This chapter reviews the management of tachycardic patients with a pulse when providing advanced cardiac life support (ACLS). At the end of this section, the learner will be able to:

• Define tachycardia
• Discuss the symptoms of tachycardia
• List and describe the variants of tachycardia
• Discuss the treatment of tachycardia.

Tachycardia can be abnormal, but it may also be physiological. Tachyarrhythmias refer to a heart rate of over 100 beats per minute and can have a narrow or wide QRS. It is vital to differentiate sinus, narrow, and wide QRS tachycardias, as well as recognized rhythms that are causing symptoms. It may be impossible to differentiate supraventricular from ventricular tachycardias, but it is generally safe to assume that wide QRS tachycardias originate in the ventricles, especially if the patient has preexisting cardiac disease. Certain classic patterns are easily recognizable, such as irregularly irregular rhythms like atrial fibrillation. However, some tachyarrhythmias can have multiple patterns.

Sinus Tachycardia ECG