Nursing Guide to Tachycardia: Nursing Diagnosis, Interventions, & Care Plans

Tachycardia refers to a heart rate that exceeds the normal resting rate, typically defined as greater than 100 beats per minute (BPM) in adults. It can be a normal physiological response to exercise or stress but may also indicate an underlying pathology, especially when persistent. Tachycardia can lead to decreased cardiac efficiency, reduced perfusion, and, if untreated, life-threatening complications such as stroke or cardiac arrest. 

Tachycardia is classified into two main types based on its origin: 

• Supraventricular tachycardia (SVT): Originates above the ventricles in the atria or atrioventricular (AV) node.
• Ventricular tachycardia (VT): Arises from the ventricles and is often more serious, as it may lead to sudden cardiac death if untreated. 

Etiology and epidemiology 

Tachycardia may be caused by various factors, including physiological, pathological, and lifestyle-related conditions. Some common causes include: 

• Physiological: Exercise, fever, dehydration, or emotional stress.
• Cardiac-related causes: Myocardial infarction, heart failure, valvular heart disease, or congenital heart defects.
• Non-cardiac causes: Hyperthyroidism, anemia, infections, hypovolemia, or electrolyte imbalances (e.g., hypokalemia).
• Medications and substances: Stimulants (e.g., caffeine, nicotine, amphetamines), certain medications (e.g., beta-agonists, decongestants), and recreational drugs.
• Electrical abnormalities: Issues such as atrial fibrillation (AFib), atrial flutter, or Wolff-Parkinson-White syndrome (WPW). 

Tachycardia is common in both inpatient and outpatient settings, with prevalence varying based on the underlying condition. SVT is more frequent in younger adults, while ventricular tachycardia is more often seen in individuals with a history of heart disease. 

ICD-10 codes for tachycardia 

• I47.1: Supraventricular tachycardia
• I47.2: Ventricular tachycardia
• R00.0: Tachycardia, unspecified 

Source: ICD10data.com (https://www.icd10data.com/ICD10CM/Codes/R00-R99/R00-R09/R00-/R00.0) 

Diagnosis 

The diagnosis of tachycardia typically involves a combination of clinical evaluation, history-taking, and diagnostic tests: 

• Electrocardiogram (ECG): The primary tool for diagnosing the type and cause of tachycardia. An ECG records the electrical activity of the heart, helping to differentiate between supraventricular and ventricular forms.
• Holter monitor or event recorder: These are used for continuous monitoring in cases of intermittent tachycardia.
• Blood tests: To assess for underlying causes such as electrolyte imbalances, thyroid dysfunction, or infection.
• Echocardiogram: Used to evaluate the heart’s structure and function, especially in cases of suspected heart failure or valvular disease.
• Stress test: Helps determine if exercise induces tachycardia or if coronary artery disease is present.
• Electrophysiology study (EPS): Involves mapping the electrical conduction pathways of the heart and is used in complex cases to identify the source of tachyarrhythmias. 

Management 

Treatment of tachycardia depends on its underlying cause, severity, and symptoms. Management goals include reducing heart rate, alleviating symptoms, and addressing any underlying conditions. 

Medical management 

• Medications:
  • Beta-blockers (e.g., metoprolol, propranolol) and calcium channel blockers (e.g., diltiazem, verapamil) are used to control heart rate in patients with SVT and atrial fibrillation.
  • Antiarrhythmics (e.g., amiodarone, sotalol) may be prescribed for rhythm control in patients with VT or recurrent SVT.
  • Adenosine: Administered intravenously in acute settings to terminate paroxysmal supraventricular tachycardia (PSVT).
  • Anticoagulation: In cases of atrial fibrillation, anticoagulants (e.g., warfarin, apixaban) may be necessary to prevent stroke.
• Non-pharmacological interventions:
  • Vagal maneuvers: Techniques such as carotid sinus massage or the Valsalva maneuver can be used to slow down SVT.
  • Cardioversion: Synchronized electrical cardioversion is often required in cases of unstable tachycardia or when pharmacological therapy fails. For VT, defibrillation may be necessary.
  • Ablation therapy: In cases of recurrent tachycardia  catheter ablation may be performed to destroy the abnormal electrical pathways in the heart. 

Lifestyle modifications 

• Reduce stimulants: Advise the patient to avoid caffeine, nicotine, and other stimulants that can trigger tachycardia.
• Hydration: Dehydration can exacerbate tachycardia, so patients should maintain proper fluid intake.
• Stress management: Stress and anxiety can trigger tachycardia; relaxation techniques, yoga, and mindfulness can help manage these triggers.
• Weight management and diet: Encourage a heart-healthy diet and regular physical activity to promote cardiovascular health. 

Tachycardia nursing care plan 

Nursing considerations 

Nurses play a key role in monitoring, educating, and supporting patients with tachycardia. Continuous cardiac monitoring, symptom management, and patient education are central to care. 

Assessment 

• Monitor vital signs: Focus on heart rate, rhythm, and blood pressure. Tachycardia can lead to hypotension and signs of poor perfusion.
• Assess for symptoms: Evaluate for palpitations, chest pain, dizziness, shortness of breath, syncope, or fatigue.
• Evaluate ECG: Identify the type of tachycardia and assess for any arrhythmias.
• Monitor for complications: Watch for signs of decreased cardiac output, such as hypotension, altered mental status, or cool extremities. 

Nursing diagnosis/risk for 

• Decreased cardiac output related to ineffective heart rate control.
• Activity intolerance related to rapid heart rate and fatigue.
• Anxiety related to the diagnosis and fear of recurrent episodes of tachycardia.
• Risk for injury related to potential syncopal episodes during tachycardia. 

Interventions 

• Monitor cardiac rhythm: Ensure continuous ECG monitoring to detect changes in rhythm and rate. Notify the healthcare provider if there is a significant change in the patient’s status.
• Administer medications: Provide medications as ordered, and closely monitor the patient for side effects such as bradycardia or hypotension.
• Education: Teach the patient how to identify early symptoms of tachycardia, such as palpitations or lightheadedness, and when to seek medical attention.
• Instruct on vagal maneuvers: Educate patients on how to perform vagal maneuvers to manage SVT episodes if applicable.
• Emotional support: Provide reassurance to reduce anxiety, especially during episodes of tachycardia. Encourage patients to express their fears and concerns. 

Expected outcomes 

• The patient will maintain stable cardiac output, as evidenced by normal heart rate, blood pressure, and absence of dizziness or chest pain.
• The patient will demonstrate understanding of tachycardia management and triggers.
• The patient will remain free of injury related to syncopal events or hypotension.
• The patient will report decreased anxiety and increased confidence in managing their condition. 

Individual/caregiver education 

• Recognizing symptoms: Educate patients and caregivers on the signs of tachycardia (e.g., palpitations, dizziness) and when to seek immediate medical attention.
• Medication adherence: Stress the importance of taking medications as prescribed, even if symptoms are not present, and discuss possible side effects.
• Trigger management: Advise patients to avoid known triggers such as caffeine, alcohol, and stress, and to keep a log of their episodes to help identify patterns.
• Follow-up care: Encourage regular follow-ups with a cardiologist and adherence to prescribed diagnostic tests like Holter monitoring or stress tests.

References 

1. American Heart Association: https://www.heart.org/
2. National Heart, Lung, and Blood Institute: https://www.nhlbi.nih.gov/
3. Mayo Clinic: https://www.mayoclinic.org/ 

Resources 

• American Heart Association: Provides educational resources on tachycardia and arrhythmias. Website: https://www.heart.org/
• National Heart, Lung, and Blood Institute (NHLBI): Offers information on heart health and managing arrhythmias. Website: https://www.nhlbi.nih.gov/
• Mayo Clinic: Comprehensive resources on the types, diagnosis, and treatment of tachycardia. Website: https://www.mayoclinic.org/