Tachycardia

The Racing Heart: Tachycardia, its Dangers, and Medical Malpractice

Tachycardia is derived from the Greek meaning “fast heart.” It is more than just a temporary flutter. It is a medical condition defined by a resting heart rate over 100 beats per minute (bpm). A rapid heart rate can be a normal physiological response to exercise, stress, or excitement (known as sinus tachycardia). However, abnormal forms of tachycardia can be symptoms of underlying pathology. It can potentially lead to grave health consequences like heart failure, stroke, or sudden cardiac death. In the realm of cardiac care, a failure to properly diagnose, investigate, or treat pathological tachycardia can constitute a breach of the standard of care, opening the door to cases of medical malpractice.

What is Tachycardia?

The heart’s rhythm is precisely controlled by electrical signals starting from the sinus node, the body’s natural pacemaker. A normal resting heart rate for adults typically falls between 60 and 100 bpm. Tachycardia occurs when these electrical signals fire too rapidly, keeping the heart chambers—the atria (upper chambers) and ventricles (lower chambers)—from adequately filling with blood between beats. This reduced filling capacity reduces the amount of blood pumped to the rest of the body. This potentially deprives vital organs, including the brain, of necessary oxygen and nutrients.

Tachycardia types are based on its origin within the heart:

• Supraventricular Tachycardia (SVT): Arrhythmias that start above the ventricles, in the atria or the atrioventricular (AV) node. Common types include Atrial Fibrillation (AFib), Atrial Flutter, and Paroxysmal SVT.
• Ventricular Tachycardia (VT): Arrhythmias that start in the ventricles. VT is often more dangerous than SVT. The lower chambers are responsible for pumping blood to the body. They beat so quickly and inefficiently that they can lead to cardiac arrest.
• Sinus Tachycardia: A normal, physiological response where the sinus node increases its firing rate due to external factors like exercise, fever, pain, anxiety, or certain medications.

Causes and Symptoms

The triggers for pathological tachycardia are numerous, ranging from primary cardiac issues to systemic health problems.

Common Causes:

1. Underlying Heart Conditions: Coronary artery disease, prior heart attack (causing scar tissue that disrupts electrical signals), heart failure, heart valve disease, cardiomyopathy, and also congenital heart defects.
2. Systemic Illnesses: Fever (the body’s response to infection), anemia (low red blood cell count forces the heart to pump faster to deliver enough oxygen), hyperthyroidism (overactive thyroid gland), and electrolyte imbalances (abnormal levels of potassium, sodium, calcium, or magnesium disrupt electrical signaling).
3. Lifestyle Factors and Stimulants: Excessive caffeine or alcohol consumption, smoking/nicotine use, and the use of illegal drugs like cocaine or methamphetamine.
4. Medications: Certain prescription and over-the-counter medications can have a side effect of increasing heart rate.

Symptoms of Tachycardia:

Symptoms vary widely and can be non-existent in some cases. When present, they often reflect the heart’s inability to pump blood effectively:

• Palpitations: A racing, pounding, or fluttering sensation in the chest or neck.
• Dizziness or Lightheadedness: Resulting from reduced blood flow to the brain.
• Shortness of Breath (Dyspnea): Due to fluid buildup in the lungs or reduced oxygen delivery.
• Chest Pain (Angina): Caused by the heart muscle itself not receiving enough oxygenated blood.
• Fainting (Syncope) or Near-Fainting: A sign of severely reduced blood pressure and cerebral perfusion.
• Fatigue or Weakness: Generalized tiredness due to inefficient circulation.

The Kopec Law Firm will assess your symptoms in evaluating a medical malpractice claim relating to tachycardia.

Diagnosis and Medical Specialists

Diagnosing the type and cause of tachycardia is crucial for effective treatment. Diagnostic tests focus on capturing the heart’s electrical activity and assessing its structure and function.

Diagnostic Tests and How They Show Tachycardia

• Electrocardiogram (ECG or EKG): Electrodes placed on the skin record the heart’s electrical signals. A 12-lead ECG is the standard initial test, showing the heart rate and rhythm in real-time. It reveals the signature patterns of different arrhythmias, such as the chaotic activity of Atrial Fibrillation or the wide, rapid complexes of Ventricular Tachycardia.
• Holter Monitor: A portable ECG device worn for 24-48 hours. It continuously records the heart’s activity during daily life, capturing intermittent episodes of tachycardia that may be missed during a brief, in-office ECG.
• Event Recorder / Implantable Loop Recorder: Longer-term monitoring devices (weeks to years) activated by the patient when symptoms occur, or automatically by the device, to record heart rhythm during symptomatic episodes.
• Echocardiogram: An ultrasound of the heart that provides images of the heart chambers, valves, and blood flow. While it doesn’t directly show the arrhythmia, it can reveal underlying structural problems (e.g., valve disease, heart failure) that may be the root cause.
• Electrophysiology (EP) Study: An invasive procedure where catheters are threaded into the heart to map the electrical pathways and precisely locate the source of the abnormal signals. This is often done to confirm the diagnosis and guide ablation treatment.
• Blood Tests: Used to rule out non-cardiac causes like thyroid dysfunction (Hyperthyroidism), anemia, and electrolyte imbalances.

The Kopec Law Firm will assess whether the tests you received reveal a medical malpractice claim for tachycardia.

Doctors to See for Tachycardia

While initial evaluation often begins with a Primary Care Physician (PCP) or an Emergency Medicine Physician (in acute cases), patients with confirmed or suspected pathological tachycardia are typically referred to other doctors:

• Cardiologist: A physician specializing in the diagnosis and treatment of heart disease.
• Electrophysiologist (EP): A cardiologist with specialized training in the diagnosis and treatment of heart rhythm disorders (arrhythmias). They perform advanced procedures like EP studies and catheter ablation.

Treatments and Mechanisms of Action

Treatment for tachycardia aims to control the immediate rapid heart rate, prevent future episodes, and treat the underlying cause.

Treatment Options:

1. Vagal Maneuvers: Simple physical actions (e.g., forceful coughing, bearing down as if having a bowel movement, or putting an ice pack to the face) that stimulate the vagus nerve, which helps regulate the heart rate.
2. Medications:
   • Anti-arrhythmics: Drugs like amiodarone, flecainide, or propafenone work by altering the electrical properties of the heart muscle cells, helping to maintain a normal rhythm.
   • Rate-Controllers: Medications such as beta-blockers (e.g., metoprolol) or calcium channel blockers (e.g., diltiazem) slow the heart rate by affecting the heart’s electrical pathways.
3. Cardioversion:
   • Electrical Cardioversion: A controlled, brief electrical shock delivered to the chest to temporarily stop the heart’s electrical activity, allowing the normal rhythm to reset.
   • Pharmacological (Chemical) Cardioversion: The use of intravenous or oral medication to reset the heart’s rhythm.
4. Catheter Ablation: An EP procedure where a catheter delivers heat (radiofrequency) or cold (cryoablation) energy to intentionally create tiny scars in the heart muscle. This scar tissue destroys or blocks the specific, faulty electrical pathways causing the tachycardia, effectively “curing” the arrhythmia in some cases.
5. Implantable Devices:
   • Pacemakers: Small devices implanted under the skin to send electrical impulses to the heart, helping to maintain a normal, slow heart rate.
   • Implantable Cardioverter-Defibrillator (ICD): A device that continuously monitors the heart rhythm and can deliver a life-saving electrical shock (defibrillation) to stop life-threatening VT or Ventricular Fibrillation.

Medical Malpractice in the Context of Tachycardia

Medical malpractice occurs when a healthcare provider’s negligence—an action or omission that deviates from the accepted standard of care—causes injury or death to a patient. Tachycardia provides two critical areas where negligence can occur. Firstly, a failure to respond to an existing tachycardia. Secondly, the negligent use of medical interventions that cause or induce a life-threatening arrhythmia.

Medical Malpractice in Failing to Respond to Tachycardia

The most common form of malpractice related to tachycardia involves a failure to recognize, investigate, or timely treat a fast heart rate, especially in an acute or high-risk setting. This is a failure to meet the accepted standard of care.

1. Delayed or Misdiagnosis: This can occur when a physician, particularly in an emergency department or primary care setting, attributes symptoms like palpitations, dizziness, or shortness of breath to a less serious condition (e.g., anxiety, heartburn) without properly ruling out a serious arrhythmia like Ventricular Tachycardia (VT) or rapid Atrial Fibrillation. Failure to order a timely ECG, correctly interpret an abnormal ECG reading, or refer to a cardiologist for follow-up can result in a catastrophic delay in treatment. For example, a patient with a life-threatening, but transient, VT episode might be discharged without appropriate monitoring, leading to sudden cardiac death at home.
2. Failure to Investigate and Treat Underlying Cause: When tachycardia is identified, the standard of care requires a diligent search for the underlying cause (e.g., hyperthyroidism, electrolyte imbalance, or structural heart disease). Failure to order necessary follow-up tests (like blood work, echocardiograms, or EP studies) prevents the definitive treatment. This allows the dangerous rhythm to persist.
3. Inadequate Monitoring and Treatment in Acute Settings: In hospital or surgical settings, rapid, unexplained tachycardia (especially VT) is an emergency. Negligence can occur if:
   • Anesthesiologists fail to investigate and stabilize new-onset complex tachycardia before doing the surgery.
   • Hospital staff fail to timely administer life-saving medications or perform electrical cardioversion for hemodynamically unstable arrhythmias.
   • Patients on high-risk anti-arrhythmic medications are not adequately monitored for side effects or rhythm changes caused by drugs.

The injury in these cases is not the tachycardia itself. It is the resulting heart damage (e.g., heart failure). Alternatively, it is death that would have been prevented with timely and appropriate intervention.

Medical Malpractice in Causing Tachycardia

While less common, medical negligence can directly or indirectly cause tachycardia, particularly a life-threatening one:

1. Medication Errors: Prescribing the incorrect anti-arrhythmic medication, a wrong dosage, or a medication contraindicated by the patient’s existing heart condition can destabilize the heart’s electrical system and trigger a new, dangerous arrhythmia (a phenomenon known as proarrhythmia). Failure to monitor drug levels or perform required follow-up ECGs while initiating new anti-arrhythmics can also constitute negligence.
2. Surgical Errors or Procedural Errors: Mistakes during cardiac procedures, such as catheter ablation, pacemaker implantation, or heart surgery, can unintentionally damage the heart’s electrical conduction system or muscle tissue. For instance, incorrect targeting during ablation could create a new, pro-arrhythmic pathway or damage the AV node. That could lead to a different rhythm problem.
3. Electrolyte Management Errors: In a hospital setting, patients often have their electrolytes (like potassium and magnesium) managed intravenously. Negligent monitoring or incorrect replenishment of these critical minerals can directly cause ventricular arrhythmias. This is especially true in vulnerable patients with heart disease.

Conclusion on Tachycardia & Medical Malpractice

Tachycardia is a critical and time-sensitive issue in health care. For a medical malpractice claim to be valid, a legal breach of the standard of care must be proven. This means the medical provider’s actions were negligent and directly caused the subsequent injury or death. In the context of the racing heart, the failure to listen to a patient’s symptoms, the delay in getting and interpreting basic tests like the ECG, or the failure to intervene in an acute cardiac crisis can all cross the line from a poor outcome to medical malpractice. The prompt and professional management of tachycardia is a cornerstone of cardiology. Deviations from this standard carry severe consequences.

If you have a potential medical malpractice case, then visit our free consultation page or video. Then contact the Kopec Law Firm at 800-604-0704 to speak directly with Attorney Mark Kopec. He is a top-rated Baltimore medical malpractice lawyer. The Kopec Law Firm is in Baltimore and pursues cases throughout Maryland and Washington, D.C.