Cardiology Letters 2025, 34(4):244-252

Sinus tachycardia and its differential diagnosis

Monika Lukáčová, Peter Mitro, Kristína Valová

Arytmologické oddelenie, I. Kardiologická klinika LF UPJŠ a VÚSCH, a. s. Košice, Slovenská republika

Sinus tachycardia is defined as a heart rate exceeding 100 beats per minute. It results from accelerated activation of the sinus node mediated by the autonomic nervous system. It is the most common arrhythmia and serves as a useful physiological response of the body to physical and emotional stress. However, its occurrence in otherwise healthy individuals, in the absence of clearly identifiable triggers, poses a frequent clinical challenge. In certain cases, it may also indicate an underlying pathological condition. This review focuses on the differential diagnosis of sinus tachycardia, with special emphasis on its distinct forms: physiological sinus tachycardia, pathological sinus tachycardia, inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome, and sinus node reentry tachycardia. The etiology, clinical manifestations, diagnostic strategies, and therapeutic approaches are discussed. Evidence from multiple studies indicates that an elevated resting heart rate is associated with increased risk of cardiovascular disease, heart failure, cancer, and all-cause mortality. Management of secondary sinus tachycardia relies primarily on addressing the underlying cause. Direct suppression of sinus tachycardia is indicated only in cases of inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome, and sinus node reentry tachycardia.

Keywords: sinus tachycardia; inappropriate sinus tachycardia; postural orthostatic tachycardia syndrome; POTS

Published: April 1, 2025  Show citation