Therapeutic target
Restoration of a normal heart rate
Therapy recommendations
- Sinus tachycardia should be treated with medication only if the increase in rate is inappropriate.
- Inappropriate sinus tachycardia (IAST; see differential diagnoses for explanations of the clinical picture): Administration of beta-blockers; alternatives: Ivabradine or non-dihydropyridine-type calcium antagonists.
- In case of demand tachycardia (e.g., fever (per 1 °C increase in frequency of about 10 beats/minute), anemia (anemia), hypoxia (reduced supply of oxygen to the body), hyperthyroidism (hyperthyroidism), hypovolemia (reduction in the circulating amount of blood, i.e., in the bloodstream), hypotension (low blood pressure), infection, pulmonary embolism, shock) see for therapy under the respective disorder/disease.
- Only if tachycardia is the cause of impaired hemodynamics, then therapy with antiarrhythmic drugs is indicated:
- Beta-blockers (e.g., bisoprolol) (first-line therapy); calcium channel blockers, if necessary.
Further notes
- Ivabradine is selective in the area of the sinus node by selectively inhibiting the “funny current” (IF) in the sinus node cells. This leads to a delay in diastolic depolarization consequently to a decrease in frequency.
- Ivabradine for the treatment of IAST is an off-label use therapy: starting dose 2 × 5 mg daily; increase as needed to 2 × 7.5 mg or reduce to 2 × 2.5 mg
