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The sinus tachycardias

Abstract

Sinus tachycardia, in the forms of four distinct rhythm disturbances, is frequently encountered in clinical practice but is often overlooked. The most common rhythm, normal sinus tachycardia, whether physiologic, pathologic or iatrogenic, is predominantly catecholamine driven, is virtually asymptomatic and is managed by identifying and treating the underlying cause. The other so-called primary sinus tachycardias, which include inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome and sinus node re-entry tachycardia, have fundamentally different clinical features, basic underlying etiologic mechanisms and treatment strategies. Differentiation of these types from normal sinus tachycardia and from other atrial arrhythmias is crucial for successful management. Accurate diagnosis and appropriate therapy of the sinus tachycardias not only prevents multiple consultations but might also have important long-term prognostic implications.

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Figure 1: The differential diagnosis of sinus tachycardia
Figure 2: The sinus node action potential
Figure 3: The molecular basis for normal sinus tachycardia
Figure 4: The baroreceptor reflex response to orthostatic stress and the principal mechanisms of postural orthostatic tachycardia syndrome
Figure 5: Testing for postural orthostatic tachycardia syndrome

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Acknowledgements

We thank Professors Michael Frenneaux, Rose Anne Kenny, George Griffin and Douglas Maxwell, and Dr Mashkur Khan for helpful comments.

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Correspondence to Shamil Yusuf.

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Competing interests

John Camm acts as the chairman of the ivabradine safety board and receives reimbursement for this work from Servier.

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Yusuf, S., Camm, A. The sinus tachycardias. Nat Rev Cardiol 2, 44–52 (2005). https://doi.org/10.1038/ncpcardio0068

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  • DOI: https://doi.org/10.1038/ncpcardio0068

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