WordNet

commit a sin; violate a law of God or a moral law (同)transgress, trespass
violent and excited activity; "they began to fight like sin" (同)hell
estrangement from god (同)sinfulness, wickedness
an act that is regarded by theologians as a transgression of Gods will (同)sinning
the 21st letter of the Hebrew alphabet
abnormally rapid heartbeat (over 100 beats per minute)
any of various air-filled cavities especially in the bones of the skull

PrepTutorEJDIC

〈U〉(宗教・道徳上の)『罪』 / 〈C〉(宗教・道徳上の)『罪の行為』,罪悪 / 〈C〉《特におどけて》違反(過失)の行為 / (宗教・道徳上の)おきてを破る,罪を犯す / (…に)違反(過失)をする,背く《+『against』+『名』》
sine
心拍急速(心臓の異常に速い拍動)　頻拍　頻脈
洞(どう)(骨や組織の中の穴・くぼみなど);静脈洞

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/02/06 01:04:43」(JST)

wiki en

Sinus tachycardia (also colloquially known as sinus tach or sinus tachy) is a heart rhythm originating from the sinoatrial node with an elevated rate of impulses, defined as a rate greater than 100 beats/min (bpm) in an average adult. The normal resting heart rate in the average adult ranges from 60–100 beats/min. Note that the normal heart rate varies with age, with infants having normal heart rate of 110–150 bpm, in contrast to the elderly, who have slower normals.^[1]

Signs and symptoms

Tachycardia is often asymptomatic. If the heart rate is too high, cardiac output may fall due to the markedly reduced ventricular filling time.^[2] Rapid rates, though they may be compensating for ischemia elsewhere, increase myocardial oxygen demand and reduce coronary blood flow, thus precipitating an ischemic heart or valvular disease^{[citation needed]}. Sinus tachycardia accompanying a myocardial infarction may be indicative of cardiogenic shock.

Cause

Sinus tachycardia is usually a response to normal physiological situations, such as exercise and an increased sympathetic tone with increased catecholamine release—stress, fright, flight, anger. Other causes include:

Pain
Fever
Anxiety
Dehydration
Malignant hyperthermia
Hypovolemia with hypotension and shock
Anemia
Heart failure
Hyperthyroidism
Mercury poisoning
Kawasaki disease
Pheochromocytoma
Sepsis
Pulmonary embolism
Acute coronary ischemia and myocardial infarction
Chronic pulmonary disease
Hypoxia
Intake of stimulants such as caffeine, nicotine, cocaine, or amphetamines
Hyperdynamic circulation
Electric shock
Drug withdrawal

Diagnosis

A 12 lead ECG showing sinus tachycardia

Usually apparent on the ECG, but if heart rate is above 140 bpm the P wave may be difficult to distinguish from the previous T wave and one may confuse it with a paroxysmal supraventricular tachycardia or atrial flutter with a 2:1 block. Ways to distinguish the three are:

Vagal maneuvers (such as carotid sinus massage or Valsalva's maneuver) to slow the rate and identification of P waves
administer AV blockers (e.g., adenosine, verapamil) to identify atrial flutter with 2:1 block

ECG characteristics

Rate: Greater than or equal to 100.
Rhythm: Regular.
P waves: Upright, consistent, and normal in morphology (if no atrial disease)
P–R interval: Between 0.12–0.20 seconds and shortens with increasing heart rate
QRS complex: Less than 0.12 seconds, consistent, and normal in morphology.

Inappropriate sinus tachycardia

Also known as chronic nonparoxysmal sinus tachycardia, patients have elevated resting heart rate and/or exaggerated heart rate in response to exercise. These patients have no apparent heart disease or other causes of sinus tachycardia. IST is thought to be due to abnormal autonomic control.

Postural orthostatic tachycardia syndrome

Usually in women with no heart problems, this syndrome is characterized by normal resting heart rate but exaggerated postural sinus tachycardia with or without orthostatic hypotension.

Treatment

Not required for physiologic sinus tachycardia. Underlying causes are treated if present.

Acute myocardial infarction. Sinus tachycardia can present in more than a third of the patients with AMI but this usually decreases over time. Patients with sustained sinus tachycardia reflects a larger infarct that are more anterior with prominent left ventricular dysfunction, associated with high mortality and morbidity. Tachycardia in the presence of AMI can reduce coronary blood flow and increase myocardial oxygen demand, aggravating the situation. Beta blockers can be used to slow the rate, but most patients are usually already treated with beta blockers as a routine regimen for AMI.

Practically, many studies showed that there is no need for any treatment.

IST and POTS. Beta blockers are useful if the cause is sympathetic overactivity. If the cause is due to decreased vagal activity, it is usually hard to treat and one may consider radiofrequency catheter ablation.

References

^ Jameson, J. N. St C.; Dennis L. Kasper; Harrison, Tinsley Randolph; Braunwald, Eugene; Fauci, Anthony S.; Hauser, Stephen L; Longo, Dan L. (2005). Harrison's principles of internal medicine. New York: McGraw-Hill Medical Publishing Division. pp. 1344–58. ISBN 0-07-140235-7.
^ Emergency Care And Transportation Of The Sick And Injured. Jones & Bartlett Learning. 2010. ISBN 1-4496-1589-9.

Hall, John E.; Guyton, Arthur C. (2000). Textbook of medical physiology. Philadelphia: W. B. Saunders. ISBN 0-7216-8677-X.
Choudhury SR, Sharma A, Kohli V (February 2005). "Inappropriate sinus node tachycardia following gastric transposition surgery in children". Pediatric Surgery International 21 (2): 127–8. doi:10.1007/s00383-004-1354-9. PMID 15654608.

UpToDate Contents

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1. Sinus tachycardia: Evaluation and management
2. 頻脈性不整脈の急性期マネージメントの概要 overview of the acute management of tachyarrhythmias
3. 胎児不整脈の診断および治療に対する一般的アプローチの概要 overview of the general approach to diagnosis and treatment of fetal arrhythmias
4. 心電図チュートリアル：洞結節での調律および不整脈 ecg tutorial rhythms and arrhythmias of the sinus node
5. 頻脈を有する小児に対するアプローチ approach to the child with tachycardia

English Journal

The therapeutic value of atropine for critical care intubation.

Jones P1.
Archives of disease in childhood.Arch Dis Child.2016 Jan;101(1):77-80. doi: 10.1136/archdischild-2014-308137. Epub 2015 Jul 21.
Recent studies of atropine during critical care intubation (CCI) have revealed that neonates frequently experience bradycardia, are infrequently affected by ventricular arrhythmias and conduction disturbances and deaths have not been reported in a series of studies. The indiscriminate use of atropin
PMID 26199407

Recent advances in ablation of ventricular tachycardia associated with structural heart disease: overcoming the challenges of functional and fixed barriers.

Proietti R1, Roux JF, Essebag V.
Current opinion in cardiology.Curr Opin Cardiol.2016 Jan;31(1):64-71. doi: 10.1097/HCO.0000000000000242.
PURPOSE OF REVIEW: Ablation of ventricular tachycardia in structural heart disease has evolved to include techniques to ablate the myocardial substrate in sinus rhythm for ventricular tachycardias that are noninducible or hemodynamically unstable. The intricacies of the complex functional and fixed
PMID 26627313

Towards Improved Care of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope Patients: A Call to Action in Australia.

Lau DH1, Mahajan R2, Lee G3, Kalman JM3, Sanders P2.
Heart, lung & circulation.Heart Lung Circ.2016 Jan;25(1):8-11. doi: 10.1016/j.hlc.2015.10.001. Epub 2015 Oct 20.
PMID 26546091

Japanese Journal

骨髄破壊的移植後に多発性筋炎および心筋障害を併発した慢性GVHD

森本有紀,岡智子,田嶌政治 [他],濱畑啓悟,直川匡晴
臨床血液 56(5), 485-490, 2015
症例は50歳女性。平成25年6月に白血球増多，貧血，血小板減少を認め，精査の結果，t(16;21)(q21;q21)を有する急性骨髄性白血病と診断。平成26年6月に，CY 120 mg/kg, TBI 12 Gyによる前処置にてHLA-DRB1一座不一致のJMDPドナーより同種骨髄移植施行。Day 55に急性GVHDに対しプレドニゾロン20 mg/dayを投与し漸減していたが，day145に発熱， …
NAID 130005076022

Uncommon Presentation of Drug-refractory Pacemaker-mediated Common Atrioventricular Nodal Reentrant Tachycardia and a Simple Solution by Reprogramming

Horie Kazunori,Otomo Kiyoshi,Mori Shumpei,Kikuchi Yuichi,Meguro Taiichiro
Internal Medicine 54(9), 1063-1066, 2015
… An 81-year-old woman who had undergone dual chamber pacemaker implantation for sick sinus syndrome was referred to our hospital with drug-refractory common atrioventricular (AV) nodal reentrant tachycardia. … Ventricular pacing (Vp) following premature atrial contraction (PAC) with a long AV interval induced ventriculoatrial (VA) conduction, which allowed the tachycardia to be initiated. …
NAID 130005068326

バセドウ病を伴う胸腺腫合併重症筋無力症の1治療例

村上順一,上田和弘,佐野史歩,林雅太郎,濱野公一
山口医学 63(2), 161-166, 2014-05-01
… Soon after the surgery, temporary sinus tachycardia was identified, which was not due to thyrotoxic storm. …
NAID 120005477832

Related Pictures

★リンクテーブル★

リンク元	「洞性徐脈」「洞性頻脈」「ST」「洞性頻拍」
関連記事	「tachycardia」

「洞性徐脈」

Sinus tachycardia
	ECG readout of an individual with sinus tachycardia. Here the heart rate is around 150.
Classification and external resources
ICD-9	427.81
DiseasesDB	12135
MeSH	D013616

　　[★]

英: sinus bradycardia
同: 洞徐脈、洞性徐拍、洞徐拍
関: 徐脈性不整脈、徐脈。洞性頻脈洞頻脈 sinus tachycardia

[show details]

洞徐脈 sinus : 87 件
洞性徐脈 sinus : 約 1,060 件

洞徐脈 : 約 30,600 件
洞性徐脈 : 約 26,200 件

心電図で洞調律かつ、心拍数が60回/分以下のものを指して言う。
脈拍は自律神経（興奮）や薬剤、ないし発熱・炎症・虚血で変動しうる。
スポーツマンの場合、スポーツ心あるいは迷走神経緊張により洞性徐脈が見られることがあるので(生理的)、気にしなくても良い。
また、健常人でも安静時に徐脈となる人もいるが、活動時にも洞性徐脈が継続するのでなければ、精査・治療対象とはならない。
しかしながら、徐脈による症状が出現するようであれば精査した方が良い。
心拍数が50回/分以下が、(体の動作にかかわらず)持続的に続くようであれば洞不全症候群が疑われるので、専門医受診が好ましい。

「洞性頻脈」

　　[★]

英: sinus tachycardia, ST
同: 洞頻脈、洞性頻拍？、洞頻拍？
関: 洞徐脈、洞頻脈

鑑別疾患

「ST」

　　[★]

「洞性頻拍」

　　[★]

英: sinus tachycardia
関: 洞頻脈, 洞性頻脈, 洞頻拍

「tachycardia」

　　[★]

n.

頻拍症、頻拍、頻脈症、頻脈

関: tachyarrhythmia