Pathophysiology== | | == [[Inappropriate sinus tachycardia overview|Overview]] == |
| The mechanism and primary [[etiology]] of Inappropriate sinus tachycardia has not been fully elucidated. The mechanism of the arrhythmia primarily involves the [[Sinus Node]] and peri-nodal tissue and does not require the AV Node ([[Atrioventricular node]]) for maintenance. Treatments in the form of [[pharmacological]] therapy or [[Catheter ablation]] are available, although it is currently difficult to treat successfully.
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| ==Diagnosis== | | == [[Inappropriate sinus tachycardia historical perspective|Historical Perspective]] == |
| No formal diagnostic criteria exist. A diagnosis of Inappropriate sinus tachycardia is primarily a diagnosis of exclusion and the following must be observed:
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| *Exclusion of all other causes of [[sinus tachycardia]]
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| *Common forms of [[supraventricular tachycardia]] (SVT) must be excluded
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| *Normal [[P wave]] morphology
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| *A resting [[sinus tachycardia]] is usually (but not always) present
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| *A nocturnal reduction in [[heart rate]] is present
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| *There is an inappropriate [[heart rate]] response on exertion
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| *The mean [[heart rate]] during 24 hrs of monitoring is > 95 bpm
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| *Symptoms are documented to be due to [[tachycardia]]
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| *[[Hypotension]] may occasionally be observed
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| *[[Syncope]] ([[fainting]]) is occasionally reported
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| === Symptoms === | | == [[Inappropriate sinus tachycardia pathophysiology|Pathophysiology]] == |
| Symptoms reported by patients vary in frequency and severity. Symptoms associated with Inappropriate sinus tachycardia include:
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| *Frequent [[Palpitations]]
| | == [[Inappropriate sinus tachycardia causes|Causes]] == |
| *[[Dyspnea]] (Shortness of Breath) and [[Palpitations]] on exertion
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| *Pre-[[syncope]] (feeling as if about to faint)
| | == [[Inappropriate sinus tachycardia differential diagnosis|Differentiating Inappropriate Sinus Tachycardia from other Diseases]] == |
| *[[Fatigue (physical)]]
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| *[[Dizziness]]
| | == [[Inappropriate sinus tachycardia epidemiology and demographics|Epidemiology and Demographics]] == |
| *[[Exercise intolerance]]
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| *Occasional [[paresthesia]] and cramping
| | == Diagnosis == |
| *Symptoms associated with [[autonomic nervous system]] disturbance, including GI disturbance
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| | [[Inappropriate sinus tachycardia diagnostic criteria|Diagnostic Criteria]] | [[Inappropriate sinus tachycardia history and symptoms|History and Symptoms]] | [[Inappropriate sinus tachycardia electrocardiogram|Electrocardiogram]] |
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| == Treatment == | | == Treatment == |
| IST has been treated both pharmacologically and invasively, with varying degrees of success.
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| Some types of medication tried by cardiologists and other physicians include: [[Beta blocker]]s, [[Calcium channel blocker]]s and [[Antiarrhythmic agent]]s. Some [[SSRI]] drugs are also occasionally tried and also treatments more commonly used to treat [[Postural orthostatic tachycardia syndrome]] such as [[Fludrocortisone]]. This approach is very much "trial-and-error". Patients with IST are often intolerant to [[Beta blocker]]s. A new selective sinus node inhibitor [[Ivabradine]] is also being used to treat IST.
| | [[Inappropriate sinus tachycardia treatment guidelines|ACC/AHA/ESC Treatment Guidelines]] | [[Inappropriate sinus tachycardia medical therapy|Medical Therapy]] | [[Inappropriate sinus tachycardia surgery|Surgery]] |
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| Invasive treatments include forms of [[Catheter ablation]] such as '''Sinus Node Modification''' (selective ablation of the Sinus Node), '''Complete Sinus Node Ablation''' (with associated implantation of a Permanent [[Artificial pacemaker]]) and '''AV Node Ablation''' in very resistant cases (creation of [[iatrogenic]] [[complete heart block]], necessitating implantation of a Permanent [[Artificial pacemaker]]).
| | ==Case Studies== |
| | [[Inappropriate sinus tachycardia case study one|Case #1]] |
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| == See also == | | ==Related Chapters== |
| *[[Supraventricular tachycardia]] | | *[[Supraventricular tachycardia]] |
| *[[Sinus tachycardia]] | | *[[Sinus tachycardia]] |
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| *[[Dysautonomia]] | | *[[Dysautonomia]] |
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| ==References==
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| {{Reflist|2}}
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| == Sources ==
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| Sato T, Mitamura H, Murata M, Shinagawa K, Miyoshi S, Kanki H,
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| Takatsuki S, Soejima K, Miyazaki T, Ogawa S. Electrophysiologic findings of a patient with inappropriate sinus
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| tachycardia cured by selective radiofrequency catheter ablation. J Electrocardiol. 2000 Oct;33(4):381-6. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11099363&dopt=Abstract Medline Abstract]
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| Lee RJ. Kalman JM. Fitzpatrick AP. Epstein LM. Fisher WG. Olgin JE.
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| Lesh MD. Scheinman MM. Radiofrequency catheter modification of the sinus node
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| for "inappropriate" sinus tachycardia. Circulation. 92(10):2919-28, 1995. [http://circ.ahajournals.org/cgi/content/abstract/92/10/2919?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Radiofrequency+catheter+modification+of+the+sinus+node+for+%22inappropriate%22+sinus&searchid=1048593786710_3685&stored_search=&FIRSTINDEX=0&search_url=http%3A%2F%2Fcirc.ahajournals.org%2Fcgi%2Fsearch&journalcode=circulationaha Circulation Abstract]
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| Yusuf S, Camm AJ. Deciphering the sinus tachycardias. Clin Cardiol. 2005 Jun;28(6):267-76. Review. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16028460&query_hl=6&itool=pubmed_docsum Medline Abstract]
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| AM Still, P Raatikainen, A Ylitalo, H Kauma, M Ikaheimo, Y Antero Kesaniemi, and HV Huikuri. Prevalence, characteristics and natural course of inappropriate sinus tachycardia. Europace, March 1, 2005; 7(2): 104-12. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15763524&query_hl=1&itool=pubmed_docsum Medline Abstract]
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| Leon H, Guzman JC, Kuusela T, Dillenburg R, Kamath M, Morillo CA. Impaired baroreflex gain in patients with inappropriate sinus tachycardia. J Cardiovasc Electrophysiol. 2005 Jan;16(1):64-8. Erratum in: J Cardiovasc Electrophysiol. 2005 Feb;16(2):109. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15673390&query_hl=4&itool=pubmed_docsum Medline Abstract]
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| Sanchez-Quintana D, Cabrera JA, Farre J, Climent V, Anderson RH, Ho SY. Sinus node revisited in the era of electroanatomical mapping and catheter ablation. Heart. 2005 Feb;91(2):189-94. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15657230&query_hl=4&itool=pubmed_docsum Medline Abstract]
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| Cruz Filho FE, Maia IG, Fagundes ML, Boghossian S, Ribeiro JC.
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| Arq Bras Cardiol. Sinus node modification by catheter using radiofrequency current in a patient with inappropriate sinus tachycardia. Evaluation of early and late results. 1998 Mar;70(3):173-6. Portuguese. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9674178&dopt=Abstract Medline Abstract]
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| Shih-Huang Lee1, Jun-Jack Cheng1, Peiliang Kuan1, Chi-Ren Hung. Radiofrequency Catheter Modification of Sinus Node for Inappropriate Sinus Tachycardia: A Case Report. Chin Med J (Taipei) ;60:117-23. 1997. [http://www.vghtpe.gov.tw/~cmj/6002/600210.htm Full Text Article]
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| {{Electrocardiography}} | | {{Electrocardiography}} |