Diagnose Tachycardia

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When the heart rate is generally faster than normal, this condition is defined as tachycardia. It is a potentially life-threatening event, as it can affect perfusion by compromising the heart’s ability to perform well. There is a shorter relaxation phrase when the heart beats rapidly, which leads to problems such as the ventricles being unable to fill completely, such that cardiac output is much lower; and less blood being transported to the coronary arteries, which means blood supply to the heart is decreased.

Different kinds of tachycardia are hard to differentiate in pediatric cases when monitoring the patient with ECG because of the child’s faster heart rate.

Signs and Symptoms of Tachycardia

  • Quickened and weakened pulse
  • Pulmonary edema/ingestion
  • Different mental state
  • Respiratory distress/failure
  • Poor tissue perfusion (e.g., abnormal urine output)

Sinus tachycardia

  • Occurs usually during fever or stress
  • Usually not life-threatening
  • Fast rate but with normal rhythm

Supraventricular tachycardia

  • Rhythm begins above ventricles

Atrial fibrillation

  • Leads to abnormal heart rhythm

Atrial flutter

  • ECG presents this as a sawtooth pattern

Ventricular tachycardia

  • Rhythm begins in the ventricles

Cases of tachyarrhythmias in children and infants are divided into narrow complex or wide complex tachycardia. The QRS complex on the ECG can be measured to study its width.

NARROW QRS COMPLEX
(≤ 0.09 s)
WIDE QRS COMPLEX
(> 0.09 s)
Atrial fibrillation or Atrial flutterVentricular tachycardia
Sinus tachycardiaUnusual SVT
Supraventricular Tachycardia (SVT)

Table 16

Narrow QRS Complex

Atrial flutter is a rare, abnormal rhythm perceivable through a sawtooth pattern on an ECG. An abnormal reentrant pathway forces the atria to beat rapidly and inefficiently. Though some contractions may exceed 300 bpm, not all will lead to ventricular contraction, as not all will reach the AV node.

PALS providers usually need to determine the difference between identical narrow QRS complex tachyarrhythmias: supraventricular tachycardia (SVT) and sinus tachycardia. SVT is usually caused by accessory pathway reenter, whereas AV node is commonly caused by reentry and ectopic atrial focus.

SINUS TACHYCARDIASUPRAVENTRICULAR
TACHYCARDIA
Infant: < 220 bpmInfant: > 220 bpm
Child: < 180 bpmChild: > 180 bpm
Slow onsetAbrupt start/stop
Fever, hypovolemiaPulmonary edema
Varies with stimulationConstant, fast rate
Visible P wavesAbsent P waves

Table 17

PALS Wide QRS Complex

Figure 14

Wide QRS Complex

Though a rare case in the pediatric age group, ventricular tachycardia (VT) can be hazardous. Until proven otherwise, an ECG reporting a QRS complex greater than 0.09 seconds is believed to be a VT. It is important to note that there are ways to reverse tachycardia as long as treatment for VT is not delayed in cases such as polymorphic VT, Torsades de pointes, and unusual SVT, as they can easily regress to ventricular fibrillation (VF).

As it is usually above 120 bpm, VT is not considered to be an abnormally fast rate and is actually fairly standard. During VT, P waves are either lost or dissociated from the QRS complex. When a supraventricular and ventricular impulse converge, this reaction yields a hybrid-appearing QRS or fusion beat.

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