Management of Palpitations with Heart Rate 105 bpm
Initial Assessment and Diagnosis
- The American Heart Association guidelines specify that ventricular rates below 150 bpm in the absence of ventricular dysfunction are more likely secondary to underlying conditions rather than the cause of instability, in patients with palpitations and a heart rate of 105 bpm 1, 2.
- Assess hemodynamic stability first, checking for acute altered mental status, ischemic chest pain, acute heart failure, hypotension, or signs of shock, in patients with palpitations and a heart rate of 105 bpm 1, 2.
- Evaluate oxygen saturation and respiratory status, looking specifically for tachypnea, intercostal retractions, suprasternal retractions, or paradoxical abdominal breathing, as hypoxemia is a common reversible cause of tachycardia, in patients with palpitations and a heart rate of 105 bpm 1, 2.
Identification and Treatment of Underlying Causes
- Do not treat the heart rate directly with rate-controlling medications, therapy must be directed toward identification and treatment of the underlying cause, in patients with palpitations and a heart rate of 105 bpm 1, 2.
- Common physiologic causes of palpitations with a heart rate of 105 bpm include fever, infection, dehydration, anemia, or pain, in otherwise healthy patients 6.
- Hyperthyroidism is a common cause of persistent tachycardia, obtain TSH testing to exclude this diagnosis, in patients with palpitations and a heart rate of 105 bpm 6.
ECG Interpretation and Referral Criteria
- Obtain a 12-lead ECG immediately to document rhythm, measure QRS duration, identify P-wave morphology and relationship to QRS, and look for pre-excitation (delta waves suggesting Wolff-Parkinson-White syndrome), in patients with palpitations and a heart rate of 105 bpm 4, 5.
- Immediate cardiology referral is required for pre-excitation (WPW syndrome) on ECG, wide-complex tachycardia of unknown origin, syncope during tachycardia or with exercise, and documented sustained supraventricular tachycardia, in patients with palpitations and a heart rate of 105 bpm 4, 5, 6.
Outpatient Monitoring Strategy
- If palpitations are infrequent and not accompanied by angina, heart failure, or syncope, use event or wearable loop recorders rather than 24-hour Holter monitoring, in patients with palpitations and a heart rate of 105 bpm 4, 5.
- For frequent episodes (several per week), 24-hour Holter monitoring may be appropriate, in patients with palpitations and a heart rate of 105 bpm 4, 5.
- For less frequent episodes, event or wearable loop recorder is preferred, in patients with palpitations and a heart rate of 105 bpm 4, 5.
- For rare symptoms (fewer than two episodes per month), consider implantable loop recorder if symptoms are severe, in patients with palpitations and a heart rate of 105 bpm 4, 5.