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Tachycardia Algorithm


Tachycardia and its ACLS Algorithm

Tachycardia/tachyarrhythmia is defined as a rhythm with a heart rate greater than 100 bpm.
An unstable tachycardia exists when cardiac output is reduced to the point of causing serious signs and symptoms.
Serious signs and symptoms commonly seen with unstable tachycardia are: chest pain, signs of shock, SOA, altered mental status, weakness, fatigue, and syncope

One important question you may want to ask is: “Are the symptoms being caused by the tachycardia?” If the symptoms are being caused by the tachycardia treat the tachycardia.

There are many causes of both stable and unstable tachycardia and appropriate treatment within the ACLS framework requires identification of causative factors. Before initiating invasive interventions, reversible causes should be identified and treated.


The most common causes of tachycardia that should be treated outside of the ACLS tachycardia algorithm are dehydration, hypoxia, fever, and sepsis. There may be other contributing causes and review of the H’s and T’s of ACLS should take place as needed.

Administration of OXYGEN and NORMAL SALINE are of primary importance for the treatment of causative factors of sinus tachycardia and should be considered prior to ACLS intervention.

Once these causative factors have been ruled out or treated, invasive treatment using the ACLS tachycardia algorithm should be implemented.

Associated Rhythms

There are several rhythms that are frequently associated with stable and unstable tachycardia these rhythms include:

Visit the links above to learn about each specific rhythm.

ACLS Treatment for Tachycardia

Click below to view the tachycardia algorithm diagram. When done click again to close the diagram. Tachycardia Algorithm Diagram. or Members Download the Hi-Resolution PDF Here

The fist question that should be asked when initiating the ACLS tachycardia algorithm is: “Is the patient stable or unstable?” The answer to this question will determine which path of the tachycardia algorithm is executed.

Patients with unstable tachycardia should be treated immediately with synchronized cardioversion. If a pulseless tachycardia is present patients should be treated using the pulseless arrest algorithm.

Patients with stable tachycardia are treated based upon whether they have a narrow or wide QRS complex. The following flow diagram shows the treatment regimen for stable tachycardia with narrow and wide QRS complex.

  • Stable (narrow QRS complex) → vagal maneuvers → adenosine (if regular) → beta-blocker/calcium channel blocker → get an expert
  • Stable (wide/regular/monomorphic) → adenosine → consider antiarrhythmic infusion → get an expert

  114 Responses to “Tachycardia Algorithm”

  1. Why use adenosine for monomorphic VT? Wouldn’t I be better to use amiodarone or synchronized cardioversion?! I’ve never seen adenosine used for VT ever, nor have I seen a doctor order it… Is this new to ACLS algorithm?

  2. this algorithm has always been difficult for me …I’m not sure why …

  3. Jeff,

    This is probably a dumb question, but what is SOA? As in “Serious signs and symptoms commonly seen with unstable tachycardia are: chest pain, signs of shock, SOA, altered mental status, weakness, fatigue, and syncope”


    • Nevermind, Jeff, I figured it out — SOA = Shortness Of Air. I’ve always used SOB = Shortness Of Breath.

      Thanks again!

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