What to give for tachycardia (heart rate of 124 beats per minute)?

From the Guidelines

For a patient with a heart rate of 124 beats per minute, intravenous beta blockers, diltiazem, or verapamil is recommended as the first line of treatment in hemodynamically stable patients with suspected focal atrial tachycardia, as stated in the 2015 ACC/AHA/HRS guideline 1.

Key Considerations

• The patient's hemodynamic stability should be assessed before initiating treatment.
• Beta blockers, such as metoprolol, can be used to reduce heart rate, with a dose of 5 mg IV slowly, as suggested in the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 2.
• Calcium channel blockers, such as diltiazem, are alternatives for patients who cannot take beta blockers, with a dose of 0.25 mg/kg IV, as recommended in the same guidelines 2.
• Adenosine may be useful in the acute setting to either restore sinus rhythm or diagnose the tachycardia mechanism in patients with suspected focal AT, as stated in the 2015 ACC/AHA/HRS guideline 1.

Important Factors to Consider

• Underlying causes of tachycardia, such as anxiety, fever, dehydration, pain, hyperthyroidism, anemia, or cardiac conditions, should be addressed.
• Symptoms like chest pain, shortness of breath, dizziness, or altered consciousness may indicate a more serious condition requiring emergency care.
• Vital signs, including blood pressure and oxygen saturation, should be monitored, and an ECG should be performed to identify any arrhythmias.
• Hydration with IV fluids may help if dehydration is contributing to the tachycardia.

Treatment Options

• Intravenous beta blockers, diltiazem, or verapamil for hemodynamically stable patients with suspected focal atrial tachycardia.
• Adenosine for diagnostic and therapeutic purposes in patients with suspected focal AT.
• Synchronized cardioversion for patients with hemodynamically unstable focal AT, as recommended in the 2015 ACC/AHA/HRS guideline 1.

From the FDA Drug Label

Metoprolol is a beta 1-selective (cardioselective) adrenergic receptor blocker. Clinical pharmacology studies have demonstrated the beta-blocking activity of metoprolol, as shown by (1) reduction in heart rate and cardiac output at rest and upon exercise, (2) reduction of systolic blood pressure upon exercise, (3) inhibition of isoproterenol-induced tachycardia, and (4) reduction of reflex orthostatic tachycardia Animal and human experiments indicate that metoprolol slows the sinus rate and decreases AV nodal conduction

For a heart rate of 124 beats per minute, which is considered tachycardia, metoprolol can be given to help reduce the heart rate.

• The beta-blocking activity of metoprolol has been shown to reduce heart rate and cardiac output at rest and upon exercise.
• Metoprolol has been demonstrated to inhibit isoproterenol-induced tachycardia.
• The drug slows the sinus rate and decreases AV nodal conduction, which can help reduce the heart rate in cases of tachycardia. However, it is essential to consult the patient's medical history and current condition before administering metoprolol, as it may not be suitable for all patients, especially those with certain heart conditions or other underlying health issues 3.

From the Research

Treatment Options for Tachycardia

• Beta blockers, such as metoprolol, are often used as the first line of treatment for arrhythmias, including supraventricular tachycardia (SVT) and ventricular tachyarrhythmias (VT) 4, 5.
• Ivabradine is another option for treating inappropriate sinus tachycardia, and has been shown to be effective in reducing heart rate and relieving symptoms 6.
• Calcium channel blockers, such as verapamil and diltiazem, may also be used to treat AVNRT, and have been shown to be as effective as adenosine in converting AVNRT to sinus rhythm 7.
• Bisoprolol is a beta-blocker that has been shown to be effective in treating both supraventricular and ventricular arrhythmias, and may be used for rate control during atrial fibrillation 8.

Considerations for Treatment

• The choice of treatment depends on the type of arrhythmia and the clinical presentation and demographics of the patient 4.
• Beta blockers, such as metoprolol, may be effective in treating SVT, but may not be as effective in treating ventricular arrhythmias 5.
• Ivabradine has been shown to be well tolerated and effective in treating inappropriate sinus tachycardia, but may not be suitable for all patients 6.
• Calcium channel blockers, such as verapamil and diltiazem, may be effective in treating AVNRT, but may have negative side effects, such as hypotension 7.