Clinical QuickieCardiac
Tachycardia & Bradycardia
Rate is a clue, not the diagnosis.
First ask if the patient is unstable
Hypotension, ischemic chest pain, acute HF, altered mental status or shock changes the urgency before you finish the differential.
Tachycardia is often a response
Pain, fever, hypovolemia, anemia, hypoxemia, PE, infection, stimulants and arrhythmia can all produce a fast rate.
Bradycardia can be physiologic or pathologic
Athletic conditioning and sleep can lower rate; medications, conduction disease, ischemia, metabolic/endocrine problems and high vagal tone can also do it.
Treat the mechanism
Do not chase the heart rate without identifying whether it is compensatory, medication-related, conduction-related or a primary rhythm problem.
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