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.
Types, Causes and Symptoms
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
While some patients may be asymptomatic, possible symptoms of tachycardia include:
- 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
Once the nurse identifies nursing diagnoses for tachycardia, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section you will find nursing care plan examples for 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.
Impaired Gas Exchange
Impaired gas exchange associated with tachycardia can be caused by disrupted blood flow and compromised gas exchange from rapid heart rate, incomplete filling of heart chambers, and decreased supply of oxygenated blood.
Nursing Diagnosis: Impaired Gas Exchange
Related to:
- Inadequate gas exchange
- Lack of oxygenated blood
- Rapid heart contraction
- Incomplete filling of the heart during contraction
- Poor blood supply
- Inadequate blood flow
- Inability of the heart to relax properly
As evidenced by:
- Dyspnea
- Coughing
- Tachypnea
- Fatigue
- Use of accessory muscles
- Nasal flaring
- Headaches
- Change in level of consciousness
- Change in skin color (pale and cyanotic)
- Tachycardia
- Anxiety
Expected outcomes:
- Patient will demonstrate oxygen saturation and breathing pattern within normal limits.
- Patient will have no complaints of difficulty breathing, dizziness, or headache.
Assessment:
1. Assess respiratory status.
Gas exchange is influenced by rapid, shallow breathing and hypoventilation. Hypoxia may be accompanied by an increase in respiratory rate, the use of accessory muscles, nasal flaring, abdominal breathing, and panic.
2. Auscultate for lung sounds.
Reduced breath sounds are associated with inadequate ventilation.
3. Monitor for the heart rate and oxygen saturation.
Hyperventilation and tachycardia will prevent adequate gas exchange.
Interventions:
1. Prevent postural tachycardia syndrome (PoTS).
After standing or sitting up, a condition known as postural tachycardia syndrome (PoTS) or postural orthostatic tachycardia syndrome causes an abrupt increase in heart rate. Signs include dyspnea, fainting, dizziness, and sweating. It can be prevented by increasing water and sodium to increase blood volume, eating smaller meals, and participating in aerobic exercise.
2. Promote breathing techniques
Teach the patient how to use therapeutic breathing techniques. Proper breathing boosts oxygenation and CO2 exchange.
3. Treat the underlying condition.
The respiratory system can be responsible for non-cardiac pathologic etiologies of tachycardia. The inability to absorb, transfer, or carry out gas exchange can lead to tachycardia.
4. Advise the patient when to seek medical help.
If there is chest pain or discomfort, shortness of breath, lightheadedness, or fainting, advise the patient to get emergency medical attention to prevent complications of tachycardia and impaired gas exchange.
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.
Risk for Unstable Blood Pressure
Risk for unstable blood pressure (BP) associated with tachycardia can be caused by disruption of blood flow and compromised blood pressure from rapid heart rate and incomplete filling of heart chambers.
Nursing Diagnosis: Risk for Unstable Blood Pressure
Related to:
- Rapid heart contraction
- Incomplete filling of the heart during contraction
- Poor blood supply
- Inadequate blood flow
- Inability of the heart to relax properly
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected outcomes:
- Patient will maintain blood pressure within acceptable limits.
- Patient will not experience chest pain or heart palpitations.
- Patient will not experience tachycardia or changes in blood pressure at rest.
Assessment:
1. Track the patient’s blood pressure.
Blood pressure can decrease significantly due to tachycardia in ventricular fibrillation.
2. Check for dysrhythmias.
ECG analyzes the electrical patterns and activity of the heart to identify the type of tachycardia. Tachycardic rhythms can quickly become fatal.
3. Determine the underlying condition.
If a condition (such as sepsis, shock, hypoxia, metabolic acidosis, or acute myocardial ischemia) is the cause of untreated pathologic tachycardia, the patient should be monitored for symptoms of complications. The underlying cause should be addressed appropriately.
4. Obtain a thorough history.
A thorough history is essential, including precipitating factors (such as fever or exertion), recent medications, hazardous exposures, caffeine or drug use, a medical history, heart disease or recent heart surgery, and family history.
Interventions:
1. Slow down the heart rate.
A rapid heartbeat may slow on its own. However, medication or other medical procedures are occasionally required to slow the rhythm. This includes the following:
- Vagus nerve maneuvers, including coughing, bearing down as if having a bowel movement, and putting an ice pack on the face.
- Medications restore the heart rhythm if vagal maneuvers are not effective.
- Cardioversion sends electric shocks to the heart through electrodes placed on the chest. This can be an emergent procedure or scheduled.
2. Control blood pressure.
The heart rate can be slowed down by medications. Additionally, they can lower blood pressure and lessen the workload on the heart. These medications include:
- Beta-blockers
- Calcium channel blockers
- Antiarrhythmics
- Digoxin
- Ace inhibitors
3. Restrict triggers.
Reduce the risk of unstable blood pressure due to tachycardia by restricting or avoiding alcohol, smoking, and caffeine. Advise the patient to inform the healthcare provider before taking herbal supplements, which can trigger tachycardia.
4. Treat underlying conditions.
Managing conditions such as hyperlipidemia and diabetes is necessary as these conditions can lead to coronary artery disease, narrowing arteries leading to hypertension and tachycardia.
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
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, interventions, and rationales (15th ed.). F A Davis Company.
- 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
