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Cited by 59Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlCardiac electrophysiology and arrhythmias

Sinus Tachycardia: a Multidisciplinary Expert Focused Review

Open access
Mayuga, Kenneth A., Fedorowski, Artur, Ricci, Fabrizio, Gopinathannair, Rakesh, Dukes, Jonathan Walter, Gibbons, Christopher, Hanna, Peter, Sorajja, Dan +24 more·2022·Circulation: Arrhythmia and Electrophysiology
DOI 10.1161/circep.121.007960PMC PMC9523592
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Abstract

Sinus tachycardia (ST) is ubiquitous, but its presence outside of normal physiological triggers in otherwise healthy individuals remains a commonly encountered phenomenon in medical practice. In many cases, ST can be readily explained by a current medical condition that precipitates an increase in the sinus rate, but ST at rest without physiological triggers may also represent a spectrum of normal. In other cases, ST may not have an easily explainable cause but may represent serious underlying pathology and can be associated with intolerable symptoms. The classification of ST, consideration of possible etiologies, as well as the decisions of when and how to intervene can be difficult. ST can be classified as secondary to a specific, usually treatable, medical condition (eg, pulmonary embolism, anemia, infection, or hyperthyroidism) or be related to several incompletely defined conditions (eg, inappropriate ST, postural tachycardia syndrome, mast cell disorder, or post-COVID syndrome). While cardiologists and cardiac electrophysiologists often evaluate patients with symptoms associated with persistent or paroxysmal ST, an optimal approach remains uncertain. Due to the many possible conditions associated with ST, and an overlap in medical specialists who see these patients, the inclusion of experts in different fields is essential for a more comprehensive understanding. This article is unique in that it was composed by international experts in Neurology, Psychology, Autonomic Medicine, Allergy and Immunology, Exercise Physiology, Pulmonology and Critical Care Medicine, Endocrinology, Cardiology, and Cardiac Electrophysiology in the hope that it will facilitate a more complete understanding and thereby result in the better care of patients with ST.

Integrity signals

Registry

Crossref · 10.1161/circep.121.007960

Cites

263 of 263 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

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  • Findingcitation

    CBT techniques reduce panic episodes in patients with heart disease.

    “as well as reduction of panic episodes in patients with heart disease.”
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    Properly dosed exercise training can be an effective non-pharmacologic therapeutic intervention for reversing severe muscle disuse atrophy and restoring normal exercise cardiac rate and rhythm caused by continuous bedrest in otherwise healthy adults.

    “Properly dosed exercise training can be an effective non-pharmacologic therapeutic intervention for reversing severe muscle disuse atrophy and restoring normal exercise cardiac rate and rhythm caused by a continuous period of bedrest in otherwise healthy adults192–194.”
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    CBT techniques including biofeedback assisted relaxation, cognitive reframing, and systematic desensitization are effective in improving function and reducing episodes in adult patients with syncope.

    “Case reports and small-scale studies indicate that cognitive behavioral therapy techniques, including biofeedback assisted relaxation, cognitive reframing, and systematic desensitization, are effective in improving function and reducing episodes in adult patients with syncope178–181”
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  • Findingcitation

    Parents of adolescent patients with POTS are often extremely worried about symptoms.

    “Programs may offer intensive education for parents and caregivers for adolescent patients, as parents are often extremely worried about these symptoms as well.186,187”
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    Ivabradine is generally well-tolerated when given in doses of 2.5-7.5 mg twice daily.

    “Nonetheless, the drug is generally well-tolerated when given in doses of 2.5–7.5 mg twice daily.”
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    Findingcitation

    Up to 25% of adult patients with POTS were found to be unable to work.

    “Up to 25% of adult patients with POTS were found to be unable to work182”
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    Findingreasoning

    Palpitations in POTS and IST are often caused by sinus tachycardia or catecholamine effects, but suppressing sinus tachycardia with drugs or ablation may not always eliminate palpitations and other symptoms.

    “Palpitations in POTS and IST are often caused by sinus tachycardia (or catecholamine effects) but suppressing sinus tachycardia with drugs or ablation may not always eliminate palpitations and other symptoms.”
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    Findingcitation

    Exercise training has proven effective for physical reconditioning and lessening episodes of sinus tachycardia triggered by hemodynamic, postural, and/or physical stressors in patients with autonomic nervous system conditions and no underlying familial or personal history of heart disease.

    “Similarly, exercise training has also proven effective for physical reconditioning and lessening episodes of sinus tachycardia triggered by hemodynamic, postural, and/or physical stressors in patients with autonomic nervous system conditions and no underlying familial or personal history of heart disease49,185,192,195,196.”
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    Findingnone given

    Patients with POTS and Ehlers-Danlos Syndrome (hypermobility type) usually have joint hypermobility, joint instability complications, and widespread musculoskeletal pain.

    “Patients with POTS and the Ehlers-Danlos Syndrome (hypermobility type) usually have joint hypermobility, joint instability complications, and widespread musculoskeletal pain.”
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    Findingcitation

    Adolescents and adults with POTS frequently experience depression, anxiety, anxiety sensitivity, and significant disability in response to their sinus tachycardia.

    “studies have shown that adolescents and adults with POTS frequently experience depression, anxiety, anxiety sensitivity, as well as significant disability in response to their sinus tachycardia183,184.”
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    Findingnone given

    Patients with POTS or IST frequently present with symptoms not involving the cardiovascular system.

    “Patients with POTS or IST frequently present with symptoms not involving the cardiovascular system.”
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    Findingnone given

    Improvements in physical conditioning and symptom severity gained through exercise training are typically slow to develop initially, but become more noticeable and sustained when exercise training is adhered to long-term.

    “Improvements in physical conditioning and symptom severity gained through exercise training are typically slow to develop initially, but become more noticeable and sustained when exercise training is adhered to long-term.”
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    Findingnone given

    Fludrocortisone may exacerbate migraine frequency and symptoms.

    “It may exacerbate migraine frequency and symptoms.”
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    Findingcitation

    In a small randomized crossover trial, both metoprolol and ivabradine suppressed sinus tachycardia, but ivabradine was moderately more effective, and the doses of metoprolol used frequently caused symptomatic hypotension.

    “In a small, randomized crossover trial both metoprolol and ivabradine suppressed sinus tachycardia, but ivabradine was moderately more effective, and the doses of metoprolol that were used frequently caused symptomatic hypotension200.”
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    Findingnone given

    No controlled trial of interventional techniques to modify the sinus node shows symptom improvement; the relationship between sinus rate and symptoms is not robust.

    “No controlled trial of interventional techniques to modify the sinus node show symptom improvement; the relationship between sinus rate and symptoms is not robust.”
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    Findingnone given

    Techniques to identify which patient may benefit from sinus node modification are not available.

    “Techniques to identify which patient may benefit from sinus node modification are not available.”
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    Findingcitation

    Ivabradine is an If inhibitor that reliably reduces heart rate and most symptoms of palpitations.

    “Ivabradine is an If inhibitor that reliably reduces heart rate and most symptoms of palpitations.”
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    Scalp tingling and goosebumps are common annoying side effects of midodrine.

    “Scalp tingling and ‘goosebumps’ are common annoying side effects.”
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    Findingnone given

    Fludrocortisone side effects include edema, hypokalemia, aggravation of migraines, and possibly osteoporosis in young women.

    “Side effects include edema, hypokalemia, aggravation of migraines, and possibly osteoporosis in young women.”
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    Findingcitation

    Tachycardia-mediated cardiomyopathy from IST has been reported in isolated case reports, and these cases were responsive to ivabradine.

    “While tachycardia-mediated cardiomyopathy from IST has been reported in isolated case reports, these cases were responsive to ivabradine 203,204, and so invasive management also is not recommended in this group.”
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    Findingcitation

    A study of ivabradine in patients with hyperadrenergic POTS reported a reduction in heart rate, improvement in quality-of-life, and a strong trend in reduction of norepinephrine levels upon standing.

    “A study of ivabradine in patients with hyperadrenergic POTS reported a reduction in heart rate, improvement in quality-of-life, and a strong trend in reduction of norepinephrine levels upon standing.95”
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    With invasive management, repeat ablation attempts are frequently required and carry a significant risk of need for permanent pacemaker along with the prospect of pacemaker generator changes over the course of patients' lives.

    “With invasive management, patients should also be informed that repeat ablation attempts are frequently required and carry a significant risk of need for permanent pacemaker along with the prospect of pacemaker generator changes over the course of patients’ lives.”
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    Findingnone given

    Pyridostigmine can contribute to bladder irritability.

    “It also can contribute to bladder irritability.”
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    Findingcitation

    While some patients have had successful lowering of heart rate over months of follow-up, one case series showed lack of reduction in heart rate during exercise, suggesting hormonal release of catecholamines may overcome sympathetic nerve blockade.

    “While some patients have had successful lowering of heart rate over months of follow-up, one case series showed lack of reduction in the heart rate during exercise, suggesting the hormonal release of catecholamines may be able to overcome sympathetic nerve blockade.223”
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    Findingcitation

    When the endocardial approach is unsuccessful, usually due to proximity of the sinus node to the phrenic nerve in about 18% of cases, alternate approaches should be employed.

    “When the endocardial approach is unsuccessful, usually due to the proximity of the sinus node to the phrenic nerve in about 18% of cases, then alternate approaches should be employed.208,209”
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    Findingnone given

    Several pharmacologic approaches for POTS have been tried, and many are successful in short term trials, but none has been tested in longer term studies.

    “Several pharmacologic approaches have been tried, and many are successful in short term trials. However, none has been tested in longer term studies.”
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    Central sympatholytic drugs have prominent side effects including sedation and dry mouth.

    “They have prominent side effects that include sedation and dry mouth.”
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    Findingnone given

    Pyridostigmine frequently causes diarrhea and may be particularly well tolerated in patients with constipation.

    “It frequently causes diarrhea and may be particularly well tolerated in patients with constipation.”
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    Findingcitation

    In a randomized trial, higher doses of propranolol were less effective at symptom improvement but more effective at heart rate control, and long-acting formulations are generally ineffective in controlling symptoms.

    “In a randomized trial197, higher doses were less effective at symptoms improvement (although more effective at heart rate control), and long-acting formulations are generally ineffective in controlling symptoms.”
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    Findingcitation

    A single case of possible IST-induced cardiomyopathy during pregnancy has been reported, and a recent cohort study did not demonstrate evidence of an increase in maternal death/major adverse cardiac events or peri-natal mortality associated with IST in pregnancy.

    “A single case of possible IST-induced cardiomyopathy during pregnancy has been reported (likely it was cardiomyopathy causing sinus tachycardia)255 a recent cohort study did not demonstrate evidence of an increase in maternal death/major adverse cardiac events (MACE) or peri-natal mortality associated with IST in pregnancy.250”
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    Findingcitation

    Right phrenic nerve injury with diaphragmatic paralysis, pericarditis, SVC stenosis, and cardiac tamponade during pericardial balloon placement requiring open-chest repair have all been reported.

    “Right phrenic nerve injury with diaphragmatic paralysis206,228, pericarditis205,213,229, SVC stenosis206,226,230 and cardiac tamponade during pericardial balloon placement requiring open-chest repair212 have all been reported.”
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    Findingcitation

    In a systematic review of 110 patients undergoing catheter ablation for IST, 30% still required rate or rhythm control medication after the procedure and 20% needed re-ablation.

    “In a systematic review of 110 patients undergoing catheter ablation for IST, 30% of patients still required rate or rhythm control medication after the procedure and 20% needed re-ablation208.”
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    Findingcitation

    Resting heart rate is inversely related to lifespan among homeothermic mammals and within individual species.

    “Resting heart rate is inversely related to the lifespan among homeothermic mammals and within individual species232.”
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    Findingcitation

    Even unstressed infants have a wide range of normal heart rate with the 99th percentile in the 180 bpm range shortly after birth, decreasing to 160 bpm at 1 year, 110 bpm by age 12, and 100 bpm by 18.

    “Even unstressed infants have a wide range of normal HR with the 99th percentile in the 180 bpm range shortly after birth, decreasing to 160 bpm at 1 year, 110 bpm by age 12, and 100 bpm by 18231.”
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    Findingnone given

    Maximal sinus tachycardia is age dependent, decreasing most rapidly early in life but continuing to decrease thereafter.

    “Maximal sinus tachycardia is age dependent decreasing most rapidly early in life but continuing to decrease thereafter.”
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    Findingcitation

    Common arrhythmias post-ablation include atrial tachycardias, comprising 71% of all non-IST arrhythmias, which may require catheter ablation.

    “Besides sinus node dysfunction including sinus pauses, common arrhythmias post-ablation includes atrial tachycardias, comprising 71% of all non-IST arrhythmias; these may also require catheter ablation206,210,225,228.”
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    Findingcitation

    These are small studies, with the largest series having 39 patients.

    “However, these are small studies, with the largest series having 39 patients201.”
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    Findingcitation

    Junctional rhythm is frequent, with 42% of patients having this arrhythmia, usually with recovery of a higher right atrial rhythm within 24 hours.

    “Junctional rhythm is also frequent, with 42% of patients having this arrhythmia, usually with recovery of a higher right atrial rhythm within 24 hours.206,208,213”
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    Findingcitation

    IST induced by pregnancy is associated with debilitating symptoms, frequent emergency department/hospitalization visits, and higher rates of induction of labor.

    “IST induced by pregnancy is associated with debilitating symptoms, frequent emergency department/hospitalization visits occur with higher rates of induction of labor.250”
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    Findingcitation

    Upright hyperventilation seems rather common and produces a POTS-like tachycardia in some children.

    “Finally, upright hyperventilation seems rather common and produces a POTS-like tachycardia in some children.242”
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    Findingcitation

    Complications of sinus node modification vary from 0-14%, but the true occurrence rate is limited by the small studies.

    “Complications vary from 0–14% but the true occurrence rate is limited by the small studies.201,202,206,207,215,225–228”
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    Findingcitation

    Initial orthostatic hypotension occurs in 20-25% of healthy young volunteers and may be associated with transient reflex sinus tachycardia into the POTS range within the first minute of standing.

    “A common brief transient form of orthostatic hypotension, known as “initial orthostatic hypotension”, occurs in 20–25% of healthy young volunteers and may be associated with transient reflex sinus tachycardia into the POTS range within the first minute of standing239.”
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    Findingnone given

    There are extensive gaps in knowledge about how to identify pathologic sinus tachycardia, link symptoms to sinus tachycardia, determine the relationship between the autonomic nervous system and sinus tachycardia, assess channelopathies that may be responsible for sinus tachycardia, and determine an approach to resolve underlying problems and sinus tachycardia itself.

    “Surprisingly, there are extensive gaps in our knowledge about how to identify pathologic sinus tachycardia, link symptoms to sinus tachycardia, determine the relationship between the autonomic nervous system and sinus tachycardia, assess channelopathies that may be responsible for sinus tachycardia and to determine an approach to resolve the underlying problems and sinus tachycardia itself for”
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    Findingnone given

    Sinus tachycardia is the most common arrhythmia and is often nothing more than an appropriate response to physical activity.

    “Sinus tachycardia is the most common arrhythmia that is often nothing more than an appropriate response to physical activity.”
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    Findingnone given

    Asymptomatic women with supine hypotension tend to have much greater azygous blood flow to compensate for impairment in flow in the inferior vena cava.

    “Asymptomatic women with supine hypotension tend to have much greater azygous blood flow to compensate for impairment in flow that is present in the inferior vena cava.”
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    Findingnone given

    There may be blunted baroreflex activity and a blunted response to Valsalva efficiency associated with an incomplete compensatory heart rate response to drop in blood pressure.

    “There may be blunted baroreflex activity and a blunted response to Valsalva efficiency associated with an incomplete compensatory heart rate response to drop in blood pressure.”
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    Findingnone given

    The supine hypotensive syndrome with sinus tachycardia occurs in 2.5-20% of women and occurs in asymptomatic women at a greater rate.

    “The syndrome itself occurs in 2.5–20% of women such supine hypotension with sinus tachycardia and occur in asymptomatic women at a greater rate.”
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    Findingnone given

    There are no human safety data on use of ivabradine in pregnancy; some animal data suggest fetotoxicity.

    “There are no human safety data on use of ivabradine in pregnancy; some animal data suggest fetotoxicity.”
    Quote in the paperSubstantial claim

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    Premisenone given

    For some individuals, sinus tachycardia can be associated with debilitating symptoms affecting functionality, quality of life and well-being, but the relationship of symptoms to tachycardia often remains obscure.

    “For some individuals, sinus tachycardia can be associated with debilitating symptoms affecting functionality, quality of life and well-being, but the relationship of symptoms to tachycardia often remains obscure.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Sinus tachycardia represents a spectrum of problems from a normal variant to a chronic ongoing autonomic condition to an underlying inflammatory or infectious process, among others.

    “As described here, sinus tachycardia represents a spectrum of problems from a normal variant to a chronic ongoing autonomic condition to an underlying inflammatory or infectious process, among others.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Sinus tachycardia may be the cause for adverse outcomes or associated with symptoms; alternatively, it may be a solitary, singular nonspecific 'barometer' of one of a multitude of underlying problems.

    “Sinus tachycardia may be the cause for adverse outcomes or associated with symptoms; alternatively, it may be a solitary, singular nonspecific “barometer” of one of a multitude of underlying problems.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisenone given

    Sinus tachycardia can be classified as secondary to a specific, usually treatable, medical condition (e.g., pulmonary embolism, anemia, infection, or hyperthyroidism) or be related to several incompletely-defined conditions (e.g., inappropriate sinus tachycardia, postural tachycardia syndrome, mast cell disorder, or post-COVID syndrome).

    “ST can be classified as secondary to a specific, usually treatable, medical condition (e.g. pulmonary embolism, anemia, infection, or hyperthyroidism) or be related to several incompletely-defined conditions (e.g. inappropriate sinus tachycardia, postural tachycardia syndrome, mast cell disorder, or post-COVID syndrome).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Like fever, sinus tachycardia can be an appropriate response to illness and various disease states and is thus a non-specific clinical sign.

    “Like fever, sinus tachycardia can be an appropriate response to illness and various disease states and is thus a non-specific clinical sign.”
    Quote in the paperSubstantial claim

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    Interpretationreasoning

    The OPERA study failed to capture, by design, the population of IST patients most often seen in clinic (young patients in their 20s), and as such gives only limited insight into this disease.

    “This study failed to capture, by design, the population of IST patients most often seen in clinic (that is, young patients in their 20s), and, as such, gives only limited insight into this disease.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    In a meta-analysis of large population studies, significant increases in relative risk per 10 bpm increase in resting heart rate were seen with coronary heart disease (RR 1.07, 95% CI: 1.05-1.10), sudden cardiac death (RR 1.09, 95% CI: 1.00-1.18), heart failure (RR 1.18, 95% CI: 1.10-1.27), total stroke (RR 1.06, 95% CI: 1.02-1.10), total cancer (RR 1.14, 95% CI: 1.06-1.23) and all-cause mortality

    “Despite these mixed findings, in a meta-analysis of the large population studies, significant increases in relative risk (RR) per 10 bpm increase in resting heart rate were seen with coronary heart disease (RR 1.07, 95% CI: 1.05–1.10), sudden cardiac death (RR 1.09, 95% CI: 1.00–1.18), heart failure (RR 1.18, 95% CI: 1.10–1.27), total stroke (RR 1.06, 95% CI: 1.02–1.10), total cancer (RR 1.14, 95%”
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    Premisecitation

    In the SHIFT trial, ivabradine given to lower the heart rate was associated with a reduction in the composite endpoint of cardiovascular death or heart failure hospitalization (HR 0.82, 95% CI 0.75-0.90); the subgroup of patients with a heart rate >87 bpm had the greatest reduction in heart rate with ivabradine and the largest reduction in the composite endpoint (HR 0.75, 95% CI 0.67-0.85); ivabrd

    “In this trial, ivabradine given to lower the heart rate was associated with a reduction in the composite endpoint of cardiovascular death or heart failure hospitalization (HR 0.82, 95% CI 0.75–0.90). The subgroup of patients with a heart rate >87 bpm had the greatest reduction in heart rate with ivabradine and the largest reduction in the composite endpoint (HR 0.75, 95% CI 0.67–0.85). This”
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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Sinus tachycardia rarely sustains for prolonged periods of time but, if it does, it is likely that there is some pathophysiological underpinning.

    “Sinus tachycardia rarely sustains for prolonged periods of time but, if it does, it is likely that there is some pathophysiological underpinning.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    POTS has been shown to have a prevalence of 0.2% in cohort studies and predominately affects females at a 5:1 ratio.

    “POTS has been shown to have a prevalence of 0.2% in cohort studies31–33 and predominately affects females at a 5:1 ratio.31,34–36”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [31]

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    • cites [32] source

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    • cites [33] source

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    • cites [34] source

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    • cites [35] source

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    • cites [36] source

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  • May combine two claims.

    Premisereasoning

    Common temporal presentations include recurrent episodes of sinus tachycardia that occur in a pattern consistent with orthostatic positional changes in the case of POTS, and reproducible and often consistent sinus tachycardia at rest, or with minimal disturbance in the case of IST.

    “Common temporal presentations include recurrent episodes of sinus tachycardia that occur in a pattern consistent with orthostatic positional changes in the case of POTS, and reproducible and often consistent sinus tachycardia at rest, or with minimal disturbance in the case of IST, for which, several clinical presentations have been described.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Sinus tachycardia paroxysms may be due to anxiety as in panic disorder (epinephrine-mediated), norepinephrine reuptake inhibition (a very rare condition; norepinephrine-mediated) or drug intake (e.g. beta-agonists in asthma).

    “It should be kept in mind that sinus tachycardia paroxysms may be due to anxiety as in panic disorder44 (epinephrine-mediated), norepinephrine reuptake inhibition45 (a very rare condition; norepinephrine-mediated) or drug intake (e.g. beta-agonists in asthma).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [44]

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    • cites [45] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Sinus tachycardia that persists and increases may indicate congestive heart failure, or an evolving underlying infectious or inflammatory condition.

    “Sinus tachycardia that persists and increases may indicate congestive heart failure, or an evolving underlying infectious or inflammatory condition.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    IST is less affected by rest and can be difficult to distinguish from deconditioning which may also show rapid rise in sinus rates with minimal activity.

    “IST is less affected by rest and can be difficult to distinguish from for instance deconditioning which may also show rapid rise in sinus rates with minimal activity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Autonomic influences modulate the intrinsic rate and sympathetic activation or parasympathetic inhibition can cause sinus tachycardia.

    “Autonomic influences modulate the intrinsic rate and sympathetic activation or parasympathetic inhibition39 can cause sinus tachycardia.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Sinus tachycardia can be a normal physiological response to internal and/or external stresses but is excessive when unnecessary physiologically or when exceeding normal bounds.

    “Sinus tachycardia can be a normal physiological response to internal and/or external stresses but is excessive when unnecessary physiologically or when exceeding normal bounds.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a 1970s study of chemical denervation in 432 subjects, there was a progressive decrease in the mean intrinsic heart rate with increasing age; the mean rate for those aged 18-30 was >100 bpm and decreased to <100 bpm for those over age 45, but sinus rates still exceeded 100 bpm in >15% of those over age 45.

    “In a 1970’s study of chemical denervation (atropine and beta-blockade) in 432 subjects, there was a progressive decrease in the mean intrinsic heart rate with increasing age. The mean rate for those aged 18–30 was >100 bpm and decreased to <100 bpm for those over age 45. Nevertheless, sinus rates still exceeded 100 bpm in >15% of those over age 45.18”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] source

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  • May combine two claims.

    Premisecitation

    Contemporary studies of mixed gender confirm a bell-shaped pattern of heart rate distribution while also showing a clear inflection point of the distribution skew at 85-90 bpm.

    “Contemporary studies of mixed gender confirm this bell-shaped pattern while also showing a clear inflection point of the distribution skew at 85–90 bpm.11”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Sinus tachycardia may be due to tonic, or phasic, changes in the autonomic nervous system, circulating neurohormones or due to an underlying pathology of regulating currents of the sinus node.

    “Thus, sinus tachycardia may be due to tonic, or phasic, changes in the autonomic nervous system, circulating neurohormones or due to an underlying pathology of regulating currents of the sinus node.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    IST may present with various patterns, and at least two distinct populations can be identified based on diurnal heart rate variation which may be useful to classify pathophysiology and ideally provide guidance to specific treatment.

    “Further, IST may present with various patterns, and at least two distinct populations can be identified based on diurnal heart rate variation which may be useful to classify pathophysiology and ideally provide guidance to specific treatment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Documentation that a tachycardia is indeed sinus tachycardia becomes the first step in evaluation but discrimination of non-sinus tachycardias from sinus tachycardia involves more than careful scrutiny of the P-wave morphology.

    “Documentation that a tachycardia is indeed sinus tachycardia becomes the first step in evaluation but discrimination of non-sinus tachycardias from sinus tachycardia involves more than careful scrutiny of the P-wave morphology.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisereasoning

    Analysis of mode of onset and termination (abrupt versus gradual), detection of premature atrial complexes at the initiation or termination of tachycardia, temporal patterns of sinus tachycardia, circadian profile of heart rate and its variability, correlation between patient symptoms and burden of sinus tachycardia, and relationship with exercise and patient position, are important clues captured

    “Analysis of mode of onset and termination (abrupt versus gradual), detection of premature atrial complexes at the initiation or termination of tachycardia, temporal patterns of sinus tachycardia (new-onset, paroxysmal or persistent) (Table 1), circadian profile of heart rate and its variability, correlation between patient symptoms and burden of sinus tachycardia, and relationship with exercise”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Such causal factors have been found in some but not all patients with the often regarded 'idiopathic tachycardias': POTS and IST.

    “Such causal factors have been found in some but not all patients with the often regarded “idiopathic tachycardias”: POTS and IST.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    Clinical presentations of IST include persistent elevation in heart rate, spikes in heart rate with minimal activity and heart rate changes with and without exercise.

    “These clinical presentations include persistent elevation in heart rate, spikes in heart rate with minimal activity and heart rate changes with and without exercise.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Triggers may be cause for only transient fluctuations in sinus rate including anemia, and pulmonary embolus.

    “Triggers may be cause for only transient fluctuations in sinus rate including anemia, and pulmonary embolus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The vast majority of POTS patients are young, with a mean age of presentation between 15-30.

    “The vast majority are young, with a mean age of presentation between 15–3034,36.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [34] source

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    • cites [36] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The only estimate of IST prevalence to date is the OPERA study that identified an IST prevalence of 1.16%, though this group included symptomatic and asymptomatic patients; in that study, 57% of IST patients were female with a mean age of 47.

    “The only estimate of prevalence to date is the OPERA (Oulu Project Elucidating Risk of Atherosclerosis) study that identified an IST prevalence of 1.16%, though this group included symptomatic and asymptomatic patients. In that study, 57% of IST patients were female with a mean age of 47.11”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] source

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  • May combine two claims.

    Premisecitation

    Heart rates above the standard definition of normal are common across large populations, with higher heart rates in women compared to men, and this can vary by age.

    “Heart rates above the standard definition of normal are common across large populations with higher heart rates in women compared to men and this can vary by age.12”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12]

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Sporadic changes in heart rate may be present under conditions of physical or mental stress, and due to sleep disorders or are due to ingestion of stimulant drugs.

    “Further, sporadic changes in heart rate may be present under conditions of physical or mental stress, and due to sleep disorders or are due to ingestion of stimulant drugs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Despite widespread clinical use, there is a surprising lack of research about ECG monitoring data and very little evidence about established reference ranges for common arrhythmias (including sinus node related tachycardias), as well as their prognostic significance and gender differences.

    “It is noteworthy that, despite widespread clinical use, there is a surprising lack of research about ECG monitoring data and very little evidence about established reference ranges for common arrhythmias (including sinus node related tachycardias), as well as their prognostic significance and gender differences.52,53”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [52]

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    • cites [53]

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  • May combine two claims.

    Premisecitation

    These mechanisms include decreased parasympathetic activity, diminished muscarinic receptor function, impaired efferent vagal activation, increased sympathetic activity and baroreceptor dysfunction.

    “These mechanisms include decreased parasympathetic activity, diminished muscarinic receptor function, impaired efferent vagal activation, increased sympathetic activity and baroreceptor dysfunction.55,75”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [55] source

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    • cites [75] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The clinical presentation of sinus tachycardia includes temporally associated symptoms, frequency, initiation, and termination of episodes.

    “The clinical presentation of sinus tachycardia includes temporally associated symptoms, frequency, initiation, and termination of episodes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Heart rate variability declines with age.

    “Heart rate variability declines with age.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Perturbations in autonomic regulation that may manifest as IST include diabetic autonomic neuropathy, baroreflex impairment, β-adrenergic receptor autoantibodies, and hyperadrenergic states such as pheochromocytoma.

    “Perturbations in autonomic regulation that may manifest as IST include diabetic autonomic neuropathy,59 baroreflex impairment,60 β-adrenergic receptor autoantibodies,61 and hyperadrenergic states such as pheochromocytoma62.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [59]

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    • cites [60] source

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    • cites [61] source

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  • May combine two claims.

    Premisecitation

    An unintended consequence of catheter ablation of arrhythmias may be IST, as several reports describe IST attributed to vagal denervation during ablation for other arrhythmias.

    “An unintended consequence of catheter ablation of arrhythmias may be IST, as several reports describe IST attributed to vagal denervation during ablation for other arrhythmias.63–66”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [63]

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    • cites [64]

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    • cites [65]

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    • cites [66]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    An ECG may reveal electrocardiographic patterns that may help identify a precipitant for sinus tachycardia.

    “Additionally, an ECG may reveal electrocardiographic patterns that may help identify a precipitant for sinus tachycardia.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    New wearable systems, incorporating specific sensors that acquire biological parameters besides ECG signals, such as respiratory frequency, peripheral oxygen saturation, arterial pulse pressure, physical activity, position and others, are transforming conventional ECG monitoring systems into 'ambulatory polygraphic monitoring'.

    “New wearable systems, incorporating specific sensors that acquire biological parameters, besides ECG signals, such as, respiratory frequency, peripheral oxygen saturation, arterial pulse pressure, physical activity, position and others, are transforming conventional ECG monitoring systems into “ambulatory polygraphic monitoring”.51”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51]

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  • May combine two claims.

    Premisecitation

    Vital signs and physical exam findings in sinus tachycardia may be within normal limits or may include abnormal findings such as orthostatic vital signs, resting HR >100 bpm, low resting oxygen saturation, pallor, rapid and regular heart rate by palpation of pulse and cardiac auscultation, pleuritic discomfort upon inspiration, stigmata of heart failure, infectious signs, and enlarged thyroid on

    “Vital signs and physical exam findings may be within normal limits or may include abnormal findings such as orthostatic vital signs, resting HR >100 bpm, low resting oxygen saturation, pallor, rapid and regular heart rate by palpation of pulse and cardiac auscultation, pleuritic discomfort upon inspiration, stigmata of heart failure (e.g. peripheral edema, decreased breath sounds or pulmonary”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The 2015 Heart Rhythm Society Expert Consensus Statement gives a class IIb recommendation for 24-hour Holter monitor, exercise testing, autonomic and tilt table testing for confirmation of both IST and POTS diagnosis.

    “The 2015 Heart Rhythm Society Expert Consensus Statement gives a class IIb recommendation for 24-hour Holter monitor, exercise testing, autonomic and tilt table testing for confirmation of both IST and POTS diagnosis.49”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    While the evaluation of the autonomic nervous system is still being further explored and has yet to be standardized, current modalities include heart rate variability to paced breathing, Valsalva testing, and quantitative sudomotor axon reflex testing.

    “While the evaluation of the autonomic nervous system is still being further explored and has yet to be standardized, current modalities include heart rate variability to paced breathing, Valsalva testing, and quantitative sudomotor axon reflex testing.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    Automated devices that record heart rate variability generally do not analyze respiratory effort and therefore cannot appropriately interpret the results.

    “Automated devices that record heart rate variability generally do not analyze respiratory effort and therefore cannot appropriately interpret the results.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Data on autoantibodies are not definitive.

    “Data on autoantibodies are not definitive.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Morillo et al studied 6 patients with IST and showed that while patients had higher intrinsic heart rates indicative of increased sinus node automaticity, they had depressed vagal outflow and increased β-adrenergic sensitivity.

    “In particular, Morillo et al studied 6 patients with IST using a battery of autonomic testing including heart rate variability analysis, cardiovagal reflex testing using cold face testing, and autonomic blockade with intravenous propranolol and atropine.57 These investigators showed that while patients had higher intrinsic heart rates indicative of increased sinus node automaticity, they had”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [57] source

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  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    This may be more than a reflexive physiologic tachycardia.

    “This may be more than a reflexive physiologic tachycardia.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    Inadequate respiratory effort will result in decreased heart rate variability, which cannot be differentiated from disease.

    “Inadequate respiratory effort will result in decreased heart rate variability, which cannot be differentiated from disease.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    This occurs in volume depletion, infection, pregnancy, heart failure or circulatory or hemorrhagic shock, or in an exaggerated response, as in POTS.

    “This occurs in volume depletion, infection, pregnancy, heart failure or circulatory or hemorrhagic shock, or in an exaggerated response, as in POTS.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the case of IST, while elevated sinus node automaticity is believed by some to contribute, impaired sympathovagal balance has also been associated with the disorder.

    “In the case of IST, while elevated sinus node automaticity is believed by some to contribute55,56, impaired sympathovagal balance has also been associated with the disorder55.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [55] source

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    • cites [56] source

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  • May combine two claims.

    Interpretationcitation

    Cardiac interventions may either cause or ameliorate IST.

    “Cardiac interventions may either cause or ameliorate IST.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    The autonomic nervous system exerts significant control over the sinoatrial node, and autonomic dysregulation has been implicated in conditions such as inappropriate sinus tachycardia.

    “The autonomic nervous system exerts significant control over the sinoatrial node, and autonomic dysregulation has been implicated in conditions such as inappropriate sinus tachycardia.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    A number of tests have been used to evaluate sympathetic adrenergic, parasympathetic and sympathetic cholinergic function in patients presenting with sinus tachycardia of unknown etiology.

    “A number of tests have been used to evaluate sympathetic adrenergic, parasympathetic and sympathetic cholinergic function in patients presenting with sinus tachycardia of unknown etiology.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisereasoning

    The Tilt Table Test has long been a cornerstone of assessing symptoms of orthostatic intolerance and can be particularly useful for sinus tachycardia; it can help differentiate syndromes of sinus tachycardia from other conditions such as vasovagal syncope and orthostatic hypotension with compensatory tachycardia, and it can be combined with ancillary testing such as 12-lead ECG monitoring, me

    “The Tilt Table Test has long been a cornerstone of assessing symptoms of orthostatic intolerance and can be particularly useful for sinus tachycardia; it can help differentiate syndromes of sinus tachycardia from other conditions such as vasovagal syncope and orthostatic hypotension with compensatory tachycardia, and it can be combined with ancillary testing such as 12-lead ECG monitoring, me”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    As a similar approach has been evaluated for both sinus bradycardia and tachycardia, the mechanism remains unclear and deserving of further study.

    “However, as a similar approach has been evaluated for both sinus bradycardia and tachycardia, the mechanism remains unclear and deserving of further study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    It is the baroreceptors that detect a decreasing BP sending signals afferently to the nucleus tractus solitarious, nucleus ambiguous and caudal ventrolateral medulla; efferent signals back to the sinoatrial node via the vagus nerve are the pathway to sinus tachycardia.

    “It is the baroreceptors that detect a decreasing BP sending signals afferently to the nucleus tractus solitarious, nucleus ambiguous and caudal ventrolateral medulla. Efferent signals back to the sinoatrial node via the vagus nerve are the pathway to sinus tachycardia.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The 2020 Canadian Cardiovascular Society Position Statement on POTS does not recommend the routine use of ECG monitoring although it may be considered to rule out POTS-mimicking conditions (Strong Recommendation, Moderate-Quality Evidence).

    “The 2020 Canadian Cardiovascular Society Position Statement on POTS does not recommend the routine use of ECG monitoring although it may be considered to rule out POTS-mimicking conditions (Strong Recommendation, Moderate-Quality Evidence).50”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50]

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  • May combine two claims.

    Premisenone given

    Although Holter and event monitoring, implantable loop recorders and smart-watches are widely used, we have no databank of normal monitoring to compare against and to determine how much abrupt change in heart rate or even sinus tachycardia can be considered within the normal range and may be dependent upon features unrelated to any specific underlying clinical circumstance, autonomic disorder or

    “Importantly, although Holter and event monitoring, implantable loop recorders and smart-watches, are widely used, we have no databank of normal monitoring to compare against and to determine how much abrupt change in heart rate or even sinus tachycardia can be considered within the normal range and may be dependent upon features unrelated to any specific underlying clinical circumstance, autonomic”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    The role of autonomic testing in patients presenting with sinus tachycardia has not been well established.

    “The role of autonomic testing in patients presenting with sinus tachycardia has not been well established.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Detailed spectral analysis of the frequencies of heart rate during rest have been performed exhaustively across many healthy and disease states, but the results have not generally been included in routine clinical testing because they do not often provide additional information relevant to a single patient.

    “Detailed spectral analysis of the frequencies of heart rate during rest have been performed exhaustively across many healthy and disease states, but the results have not generally been included in routine clinical testing because they do not often provide additional information relevant to a single patient.81”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81]

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  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Mast cells may inappropriately release chemical mediators that elicit an array of symptoms including rapid heart beating, allergic reactions, skin rashes, and gastrointestinal complaints, termed mast cell activation disorder (MCAD).

    “Mast cells may inappropriately release chemical mediators that elicit an array of symptoms. In particular, symptoms include rapid heart beating, allergic reactions, skin rashes, and gastrointestinal complaints, and is termed ‘mast cell activation disorder’ (MCAD).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Blockade using a proteolysis resistant decoy peptide mimicking putative epitopes for these autoantibodies returned the postural pulse response to normal, supporting a pathophysiological role for autoantibodies in this animal model.

    “Blockade using a proteolysis resistant decoy peptide mimicking putative epitopes for these autoantibodies returned the postural pulse response to normal, supporting a pathophysiological role for autoantibodies in this animal model107.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [107] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The heart rate and blood pressure changes during the Valsalva maneuver occur in 4 phases.

    “The heart rate and blood pressure changes during the Valsalva maneuver occur in 4 phases.83”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [83]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Any relationship of these autoantibodies with tachycardia remains speculative.

    “Some subjects with idiopathic postural hypotension and tachycardia harbor autoantibodies in variable degrees, but any relationship of these autoantibodies with tachycardia remains speculative.111”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [111] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In most tilt table test protocols, the duration of upright position is at least 10 minutes, and many centers use longer protocols such as 45 minutes.

    “In most TTT protocols, the duration of upright position is at least 10 minutes, and in many centers longer protocols are used, such as 45 minutes90,91.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [90]

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    • cites [91]

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  • May combine two claims.

    Premisecitation

    Postural change from supine to upright leads to venous pooling, with 500-1000 ml of blood shifting from the thorax into the peripheral vascular compartments.

    “Postural change from supine to upright position leads to venous pooling, a process where 500–1000 ml of blood shift from the thorax into the peripheral vascular compartments (the legs and the abdominal and pelvic regions).77,85,86”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [77]

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    • cites [85]

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    • cites [86]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The active standing test causes a shift in blood volume of 300-800 milliliters from the central intravascular compartment to the peripheral vascular system and stimulates both parasympathetic withdrawal and sympathetic activation.

    “This test causes a shift in blood volume of 300–800 milliliters from the central intravascular compartment to the peripheral vascular system and stimulates both parasympathetic withdrawal and sympathetic activiation.84”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Heart rate variability might be tested in patients with POTS or IST to determine if there is evidence of parasympathetic dysfunction as the cause of the condition.

    “Heart rate variability might be tested in patients with POTS or IST to determine if there is evidence of parasympathetic dysfunction as the cause of the condition.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Patients with IST may also display a postural increase in heart rate, and mixed forms of IST/POTS are not uncommon.

    “Importantly, patients with IST may also display a postural increase in heart rate; mixed forms of IST/POTS are not uncommon74.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    MCAD is uncommon but may cause a clinical picture resembling postural orthostatic tachycardia syndrome (POTS).

    “MCAD is uncommon but may cause a clinical picture resembling postural orthostatic tachycardia syndrome (POTS).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Circulating autoantibodies affecting cardiovascular G-protein coupled receptors may be found in patients with inappropriate sinus tachycardia and POTS.

    “Circulating autoantibodies affecting cardiovascular G-protein coupled receptors may be found in patients with inappropriate sinus tachycardia and POTS.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Histamine can drop systolic and diastolic blood pressure, increase cardiac output and catecholamines, and cause sinus tachycardia.

    “Histamine, the best known and most studied mast cell mediator can drop systolic and diastolic blood pressure, increase cardiac output and catecholamines, and cause sinus tachycardia115.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [115]

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    MCAD symptoms tend to occur episodically as flares and differ from mastocytosis, which tends to be more persistent and characterized by elevated tryptase levels.

    “MCAD symptoms tend to occur episodically (‘flares’) and differs from mastocytosis which tends to be more persistent and characterized by elevated tryptase levels.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Circulating autoantibodies to beta-1 and 2 adrenergic and M2 receptors can modulate activity of targeted cardiac receptors and may be related to reported persistence of sinus tachycardia following normalization of thyroid hormone.

    “Circulating autoantibodies to beta-1 and 2 adrenergic and the M2 receptors can modulate activity of targeted cardiac receptors and may be related to a reported persistence of sinus tachycardia following normalization of thyroid hormone100.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [100]

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    No single laboratory finding is diagnostic of MCAD, but an elevated circulating prostaglandin (D2 or F2alpha), especially when accompanied by increased histamine marker, is highly suggestive.

    “No single laboratory finding is diagnostic of MCAD, but an elevated circulating prostaglandin (D2 or F2alpha), especially when accompanied by increased histamine marker (plasma histamine, urine methylhistamine), is highly suggestive.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    The stimulus for tachycardia during a Valsalva maneuver is the drop in blood pressure; if there is no drop in blood pressure during phase II because of inadequate respiratory effort, there will not be a tachycardia.

    “The stimulus for tachycardia during a Valsalva maneuver is the drop in blood pressure. If there is no drop in blood pressure during phase II because of inadequate respiratory effort, there will not be a tachycardia.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Conditions identifiable during tilt table testing include neurally mediated syncope, orthostatic hypotension, postural orthostatic tachycardia syndrome, and delayed orthostatic hypotension.

    “The following conditions can be identified during tilt table testing: neurally mediated syncope, orthostatic hypotension, postural orthostatic tachycardia syndrome and delayed orthostatic hypotension.88”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [88] source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Abnormalities detectable on active standing include parasympathetic dysfunction, orthostatic hypotension, or postural tachycardia as seen in POTS.

    “Abnormalities that can be detected on active standing include evidence of parasympathetic dysfunction, orthostatic hypotension, or postural tachycardia (as seen in POTS).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In Graves' hyperthyroidism, thyroid stimulating immunoglobulins cause elevated thyroid hormones, especially T3, altered K+ channel activity, and sinus tachycardia.

    “The presence of thyroid stimulating immunoglobulins cause elevated thyroid hormones, especially T3, altered K+ channel activity and sinus tachycardia.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [99]

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    The sudden, transient tachycardia after blood transfer is mediated by inhibition of vagal tone and is called the exercise reflex.

    “This sudden, and transient, tachycardia is mediated by inhibition of vagal tone and is referred to as the exercise reflex.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The tilt table test has been a longstanding cornerstone in the assessment of orthostatic intolerance and is particularly useful in evaluating sinus tachycardia.

    “The tilt table test (TTT) has been a longstanding cornerstone in the assessment of orthostatic intolerance89 and is particularly useful in evaluating sinus tachycardia.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [89]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most centers use an increase of at least 30 bpm within 10 minutes of upright tilt without a drop in blood pressure to be diagnostic for POTS in patients aged 19 or older, though a longer duration to onset has also been described.

    “While the rapidity and pattern of the heart rate increase can be somewhat variable, most centers use an increase of at least 30 bpm within 10 minutes of upright tilt (without drop in blood pressure) to be diagnostic for POTS in patients aged 19 or older, though a longer duration to onset has also been described49,92.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [49] source

      Not checked in the free run.

    • cites [92]

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Autoantibodies activating adrenergic receptors or blocking muscarinic receptors may initiate sinus tachycardia.

    “Although autoantibodies activating adrenergic receptors or blocking muscarinic receptors may initiate sinus tachycardia, such autoantibodies are also detected in normal healthy controls without sinus tachycardia.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Normally upon tilt up, a transient blood pressure drop due to venous pooling triggers baroreceptors to signal a compensatory heart-rate increase through withdrawal of parasympathetic tone and an increase in blood pressure due to increased sympathetic adrenergic tone.

    “Normally, upon tilt up there is a transient blood pressure drop due to venous pooling, which then triggers the baroreceptors in the carotid and aortic arch to signal a compensatory heart rate increase through withdrawal of parasympathetic tone and an increase in blood pressure due to an increase in sympathetic adrenergic tone.85,87”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [85]

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    • cites [87]

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    A larger Valsalva ratio indicates the normal functioning of the parasympathetic sympathetic system, while a lower ratio might indicate damage to the parasympathetic nervous system.

    “A larger Valsalva ratio indicates the normal functioning of the parasympathetic sympathetic system, while a lower ratio might indicate damage to the parasympathetic nervous system.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Sinus tachycardia remains a key hemodynamic marker that alerts clinicians to worse or deteriorating illness and predicts increased mortality.

    “Until further research provides conclusive evidence regarding the utility of heart rate reduction in critically ill patients152, sinus tachycardia remains a key hemodynamic marker that alerts clinicians to worse or deteriorating illness and predicts increased mortality.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [152]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Tachycardia is one of seven variables incorporated in the clinical decision rule for the diagnosis of acute pulmonary embolism (Wells score).

    “Tachycardia is one of seven variables incorporated in the clinical decision rule for the diagnosis of acute pulmonary embolism (Well’s score)153–155.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [153]

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    • cites [154]

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    • cites [155]

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Ten percent of pheochromocytomas can be malignant and 40% are familial.

    “Ten percent can be malignant and 40% are familial (Von-Hippel-Lindau disease, Multiple Endocrine Neoplasia type 2A and 2B, Neurofibromatosis type 1, Carney Triad, Succinate Dehydrogenase gene Mutations, plus a few other rare genetic forms).128”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [128] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Pheochromocytomas are rare catecholamine-secreting tumors.

    “Pheochromocytomas are rare catecholamine- secreting tumors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Tachycardia is a cardinal manifestation of anaphylaxis, associated with systemic mast cell activation.

    “Tachycardia is a cardinal manifestation of anaphylaxis, associated with systemic mast cell activation.117”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [117]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    All four known histamine receptors are expressed in the heart, and chronotropic effects of histamine have been linked to H2 receptor activation.

    “All 4 known histamine receptors are expressed in the heart; chronotropic effects of histamine have been linked to H2 receptor activation116.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [116]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a recent study of 650 patients with pheochromocytoma seen between 2004 and 2019, 10.9% had some form of tachyarrhythmia, of whom 98.6% developed sinus tachycardia at some point, 11.3% developed atrial fibrillation, 5.6% developed atrial flutter, and 4.2% developed ventricular tachycardia.

    “In a recent study of 650 patients with pheochromocytoma seen between 2004 and 2019, 10.9% were found to have some form of tachyarrhythmia, of whom, 98.6% developed sinus tachycardia at some point, 11.3% developed atrial fibrillation, 5.6% developed atrial flutter, and 4.2% developed ventricular tachycardia.133”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [133]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Multi-organ damage in acute COVID-19 is usually associated with transient sinus tachycardia, which resolves as the patient recovers.

    “Multi-organ damage in acute coronavirus disease-19 (COVID-19) is usually associated with transient sinus tachycardia164, which resolves as the patient recovers; however, prolonged tachycardia that persists after COVID-19 can pose a diagnostic conundrum.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [164] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In one study, heart rate responses to upright posture were similar in POTS patients with mast cell activation symptoms and elevated urine N-methylhistamine compared with POTS patients with episodic flushing but normal urine methylhistamine, and both groups had increased responses compared with healthy controls.

    “One study compared POTS patients with mast cell activation symptoms (flushing, shortness of breath, headache, lightheadedness, excessive diuresis, and gastrointestinal symptoms) and elevated urine N-methylhistamine to POTS patients with episodic flushing but normal urine methylhistamine127. Heart rate responses to upright posture were similar in both groups and were increased similarly as compared”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [127] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The mechanism of histamine-induced tachycardia probably involves a compensatory mechanism to vasodilation, associated with increased catecholamine response as well as a direct chronotropic effect.

    “Therefore, the mechanism of histamine-induced tachycardia probably involves a compensatory mechanism to vasodilation, associated with increased catecholamine response as well as a direct chronotropic effect.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In one series, 56% of pheochromocytoma patients had hypertension, of whom 32% had persistent hypertension and 24% had paroxysmal hypertension.

    “In one series 56% of patients had hypertension, of which, 32% had persistent HTN and 24% had paroxysmal HTN.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [134]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The presence of the entire triad is more specific for pheochromocytoma but less sensitive.

    “The presence of the entire triad is more specific for pheochromocytoma but less sensitive.132”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [132]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A study of dietary salt intake in patients with POTS reported that high sodium intake increases plasma volume, lowers standing plasma norepinephrine, and decreases the change in heart rate with standing.

    “A study of dietary salt intake in patients with POTS reported that high sodium intake increases plasma volume, lowers standing plasma norepinephrine, and decreases the change in heart rate withstanding172 but long-term benefits are not established to indicate benefit over risk.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [172]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a phase II randomized clinical trial, ivabradine 5 mg orally twice daily did not achieve the target reduction in heart rate of 10 bpm and did not improve hemodynamics or vasopressor use compared with a control group.

    “In a phase II randomized clinical trial, Ivabradine (5 mg by orally twice daily) did not achieve the target reduction in heart rate (10 bpm) and did not improve hemodynamics or vasopressor use compared to a control group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [152]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Pheochromocytoma is rare, with an estimated prevalence of 0.1-0.6%.

    “Pheochromocytoma is rare (estimated prevalence 0.1–0.6%).129,130”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [129]

      Not checked in the free run.

    • cites [130]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A study in patients with POTS reported that abdominal and lower body compression reduced heart rates and improved symptoms during a tilt table test, with some benefit from abdominal compression alone.

    “A study in patients with POTS reported that abdominal and lower body compression reduced heart rates and improved symptoms during a Tilt Table Test, with some benefit from abdominal compression alone as well.175”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [175]

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    A baseline tryptase level greater than 20 ng/ml often indicates increased mast cell burden and is a minor diagnostic criterion for mastocytosis.

    “Normal median tryptase level is approximately 5 ng/ml, while a baseline tryptase level >20 ng/ml often indicates increased mast cell burden and is a minor diagnostic criterion for mastocytosis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In ambulatory COPD patients, the prevalence of sinus tachycardia varies from 2% up to 38%.

    “In ambulatory COPD patients, the prevalence of sinus tachycardia varies from 2% up to 38%158,159.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [158]

      Not checked in the free run.

    • cites [159]

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  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Inappropriate sinus tachycardia and postural orthostatic tachycardia syndrome can occur in patients with persistent COVID symptoms (Long COVID) and may be part of less specific and multi-organ post-acute COVID-19 sequelae (PACS).

    “Inappropriate Sinus Tachycardia (IST) and Postural Orthostatic Tachycardia Syndrome (POTS) can occur in patients with persistent COVID symptoms (“Long COVID”) and may be a part of less specific and multi-organ Post-Acute COVID-19 Sequelae (PACS).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Clinically, idiopathic sinus tachycardia comprises two principal diagnostic categories, POTS and IST.

    “Clinically, ‘Idiopathic sinus tachycardia’ comprises two principal diagnostic categories, POTS and IST.49,50,75,167,170”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [49] source

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    • cites [50]

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    • cites [75] source

      Not checked in the free run.

    • cites [167]

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    • cites [170] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mastocytosis is a clonal disorder of the hematopoietic mast cell progenitor associated with a somatic gain-of-function mutation in KIT gene, characterized by abnormal proliferation and accumulation of mast cells in tissues, and is frequently associated with mast cell activation symptoms and sinus tachycardia.

    “Mastocytosis, a clonal disorder of the hematopoietic mast cell progenitor associated with a somatic gain of function mutation in KIT gene)118, is characterized by abnormal proliferation and accumulation of mast cells in tissues, such as skin and bone marrow, and is frequently associated with mast cell activation symptoms and sinus tachycardia.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [118] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Idiopathic sinus tachycardia tends to occur primarily in the young, particularly young women.

    “It tends to occur primarily in the young, particularly young women.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Pharmacologic agents targeting differing mechanisms have been used, such as beta blockers, ivabradine, pyridostigmine, fludrocortisone, and midodrine.

    “Pharmacologic agents targeting differing mechanisms have been used, such as betablockers, ivabradine, pyridostigmine, fludrocortisone, and midodrine among others.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    While suppression of tachycardia is generally considered in symptomatic sinus tachycardia, in some cases symptoms may not be completely alleviated.

    “While suppression of tachycardia is generally considered in conditions of symptomatic sinus tachycardia, in some cases symptoms may not be completely alleviated.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    It is not always easy to distinguish between POTS and IST, and their treatments differ in some respects.

    “It is not always easy to distinguish between POTS and IST, and their treatments differ in some respects.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    The biopsychosocial model provides an understanding of symptoms related to sinus tachycardia in the absence of anatomical or disease-related causes.

    “The biopsychosocial model provides an understanding of symptoms related to sinus tachycardia in the absence of anatomical or disease-related causes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Patients with maladaptive or avoidant coping styles perceive autonomic symptoms as dangerous, leading to increased fear and distress, and avoidance of situations where symptoms may occur.

    “Patients with maladaptive or avoidant coping styles perceive this as dangerous, leading to increased fear and distress, and avoidance of situations where symptoms may occur.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    Anticipatory anxiety increases attention to somatic experience, intensifies sympathetic reactivity, and results in worsening symptoms and greater impairment.

    “Anticipatory anxiety, a normal response to a distressing stimulus, increases attention to the somatic experience, intensifies sympathetic reactivity, and results in worsening symptoms and greater impairment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Idiopathic sinus tachycardia can be a disabling condition.

    “In summary, idiopathic sinus tachycardia can be a disabling condition.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    About half of patients may no longer meet POTS criteria within 3 months.

    “About half of patients may no longer meet POTS criteria within 3 months.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Other exercises involving horizontal leg position movements, such as rowing or swimming, may be less tolerable to patients due to whole body metabolic and blood flow demands.

    “Other exercises involving horizontal leg position movements, such as rowing or swimming are also options, but may be less tolerable to patients due to whole body metabolic and blood flow demands.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The debilitation observed in patients with POTS has been likened to functional disability in chronic pain, and interdisciplinary pain rehabilitation program structure has been utilized to treat patients with POTS successfully.

    “The debilitation observed in patients with POTS has been likened to the functional disability observed in patients with chronic pain and the interdisciplinary pain rehabilitation program structure has been utilized to treat patients with POTS successfully.188”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [188] source

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  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Individualized exercise training for patients with sinus tachycardia should be developed based on current physical abilities, which for most can be safely evaluated during maximal effort clinical exercise stress testing.

    “Individualized exercise training for patients with sinus tachycardia should be developed based on current physical abilities, which for most, can be safely evaluated during maximal effort clinical exercise stress testing.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Exercise is an HRS Class IIA indication for POTS but remains a target of study, and its value in IST is unknown.

    “Exercise is an HRS Class IIA indication for POTS but remains a target of study49,50,125,170,173; its value in IST is unknown.49,50,125”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [49] source

      Not checked in the free run.

    • cites [50]

      Not checked in the free run.

    • cites [125] source

      Not checked in the free run.

    • cites [170] source

      Not checked in the free run.

    • cites [173]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    POTS is excessive sinus tachycardia triggered by minimal physical activity, especially movement to upright posture.

    “POTS is excessive sinus tachycardia triggered by minimal physical activity, especially movement to upright posture.36,50,125,171”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [36] source

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    • cites [50]

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    • cites [125] source

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    • cites [171]

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  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Symptomatic sinus tachycardia can significantly affect a patient's quality of life.

    “Symptomatic sinus tachycardia can significantly affect a patient’s quality of life, and evaluating and addressing a patient’s mental wellbeing is an important part of patient care.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Lower body resistance training can help strengthen the skeletal muscle pump and venous return to aid in counteracting orthostasis.

    “This is because lower body resistance training can help further strengthen the skeletal muscle pump and venous return to aid in counteracting orthostasis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Although lifestyle modifications may prove helpful, treatment of idiopathic sinus tachycardia is suboptimal, and many affected individuals experience lengthy periods of adversely impacted quality of life.

    “Although life-style modifications may prove helpful, treatment is suboptimal, and many affected individuals experience lengthy periods of time during which their quality-of-life is adversely impacted.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Avoidance of symptoms and fear of experiencing symptoms affect quality of life and set up a problematic cycle of disability.

    “This approach also sets up a problematic cycle of disability where quality-of-life is affected by both avoidance of the symptoms and fear of experiencing the symptoms.177”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [177]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Addition of resistance training focusing on seated lower body and core work can prove beneficial after comfort with aerobic exercise training.

    “After a firm level of comfort has been established with aerobic exercise training, the addition of resistance training to the program focusing on seated lower body and core work can also prove beneficial (Table 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Physical therapy provides gradual step-wise conditioning and exposure to increased heart rate while patients learn strategies to cope with changes in somatic symptoms conditioned to provoke anxiety/panic.

    “A key to rehabilitation is physical therapy, which provides gradual step-wise conditioning and exposure to increased heart rate, while patients learn strategies to cope with changes in somatic symptoms that have been conditioned to provoke significant anxiety/panic.185”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [185]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    In some or most cases, a slight reduction in heart rate can improve symptoms, but a more aggressive reduction in heart rate can worsen symptoms.

    “In some or most cases, a slight reduction in heart rate can improve symptoms, but a more aggressive reduction in heart rate can worsen symptoms.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Occupational therapy assists patients in returning to academic or work environments that require pacing and planning and has been an integral part of the success of these programs.

    “Occupational therapy assists patients in returning to academic or work environments that require pacing and planning and has been an integral part of the success of these programs.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    These clinical signs and symptoms can limit ability to regularly participate in an exercise program if not carefully considered.

    “If not carefully considered, these clinical signs and symptoms can limit their ability to regularly participate in an exercise program.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Successfully suppressing sinus tachycardia may not suppress palpitations, and successfully suppressing palpitations might not remove all or even most troublesome symptoms.

    “successfully suppressing sinus tachycardia may not suppress palpitations, and successfully suppressing palpitations might not remove all or even most troublesome symptoms.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Aerobic-based exercise training emphasizing submaximal intensity effort and tailored progression can be safe, confidence reinforcing, and an effective non-pharmacological intervention for long-term management of signs and symptoms associated with sinus tachycardia.

    “Aerobic-based exercise training that emphasizes submaximal intensity effort and tailored progression can be safe, confidence reinforcing, and an effective non-pharmacological intervention for the long-term management of signs and symptoms associated with sinus tachycardia.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Pharmacologic therapy is generally used in conjunction with other treatment modalities such as lifestyle changes, exercise training, and cognitive behavioral therapy.

    “Pharmacologic therapy is generally used in conjunction with other treatment modalities such as lifestyle changes, exercise training, and cognitive behavioral therapy.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    In response to biological, psychological, or social stressors, the sympathetic nervous system activates and produces symptoms frequently associated with tachycardia including dizziness, altered vision, or nausea.

    “In response to biological stressors, such as, dehydration or exertion, psychological stressors, such as anxiety or excitement, or social stressors such as performance expectation or symptom response, the sympathetic nervous system activates and produces symptoms frequently associated with tachycardia including dizziness, altered vision, or nausea.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Sinus rate is importantly modulated by the sympathetic and parasympathetic nervous system.

    “Sinus rate is importantly modulated by the sympathetic and parasympathetic nervous system.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Invasive approaches to ablate the sinus node to mollify sinus tachycardia are not established; such an approach may cause more harm than good and must be considered only for the most refractory inappropriate sinus tachycardia patients.

    “Invasive approaches to ablate the sinus node to mollify sinus tachycardia are not established; such an approach may cause more harm than good and must be considered only for the most refractory inappropriate sinus tachycardia patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Typically, faster sinus node rates involve the superior aspect of the sinus node, and ablation is typically targeted here.

    “Typically, faster sinus node rates involve the superior aspect of the sinus node, and ablation is typically targeted here.206,207(Appendix 1)”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [206] source

      Not checked in the free run.

    • cites [207]

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Fludrocortisone promotes fluid retention and may increase plasma volume and maintain orthostatic preload.

    “Fludrocortisone promotes fluid retention and may increase plasma volume and therefore maintain orthostatic preload.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Desmopressin, octreotide, atomoxetine, and other interventions have been considered with less convincing evidence.

    “Desmopressin, octreotide, atomoxetine, and other interventions have been considered with less convincing evidence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Minimally invasive thoracoscopic surgery with bipolar radiofrequency clamp or cryoablation, isolation of the superior right atrium, and inferior vena cava isolation are alternative approaches.

    “Minimally invasive thoracoscopic surgery with use of bipolar radiofrequency clamp or cryoablation, 75,205,215–219, isolation of the superior right atrium from the rest of the atrium217,218,220, and inferior vena cava isolation 205,217 are alternative approaches.”
    Quote in the paperNot a substantial claim0 of 8 sources checked
    • cites [75] source

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    • cites [205]

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    • cites [215] source

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    • cites [216] source

      Not checked in the free run.

    • cites [217]

      Not checked in the free run.

    • cites [218]

      Not checked in the free run.

    • cites [219] source

      Not checked in the free run.

    • cites [220] source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Central sympatholytic drugs are occasionally used, particularly in hyperadrenergic POTS, but may not be tolerated in patients with any degree of orthostatic hypotension.

    “Central sympatholytic drugs are occasionally used, particularly in patients with hyperadrenergic POTS, but may not be tolerated in patients with any degree of orthostatic hypotension.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Pacemaker function of the sinus node is the result of over a dozen ion channels, of which If, the funny current, is the most important.

    “Pacemaker function of the sinus node is the result of over a dozen ion channels, of which, If, the funny current, is the most important.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    IST patients have a generally benign prognosis and only a very narrow group likely benefit from invasive management.

    “Since these IST patients have a generally benign prognosis and only a very narrow group of patients likely benefit from invasive management, sinus node modification, surgical ablation, and sympathetic denervation are not recommended (Class III recommendation) as routine intervention for IST.49”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Midodrine is a prodrug metabolized to a peripheral alpha-1 adrenergic receptor agonist that enhances vasoconstriction and venoconstriction, with subsequent increases in venous return, cardiac preload, and stroke volume.

    “Midodrine50 is a prodrug metabolized to a peripheral alpha-1 adrenergic receptor agonist that enhances vasoconstriction and venoconstriction, with subsequent increases in venous return, cardiac preload, and stroke volume.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50]

      Not checked in the free run.

  • The quote only partly states this claim.

    Interpretationnone given

    When used with comprehensive lifestyle modification and strong supportive measures, most patients with POTS and IST respond sufficiently well to return towards a normal life.

    “When used with comprehensive lifestyle modification and strong supportive measures most patients respond sufficiently well to return towards a normal life.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Treatment of POTS and IST has improved markedly in the past 15 years.

    “Generally speaking, the treatment of POTS and IST has improved markedly in the past 15 years.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Pyridostigmine is a peripheral acetylcholinesterase inhibitor that increases synaptic acetylcholine and may be helpful when used in combination with a beta-blocker to reduce orthostatic tachycardia and improve symptoms.

    “Pyridostigmine is a peripheral acetylcholinesterase inhibitor that increases synaptic acetylcholine and may be helpful when used in combination with a beta-blocker to reduce orthostatic tachycardia and improve symptoms.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    For patients with IST and POTS, emerging technologies that modify sinus rate without affecting the sinus node directly (sinus node sparing hybrid ablation) may prove to be an effective and safe therapeutic option in symptomatic drug-resistant IST and POTS, but these techniques are not yet established to treat sinus tachycardia.

    “For patients with inappropriate sinus tachycardia and POTS, emerging technologies that modify sinus rate without affecting the sinus node directly (sinus node sparing hybrid ablation) may prove to be an effective and safe therapeutic option in patients with symptomatic drug-resistant IST and POTS. but these techniques are not yet established to treat sinus tachycardia.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Midodrine is likely to benefit patients with a tendency to hypotension and of lesser benefit in patients with hyperadrenergic symptoms, although it may lead to an indirect decrease in adrenergic tone.

    “Midodrine, in theory, is likely to benefit patients with a tendency to hypotension and of lesser benefit in patients with hyperadrenergic symptoms, although it may lead to an indirect decrease in adrenergic tone.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    POTS patients frequently have inappropriate vasodilation or insufficient vasoconstriction resulting from autonomic pathology, and ablation in this cohort will prevent the sinus node's ability to increase heart rate during position change.

    “These patients frequently have inappropriate vasodilation or insufficient vasoconstriction resulting from autonomic pathology, and ablation in this cohort will prevent the sinus node’s ability to increase the heart rate during position change.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    These drugs may affect the heart rate response but may not improve symptoms.

    “These drugs may affect the heart rate response but may not improve symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    While experience with invasive therapy for IST is limited to small case series, the procedure is able to limit sympathetic input into the sinus node leading to heart rate reduction, but not always symptom improvement.

    “While the experience with invasive therapy for IST is limited to small case series, the procedure is able to limit sympathetic input into the sinus node leading to heart rate reduction, but not always symptom improvement.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Cardiac output increases with heart rate provided stroke volume remains sufficient, but increasing sinus tachycardia reduces cardiac output above approximately 120-130 bpm regardless of cause.

    “CO= HR x Stroke volume. Stroke volume (SV) is inversely related to HR. Thus, CO increases with HR provided SV remains sufficient. This dependence becomes most evident with orthostasis when venous return and SV are reduced due to gravitational blood pooling, and increasing sinus tachycardia reduces CO above approximately 120–130 bpm regardless of the cause of sinus tachycardia.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The success rate of sinus node modification is likely lower in patients with concurrent features of POTS, with probable worsening of symptoms post ablation due to loss of the compensatory heart rate increase needed to maintain cardiac output.

    “The success rate is likely lower in patients with concurrent features of POTS with probable worsening of symptoms post ablation due to loss of the compensatory heart rate increase needed to maintain cardiac output.75,202”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [75] source

      Not checked in the free run.

    • cites [202] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    After conception, release of pregnancy related hormones is associated with vasodilation with reduction in total peripheral resistance with subsequent increase in cardiac output.

    “After conception, release of pregnancy related hormones is associated with vasodilation with reduction in total peripheral resistance with subsequent increase in cardiac output.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    β-blockers can be continued during early post-partum period even if the mother is breast feeding, although symptom resolution generally occurs with delivery.

    “β-blockers can be continued during early post-partum period (even if the mother is breast feeding) although symptom resolution generally occurs with delivery.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Sinus tachycardia may be a persistent or paroxysmal problem for which electrophysiologists are often consulted with the thought that sinus tachycardia may represent POTS or IST.

    “Sinus tachycardia may be a persistent or paroxysmal problem for which electrophysiologists are often consulted with the thought that sinus tachycardia may represent POTS or IST.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Women with large pelvic masses may also develop the same type of problem as supine hypotensive syndrome.

    “Women with large pelvic masses may also develop the same type of problem.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Symptoms and hypotension in supine hypotensive syndrome can be assuaged by lying in a lateral position; the left lateral position is better to prevent liver congestion.

    “Symptoms and hypotension can be assuaged by lying in a lateral position; the left lateral position is better to prevent liver congestion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Sinus tachycardia can become a substantial problem that is a clinical manifestation of substantial underlying pathology and/or reflective of autonomic dysfunction requiring careful and complete evaluation leading to specific and substantial interventions.

    “However, sinus tachycardia can become a substantial problem that is a clinical manifestation of substantial underlying pathology and/or reflective of the presence of autonomic dysfunction that requires careful and complete evaluation leading to specific and substantial interventions.”
    Quote in the paperNot a substantial claim
199 of 199

  • The paper relies on this without support.

    No controlled clinical trials or evidence-based guidelines currently provide direction for initial, appropriate management of sinus tachycardia.

    “Despite the frequency of sinus tachycardia and the wide range of clinical presentations, no controlled clinical trials or evidence-based guidelines currently provide direction for initial, appropriate management.”

  • The paper relies on this without support.

    The vast majority of patients with sinus tachycardia are asymptomatic.

    “The vast majority of patients with sinus tachycardia are asymptomatic.”

  • The paper relies on this without support.

    Symptomatic sinus tachycardia syndromes are rare and are represented by Postural Orthostatic Tachycardia Syndrome (POTS) and Inappropriate Sinus Tachycardia (IST).

    “Symptomatic sinus tachycardia syndromes are rare and are represented by Postural Orthostatic Tachycardia Syndrome (POTS) and Inappropriate Sinus Tachycardia (IST).”

  • The paper relies on this without support.

    There is a wide variation in baseline heart rates by age, sex, mental/emotional state and physical status.

    “However, there is a wide variation in baseline heart rates by age, sex, mental/emotional state and physical status.”

  • The paper relies on this without support.

    For new-onset sinus tachycardia, a precipitant is likely.

    “For new-onset sinus tachycardia, a precipitant is likely.”

  • The paper relies on this without support.

    Triggers may be cause for only transient fluctuations in sinus rate including anemia, and pulmonary embolus.

    “Triggers may be cause for only transient fluctuations in sinus rate including anemia, and pulmonary embolus.”

  • The paper relies on this without support.

    Such causal factors have been found in some but not all patients with the often regarded 'idiopathic tachycardias': POTS and IST.

    “Such causal factors have been found in some but not all patients with the often regarded “idiopathic tachycardias”: POTS and IST.”

  • The paper relies on this without support.

    Common temporal presentations include recurrent episodes of sinus tachycardia that occur in a pattern consistent with orthostatic positional changes in the case of POTS, and reproducible and often consistent sinus tachycardia at rest, or with minimal disturbance in the case of IST.

    “Common temporal presentations include recurrent episodes of sinus tachycardia that occur in a pattern consistent with orthostatic positional changes in the case of POTS, and reproducible and often consistent sinus tachycardia at rest, or with minimal disturbance in the case of IST, for which, several clinical presentations have been described.”

  • The paper relies on this without support.

    Clinical presentations of IST include persistent elevation in heart rate, spikes in heart rate with minimal activity and heart rate changes with and without exercise.

    “These clinical presentations include persistent elevation in heart rate, spikes in heart rate with minimal activity and heart rate changes with and without exercise.”

  • The paper relies on this without support.

    Sporadic changes in heart rate may be present under conditions of physical or mental stress, and due to sleep disorders or are due to ingestion of stimulant drugs.

    “Further, sporadic changes in heart rate may be present under conditions of physical or mental stress, and due to sleep disorders or are due to ingestion of stimulant drugs.”

  • The paper relies on this without support.

    IST is less affected by rest and can be difficult to distinguish from deconditioning which may also show rapid rise in sinus rates with minimal activity.

    “IST is less affected by rest and can be difficult to distinguish from for instance deconditioning which may also show rapid rise in sinus rates with minimal activity.”

  • The paper relies on this without support.

    IST may present with various patterns, and at least two distinct populations can be identified based on diurnal heart rate variation which may be useful to classify pathophysiology and ideally provide guidance to specific treatment.

    “Further, IST may present with various patterns, and at least two distinct populations can be identified based on diurnal heart rate variation which may be useful to classify pathophysiology and ideally provide guidance to specific treatment.”

  • The paper relies on this without support.

    It is the baroreceptors that detect a decreasing BP sending signals afferently to the nucleus tractus solitarious, nucleus ambiguous and caudal ventrolateral medulla; efferent signals back to the sinoatrial node via the vagus nerve are the pathway to sinus tachycardia.

    “It is the baroreceptors that detect a decreasing BP sending signals afferently to the nucleus tractus solitarious, nucleus ambiguous and caudal ventrolateral medulla. Efferent signals back to the sinoatrial node via the vagus nerve are the pathway to sinus tachycardia.”

  • The paper relies on this without support.

    This may be more than a reflexive physiologic tachycardia.

    “This may be more than a reflexive physiologic tachycardia.”

  • The paper relies on this without support.

    This occurs in volume depletion, infection, pregnancy, heart failure or circulatory or hemorrhagic shock, or in an exaggerated response, as in POTS.

    “This occurs in volume depletion, infection, pregnancy, heart failure or circulatory or hemorrhagic shock, or in an exaggerated response, as in POTS.”

  • The paper relies on this without support.

    Sympathovagal imbalance may result from autonomic dysfunction.

    “Sympathovagal imbalance may result from autonomic dysfunction.”

  • The paper relies on this without support.

    Data on autoantibodies are not definitive.

    “Data on autoantibodies are not definitive.”

  • The paper relies on this without support.

    Cardiac interventions may either cause or ameliorate IST.

    “Cardiac interventions may either cause or ameliorate IST.”

  • The paper relies on this without support.

    The clinical presentation of sinus tachycardia includes temporally associated symptoms, frequency, initiation, and termination of episodes.

    “The clinical presentation of sinus tachycardia includes temporally associated symptoms, frequency, initiation, and termination of episodes.”

  • The paper relies on this without support.

    An ECG may reveal electrocardiographic patterns that may help identify a precipitant for sinus tachycardia.

    “Additionally, an ECG may reveal electrocardiographic patterns that may help identify a precipitant for sinus tachycardia.”

  • The paper relies on this without support.

    The autonomic nervous system exerts significant control over the sinoatrial node, and autonomic dysregulation has been implicated in conditions such as inappropriate sinus tachycardia.

    “The autonomic nervous system exerts significant control over the sinoatrial node, and autonomic dysregulation has been implicated in conditions such as inappropriate sinus tachycardia.”

  • The paper relies on this without support.

    While the evaluation of the autonomic nervous system is still being further explored and has yet to be standardized, current modalities include heart rate variability to paced breathing, Valsalva testing, and quantitative sudomotor axon reflex testing.

    “While the evaluation of the autonomic nervous system is still being further explored and has yet to be standardized, current modalities include heart rate variability to paced breathing, Valsalva testing, and quantitative sudomotor axon reflex testing.”

  • The paper relies on this without support.

    The Tilt Table Test has long been a cornerstone of assessing symptoms of orthostatic intolerance and can be particularly useful for sinus tachycardia; it can help differentiate syndromes of sinus tachycardia from other conditions such as vasovagal syncope and orthostatic hypotension with compensatory tachycardia, and it can be combined with ancillary testing such as 12-lead ECG monitoring, me

    “The Tilt Table Test has long been a cornerstone of assessing symptoms of orthostatic intolerance and can be particularly useful for sinus tachycardia; it can help differentiate syndromes of sinus tachycardia from other conditions such as vasovagal syncope and orthostatic hypotension with compensatory tachycardia, and it can be combined with ancillary testing such as 12-lead ECG monitoring, me”

  • The paper relies on this without support.

    The role of autonomic testing in patients presenting with sinus tachycardia has not been well established.

    “The role of autonomic testing in patients presenting with sinus tachycardia has not been well established.”

  • The paper relies on this without support.

    A number of tests have been used to evaluate sympathetic adrenergic, parasympathetic and sympathetic cholinergic function in patients presenting with sinus tachycardia of unknown etiology.

    “A number of tests have been used to evaluate sympathetic adrenergic, parasympathetic and sympathetic cholinergic function in patients presenting with sinus tachycardia of unknown etiology.”

  • The paper relies on this without support.

    The rationale for testing the autonomic nervous system is that several potential mechanisms of autonomic dysregulation have been implicated in IST.

    “The rationale for testing the autonomic nervous system is that several potential mechanisms of autonomic dysregulation have been implicated in IST.”

  • The paper relies on this without support.

    The overlapping features of IST with POTS also suggest autonomic evaluation is helpful in differentiating between these two disorders in some instances where bedside orthostatic vital signs are not able to differentiate.

    “The overlapping features of IST with POTS also suggest autonomic evaluation is helpful in differentiating between these two disorders in some instances where bedside orthostatic vital signs are not able to differentiate.”

  • The paper relies on this without support.

    Heart rate variability declines with age.

    “Heart rate variability declines with age.”

  • The paper relies on this without support.

    Inadequate respiratory effort will result in decreased heart rate variability, which cannot be differentiated from disease.

    “Inadequate respiratory effort will result in decreased heart rate variability, which cannot be differentiated from disease.”

  • The paper relies on this without support.

    Automated devices that record heart rate variability generally do not analyze respiratory effort and therefore cannot appropriately interpret the results.

    “Automated devices that record heart rate variability generally do not analyze respiratory effort and therefore cannot appropriately interpret the results.”

  • The paper relies on this without support.

    As with other measures of autonomic function, there is an age related decline in the Valsalva ratio.

    “As with other measures of autonomic function, there is an age related decline in the Valsalva ratio.”

  • The paper relies on this without support.

    A larger Valsalva ratio indicates the normal functioning of the parasympathetic sympathetic system, while a lower ratio might indicate damage to the parasympathetic nervous system.

    “A larger Valsalva ratio indicates the normal functioning of the parasympathetic sympathetic system, while a lower ratio might indicate damage to the parasympathetic nervous system.”

  • The paper relies on this without support.

    The stimulus for tachycardia during a Valsalva maneuver is the drop in blood pressure; if there is no drop in blood pressure during phase II because of inadequate respiratory effort, there will not be a tachycardia.

    “The stimulus for tachycardia during a Valsalva maneuver is the drop in blood pressure. If there is no drop in blood pressure during phase II because of inadequate respiratory effort, there will not be a tachycardia.”

  • The paper relies on this without support.

    Automated devices typically do not measure expiratory pressure or beat to beat blood pressures, preventing appropriate interpretation of the heart rate response to a Valsalva maneuver.

    “Automated devices typically do not measure expiratory pressure or beat to beat blood pressures, preventing appropriate interpretation of the heart rate response to a Valsalva maneuver.”

  • The paper relies on this without support.

    Integrated treatment programs based on cognitive behavioral therapy with multiple providers can provide intensive care for patients with postural tachycardia syndrome.

    “Integrated treatment programs, based on cognitive behavioral therapy, encompassing multiple providers such as physicians, psychologists, physical therapists, occupational therapists, and nurses can be considered to provide intensive care for patients with postural tachycardia syndrome.”

  • The paper relies on this without support.

    Patients with mild symptoms may respond to education, reassurance, and lifestyle changes provided in office.

    “First, patients with mild symptoms may respond to education, reassurance, and lifestyle changes provided in office, such as the recommendation to avoid common triggers.”

  • The paper relies on this without support.

    Patients with sinus tachycardia who do not respond to education and reassurance benefit from a referral for outpatient cognitive behavioral therapy, whether they have a mental health diagnosis or not.

    “Second, patients with sinus tachycardia who do not respond to education and reassurance benefit from a referral for outpatient cognitive behavioral therapy, whether they have a mental health diagnosis or not.”

  • The paper relies on this without support.

    The biopsychosocial model provides an understanding of symptoms related to sinus tachycardia in the absence of anatomical or disease-related causes.

    “The biopsychosocial model provides an understanding of symptoms related to sinus tachycardia in the absence of anatomical or disease-related causes.”

  • The paper relies on this without support.

    Treatment of sinus tachycardia should first target underlying conditions such as hyperthyroidism, adrenal insufficiency, infections, hypotension, and drug side effects.

    “Treatment of sinus tachycardia should first target underlying conditions such as hyperthyroidism, adrenal insufficiency, infections, hypotension, and drug side effects.”
39 of 39

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Reported hazard ratio falls outside its confidence interval

    Minor

    The reported hazard ratio is 1.51, but its stated 95% confidence interval runs from 1.95 to 2.17. A confidence interval for this estimate must contain the point estimate.

1 of 1

Cites

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Related

Authors
Mayuga, K. A., Fedorowski, A., Ricci, F., Gopinathannair, R., Dukes, J. W., Gibbons, C., Hanna, P., Sorajja, D., Chung, M., Benditt, D., Sheldon, R., Ayache, M. B., AbouAssi, H., Shivkumar, K., Grubb, B. P., Hamdan, M. H., Stavrakis, S., Singh, T., Goldberger, J. J., Muldowney, J. A. S., Belham, M., Kem, D. C., Akin, C., Bruce, B. K., Zahka, N. E., Fu, Q., Van Iterson, E. H., Raj, S. R., Fouad-Tarazi, F., Goldstein, D. S., Stewart, J., & Olshansky, B.
Affiliations
  • Cleveland Clinic (US)
  • Karolinska University Hospital (SE)
  • University of Chieti-Pescara (IT)
  • Kansas City Heart Rhythm Institute (US)
  • Community Memorial Hospital, Ventura, CA (J.W.D.).
  • Beth Israel Deaconess Medical Center (US)
  • University of California, Los Angeles (US)
  • Mayo Clinic in Arizona (US)
  • University of Minnesota (US)
  • University of Calgary (CA)
  • MetroHealth (US)
  • Duke University (US)
  • University of Toledo Medical Center (US)
  • University of Wisconsin–Madison (US)
  • University of Oklahoma Health Sciences Center (US)
  • University of Miami (US)
  • United States Department of Veterans Affairs (US)
  • Cambridge University Hospitals NHS FT, United Kingdom (M.B.).
  • University of Michigan (US)
  • Mayo Clinic in Florida (US)
  • Cincinnati Children's Hospital Medical Center (US)
  • Texas Health Dallas (US)
  • Section of Preventive Cardiology &amp; Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular &amp; Thoracic Institute, Cleveland Clinic, OH (E.H.V.I.).
  • National Institutes of Health (US)
  • New York Medical College (US)
  • University of Iowa (US)
ORCID
Venue
Circulation: Arrhythmia and Electrophysiology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2022-09
Volume
15
Issue
9
Pages
e007960-e007960
ISSN
  • 1941-3084 (ISSN-L)
  • 1941-3149
DOI
10.1161/circep.121.007960
PMC
PMC9523592
OpenAlex
W4294982945
Cited by
59
References
263
Citations by year
2026: 15 · 2025: 22 · 2024: 11 · 2023: 9 · 2022: 2
FWCI
2.61
Type
journal article
Language
en
Open access
Locations
  • Circulation Arrhythmia and Electrophysiology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Touro Scholar (Touro College) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (R01HL111314, R01HL158071, P01HL158502)
  • National Institute of Neurological Disorders and Stroke (ZIANS003033)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
sinus tachycardia, inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome, mast cell activation, long COVID, autonomic dysfunction, hyperthyroidism, pulmonary embolism, anemia, cardiac electrophysiology, multidisciplinary care
MeSH terms
COVID-19, Humans, Tachycardia, Sinus, Postural Orthostatic Tachycardia Syndrome

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

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