‘Inappropriate’ Sinus Tachycardia: Does the 100 Beats Per Min cut-off matter?

Abstract

Sinus tachycardia is commonly encountered in clinical practice and when persistent, can result in significant symptoms and impaired quality of life, warranting further evaluation. On the other hand, a growing body of epidemiological and clinical evidence has shown that high resting heart rate (HR) within the accepted normal range is independently associated with increased risk of all-cause and cardiovascular mortality. However, higher HR as a risk factor for adverse cardiovascular outcomes is frequently underappreciated. In this review, we focus on two challenging problems that span the spectrum of abnormally fast sinus HR. The first section reviews inappropriate sinus tachycardia, a complex disorder characterized by rapid sinus HR without a clear underlying cause, with particular emphasis on current management options. The latter section discusses the prognostic significance of elevated resting HR and reviews clinical evidence aimed at modifying this simple, yet highly important risk factor.

Electrocardiogram Alterations Associated With Psychotropic Drug Use and CACNA1C Gene Variants in Three Independent Samples

“…clozapine, olanzapine, quetiapine, risperidone, paliperidone) antipsychotics, have been associated with increased heart rate or tachycardia . A growing body of epidemiological and clinical evidence has shown that high resting heart rate even within the accepted normal range is independently associated with increased risk of cardiovascular mortality and all‐mortality causes . Thus, high resting heart rate should not be overlooked in patients treated with psychotropic drugs, particularly because pharmacological heart rate control can be easily obtained.…”

Management of tachycardia

“…A small percentage of patients can have persistent sinus tachycardia without any underlying illness or structural heart disease, and are classified as having inappropriate sinus tachycardia [ 4 , 5 ]. Inappropriate sinus tachycardia is under-recognized, can be associated with debilitating symptoms and poses significant management challenges.…”