Tachycardia is the rapid pumping of the heart at a rate of more than 100 beats per minute. It is a typical response to exercise or stress. However, if the cause is unknown or left untreated, it may result in severe health conditions such as stroke, heart failure, or cardiac arrest.
There are several types of tachycardia, including the following:
- Sinus tachycardia is a rapid heart rate with a normal pattern.
- Atrial fibrillation (Afib or AF) is characterized by chaotic and irregular electrical signals in the heart’s upper chambers (atria).
- Atrial flutter is similar to atrial fibrillation, but the heartbeats are more organized. It may or may not require treatment.
- Ventricular tachycardia (VTach) occurs in the lower chambers (ventricles), resulting in inadequate blood supply to different parts of the body.
- Supraventricular tachycardia, or SVT starts above the ventricles and causes palpitations that start and stop abruptly.
Possible causes of tachycardia include:
- Fever
- Alcohol withdrawal
- Caffeine
- Alterations in blood pressure
- Electrolyte imbalances
- Hyperthyroidism
- Bleeding
- Anemia
- Smoking
- Illegal substances
- Medications
Some patients may be asymptomatic, while others experience symptoms like:
- Palpitations
- Syncope
- Chest pain
- Lightheadedness
- Shortness of breath
- A rapid and bounding pulse
A physical exam and thorough history evaluation regarding the symptoms, lifestyle factors, and medical history is necessary to diagnose tachycardia. To identify the underlying cause, the patient will also undergo diagnostic tests, such as:
- Electrocardiogram
- Holter monitor
- Event recording
- Echocardiogram
- MRI
- CT scan
- Stress test
- Coronary angiogram
Nursing Process
Nursing management of tachycardia involves interventions to help prevent the heart from beating too fast. Some instances of sinus tachycardia may not require treatment. If tachycardia is prolonged or the rhythm is abnormal, treatment may include medications, implanted medical devices, surgery, and cardioversion.
The nurse will closely monitor patients on continuous telemetry, assess vital signs, and implement advanced cardiovascular life support (ACLS) as necessary.
Nursing Care Plans Related to Tachycardia
Acute Pain
Acute pain related to tachycardia can be caused by insufficient oxygenated blood to the heart due to rapid heart contraction.
Nursing Diagnosis: Acute Pain
Related to:
- Cardiac tissue death
- Inadequate oxygenated blood
- Impaired heart structure
- Rapid heart contraction
- Abnormal electrical signals in the heart
- Irregular cardiac contraction
- Impaired cardiac muscle relaxation
- Substances that alter heart contraction
- Medication side effects
As evidenced by:
- Report of pain or discomfort
- Expressive behavior
- Guarding behavior
- Reports of chest pain
- Protective behavior
- Facial grimacing
- Restlessness
- Hypertension
- Increased pulse rate
- Palpitations
- Excessive sweating
- Poor concentration
- Fatigue
- Dizziness
- Shortness of breath
- Irritability
Expected outcomes:
- Patient will verbalize relief from chest pain.
- Patient will display a calm and relaxed appearance.
- The patient will manifest a pulse rate within expected limits.
Assessment:
1. Ask the patient to describe the pain.
Acute pain in tachycardia is described as a sensation of a racing heartbeat or palpitations. The patient may describe chest pressure or a squeezing sensation. Ask the patient to rate the pain from 0-10.
2. Identify symptoms accompanying the chest pain.
Due to decreased oxygenated blood from tachycardia, accompanying symptoms of chest pain are:
- Generalized weakness
- Fainting
- Dizziness
- Poor concentration
- Shortness of breath
- Hypertension
Interventions:
1. Promote a calming environment.
Decrease unnecessary stimuli, which could exacerbate chest pain and anxiety. Offer a quiet space with dim lighting.
2. Administer pain medications as indicated.
The heart rate can be slowed by medications to treat pain in tachycardia. Morphine can lessen the workload on the heart, slowing breathing and heart rate.
3. Ask the patient to perform vagal maneuvers.
Instruct the patient to cough or bear down as if having a bowel movement. These actions stimulate the vagus nerve to slow the heart rate.
4. Provide oxygen as ordered.
Chest pain in tachycardia often results from excessive heart contraction and reduced oxygenated blood supply. Providing supplemental oxygen ensures cardiac muscle relaxation and adequate cardiac oxygenation and reduces the risk of cardiac tissue death (ischemia).
5. Ensure adequate rest periods.
Decrease the heart rate by reducing the workload of the heart. Rest periods in between activities will allow the relaxation of the heart muscles. If the patient is at risk for tachycardia due to other medical conditions, ensure activity is limited as tolerated.
Risk for Decreased Cardiac Output
Risk for decreased cardiac output related to tachycardia reduces the stroke volume due to decreased ventricular filling time.
Nursing Diagnosis: Risk for Decreased Cardiac Output
Related to:
- Cardiac tissue death
- Impaired heart structure
- Rapid heart contraction
- Abnormal electrical signals in the heart
- Impaired cardiac muscle relaxation
- Substances that alter heart contraction
- Treatment side effects
- Underlying conditions
- Altered afterload
- Increased heart rate
- Impaired contractility
- Irregular heart rhythm
- Altered stroke volume
- Change in preload
As evidenced by:
A risk diagnosis is not evidenced by any signs and symptoms, as the problem has not occurred yet, and the nursing interventions will be directed at the prevention of possible signs and symptoms.
Expected outcomes:
- Patient will not experience an arrhythmia.
- Patient will remain free from any complications associated with decreased cardiac output.
- Patient will demonstrate lifestyle modifications to maintain cardiac output and prevent tachycardia.
Assessment:
1. Note any signs and symptoms.
Signs and symptoms of decreased cardiac output related to tachycardia include:
- Difficulty breathing (dyspnea)
- Fatigue
- Shortness of breathing while lying flat (orthopnea)
- Increased central venous pressure (CVP)
2. Determine the underlying cause.
Tachycardia is a symptom of a disease. Appropriate identification of underlying causes is necessary to formulate the most appropriate management of the underlying cause.
3. Assess the cardiovascular status.
Fatal dysrhythmias (such as ventricular fibrillation) prevent adequate pumping of the heart, which reduces blood flow to the rest of the body and results in death if not promptly treated.
Interventions:
1. Obtain vital signs regularly.
Tachycardia can affect the patient’s other vital signs, such as a drop in blood pressure. Inadequate perfusion to other organs can quickly result in a life-threatening emergency.
2. Implement ACLS.
Advanced cardiovascular life support is training and skills nurses receive to care for patients in cardiac emergencies. This may include administering medications, airway management, and resuscitation.
3. Instruct on necessary testing.
The patient may need an echocardiogram, stress testing, event recording, or other diagnostic tests to assess the cause of tachycardia.
4. Assist with cardioversion.
The nurse may assist with cardioversion at the bedside or administer medications prior to cardioversion, which shocks the heart back into a normal rhythm.
Risk for Decreased Cardiac Tissue Perfusion
Risk for decreased cardiac tissue perfusion related to tachycardia can be caused by reduced oxygenated blood to the heart.
Nursing Diagnosis: Risk for Decreased Cardiac Tissue Perfusion
Related to:
- Disease process
- Tachycardia
- Ischemia
- Decreased oxygen (hypoxia)
- Decreased oxygen in the blood (hypoxemia)
- Smoking
- Substance abuse
As evidenced by:
A risk diagnosis is not evidenced by any signs and symptoms, as the problem has not occurred yet, and the nursing interventions will be directed at the prevention of possible signs and symptoms.
Expected outcomes:
- Patient will maintain heart rhythm and vital signs within normal limits.
- Patient will verbalize their risk factors for tachycardia.
- Patient will remain free from tachycardic arrhythmias.
Assessment:
1. Note any signs of dysrhythmias.
Changes in heart rate and rhythm can compromise tissue perfusion. Screening for any dysrhythmias through continuous ECG is necessary to prevent and immediately treat complications.
2. Assess lab values.
Assess the results of cardiac enzymes, ABGs, C-reactive protein, and drug screens to determine underlying causes.
Interventions:
1. Promote vasodilation.
Vasodilators are indicated to help reduce the heart’s workload and promote cardiac tissue perfusion. Do not use vasodilators when the patient is hypotensive.
2. Assist with pacemaker or ICD insertion.
A pacemaker or cardioverter defibrillator (ICD) may be necessary for patients at high risk for VTach or VFib. When the pacemaker detects an irregular rhythm, it sends an electrical pulse to reset the heart rhythm.
3. Emphasize the importance of lifestyle changes.
Patients at high risk for tachycardia may need education on lifestyle changes such as weight loss, quitting smoking, substance abuse treatment, limiting caffeine, and eating a heart-healthy diet.
4. Administer antiarrhythmics.
Beta-blockers, calcium channel blockers, digoxin, and more slow electrical heart impulses.
References
- American Heart Association. (2017, December 5). Tachycardia: Fast heart rate. www.heart.org. Retrieved February 2023, from https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/tachycardia–fast-heart-rate
- Burns, S. (2014). AACN essentials of critical care nursing (3rd ed.). McGraw-Hill Education / Medical.
- Cleveland Clinic. (2022, October 3). Tachycardia: Causes, symptoms, and treatment. Retrieved February 2023, from https://my.clevelandclinic.org/health/diseases/22108-tachycardia
- Mayo Clinic. (2022, May 20). Tachycardia – Diagnosis and treatment – Mayo Clinic. Mayo Clinic – Mayo Clinic. Retrieved February 2023, from https://www.mayoclinic.org/diseases-conditions/tachycardia/diagnosis-treatment/drc-20355133
- National Center for Biotechnology Information. (2022, August 8). Sinus tachycardia – StatPearls – NCBI bookshelf. Retrieved February 2023, from https://www.ncbi.nlm.nih.gov/books/NBK553128/
- WebMD. (2015, December 21). Flutter, thump, bump: Facts about tachycardia. Retrieved February 2023, from https://www.webmd.com/heart-disease/atrial-fibrillation/what-are-the-types-of-tachycardia
