Sinus Tachycardia: a Multidisciplinary Expert Focused Review

Kenneth A Mayuga¹, Artur Fedorowski², Fabrizio Ricci³, Rakesh Gopinathannair⁴, Jonathan Walter Dukes⁵, Christopher Gibbons⁶, Peter Hanna⁷, Dan Sorajja⁸, Mina Chung⁹, David Benditt¹⁰, Robert Sheldon¹¹, Mirna B Ayache¹², Hiba AbouAssi¹³, Kalyanam Shivkumar¹⁴, Blair P Grubb¹⁵, Mohamed H Hamdan¹⁶, Stavros Stavrakis¹⁷, Tamanna Singh¹⁸, Jeffrey J Goldberger¹⁹, James A S Muldowney 3rd²⁰, Mark Belham²¹, David C Kem²², Cem Akin²³, Barbara K Bruce²⁴, Nicole E Zahka²⁵, Qi Fu²⁶, Erik H Van Iterson²⁷, Satish R Raj²⁸, Fetnat Fouad-Tarazi²⁹, David S Goldstein³⁰, Julian Stewart³¹, Brian Olshansky³²

Affiliations

¹ Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, OH (K.A.M.).
² Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden (A.F.).
³ Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University of Chieti-Pescara, Chieti Scalo, Italy (F.R.).
⁴ Kansas City Heart Rhythm Institute, Overland Park (R.G.).
⁵ Community Memorial Hospital, Ventura, CA (J.W.D.).
⁶ Beth Israel Deaconess Medical Center, Boston, MA (C.G.).
⁷ University of California, Los Angeles (P.H.).
⁸ Mayo Clinic Arizona (D.S.).
⁹ Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH (M.C.).
¹⁰ University of Minnesota Medical School, Minneapolis (D.B.).
¹¹ University of Calgary, Canada (R.S.).
¹² MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (M.B.A.).
¹³ Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC (H.A.A.).
¹⁴ University of California, Los Angeles (K.S.).
¹⁵ The University of Toledo Medical Center, OH (B.P.G.).
¹⁶ University of Wisconsin, Madison (M.H.H.).
¹⁷ University of Oklahoma Health Science Center, Oklahoma City (S.S.).
¹⁸ Department of Cardiovascular Medicine, Cleveland Clinic, OH (T.S.).
¹⁹ Division of Cardiology, Department of Medicine, University of Miami, FL (J.J.G.).
²⁰ Vanderbilt University Medical Center &Tennessee Valley Healthcare System, Nashville Campus, Department of Veterans Affairs, TN (J.A.S.M.).
²¹ Cambridge University Hospitals NHS FT, United Kingdom (M.B.).
²² University of Oklahoma Health Sciences Center, Oklahoma City (D.C.K.).
²³ University of Michigan, Ann Arbor (C.A.).
²⁴ Mayo Clinic, Jacksonville, FL (B.K.B.).
²⁵ Cincinnati Children's Hospital Medical Center, OH (N.E.Z.).
²⁶ Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas & University of Texas Southwestern Medical Center (Q.F.).
²⁷ Section of Preventive Cardiology & Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, OH (E.H.V.I.).
²⁸ Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Canada (S.R.R.).
²⁹ Cleveland Clinic, OH (F.F.-T.).
³⁰ CNP/DIR/NINDS/NIH, Bethesda, MD (D.S.G.).
³¹ New York Medical College, Hawthorne (J.S.).
³² University of Iowa (B.O.).

PMID: 36074973
PMCID: PMC9523592
DOI: 10.1161/CIRCEP.121.007960

Review

Sinus Tachycardia: a Multidisciplinary Expert Focused Review

Kenneth A Mayuga et al. Circ Arrhythm Electrophysiol. 2022 Sep.

. 2022 Sep;15(9):e007960.

doi: 10.1161/CIRCEP.121.007960. Epub 2022 Sep 8.

Authors

Affiliations

¹ Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, OH (K.A.M.).
² Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden (A.F.).
³ Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University of Chieti-Pescara, Chieti Scalo, Italy (F.R.).
⁴ Kansas City Heart Rhythm Institute, Overland Park (R.G.).
⁵ Community Memorial Hospital, Ventura, CA (J.W.D.).
⁶ Beth Israel Deaconess Medical Center, Boston, MA (C.G.).
⁷ University of California, Los Angeles (P.H.).
⁸ Mayo Clinic Arizona (D.S.).
⁹ Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH (M.C.).
¹⁰ University of Minnesota Medical School, Minneapolis (D.B.).
¹¹ University of Calgary, Canada (R.S.).
¹² MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (M.B.A.).
¹³ Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC (H.A.A.).
¹⁴ University of California, Los Angeles (K.S.).
¹⁵ The University of Toledo Medical Center, OH (B.P.G.).
¹⁶ University of Wisconsin, Madison (M.H.H.).
¹⁷ University of Oklahoma Health Science Center, Oklahoma City (S.S.).
¹⁸ Department of Cardiovascular Medicine, Cleveland Clinic, OH (T.S.).
¹⁹ Division of Cardiology, Department of Medicine, University of Miami, FL (J.J.G.).
²⁰ Vanderbilt University Medical Center &Tennessee Valley Healthcare System, Nashville Campus, Department of Veterans Affairs, TN (J.A.S.M.).
²¹ Cambridge University Hospitals NHS FT, United Kingdom (M.B.).
²² University of Oklahoma Health Sciences Center, Oklahoma City (D.C.K.).
²³ University of Michigan, Ann Arbor (C.A.).
²⁴ Mayo Clinic, Jacksonville, FL (B.K.B.).
²⁵ Cincinnati Children's Hospital Medical Center, OH (N.E.Z.).
²⁶ Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas & University of Texas Southwestern Medical Center (Q.F.).
²⁷ Section of Preventive Cardiology & Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, OH (E.H.V.I.).
²⁸ Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Canada (S.R.R.).
²⁹ Cleveland Clinic, OH (F.F.-T.).
³⁰ CNP/DIR/NINDS/NIH, Bethesda, MD (D.S.G.).
³¹ New York Medical College, Hawthorne (J.S.).
³² University of Iowa (B.O.).

PMID: 36074973
PMCID: PMC9523592
DOI: 10.1161/CIRCEP.121.007960

Abstract

Sinus tachycardia (ST) is ubiquitous, but its presence outside of normal physiological triggers in otherwise healthy individuals remains a commonly encountered phenomenon in medical practice. In many cases, ST can be readily explained by a current medical condition that precipitates an increase in the sinus rate, but ST at rest without physiological triggers may also represent a spectrum of normal. In other cases, ST may not have an easily explainable cause but may represent serious underlying pathology and can be associated with intolerable symptoms. The classification of ST, consideration of possible etiologies, as well as the decisions of when and how to intervene can be difficult. ST can be classified as secondary to a specific, usually treatable, medical condition (eg, pulmonary embolism, anemia, infection, or hyperthyroidism) or be related to several incompletely defined conditions (eg, inappropriate ST, postural tachycardia syndrome, mast cell disorder, or post-COVID syndrome). While cardiologists and cardiac electrophysiologists often evaluate patients with symptoms associated with persistent or paroxysmal ST, an optimal approach remains uncertain. Due to the many possible conditions associated with ST, and an overlap in medical specialists who see these patients, the inclusion of experts in different fields is essential for a more comprehensive understanding. This article is unique in that it was composed by international experts in Neurology, Psychology, Autonomic Medicine, Allergy and Immunology, Exercise Physiology, Pulmonology and Critical Care Medicine, Endocrinology, Cardiology, and Cardiac Electrophysiology in the hope that it will facilitate a more complete understanding and thereby result in the better care of patients with ST.

Keywords: autonomic dysfunction; hyperthyroidism; inappropriate sinus tachycardia; post-COVID syndrome; postural orthostatic tachycardia syndrome; sinus tachycardia.

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Figures

**Figure 1.. Evaluation of sinus tachycardia.**
AAbs, autoantibodies; ABG, arterial blood gas; ABPM, ambulatory blood pressure monitoring; AF, atrial fibrillation; AFL, atrial flutter; AVNRT, atrioventricular node re-entry tachycardia; AVRT, atrioventricular re-entry tachycardia; BNP, B-type natriuretic peptide; CMR, cardiovascular magnetic resonance; COPD, chronic obstructive pulmonary disease; CPET, cardiopulmonary exercise testing; CRP, C-reactive protein; EAT, ectopic atrial tachycardia; hCG, human chorionic gonadotropin; ILD, interstitial lung disease; IST, inappropriate sinus tachycardia; MCAS, mast cell activation syndrome; LV, left ventricle; PCT, procalcitonin; PFTs, pulmonary function tests; PGD2, prostaglandin D2; POTS, postural orthostatic tachycardia syndrome; RV, right ventricle; SNRT, sinus node re-entry tachycardia; ST, sinus tachycardia; TSH, thyroid-stimulating hormone; VHD, valvular heart disease; WBC, white blood cells; 6MWT, 6-minute walking test.

**Figure 2.. Autonomic control of the sinoatrial node activity and modulators of autonomic inputs.**
Created with Biorender.com

**Figure 3.. Classification of Sinus Tachycardia.**
Created with Biorender.com

**Figure 4.. Work-up of sinus tachycardia following COVID-19.**

See this image and copyright information in PMC

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Sinus Tachycardia: a Multidisciplinary Expert Focused Review

Affiliations

Sinus Tachycardia: a Multidisciplinary Expert Focused Review

Authors

Affiliations

Abstract

Figures

References

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MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical