[The behavior of the general practitioner in dealing with tachycardia]

In medical practice the physician may face 3 situations when dealing with tachycardia or arrhythmia: 1) when seen, the patient has tachycardia and the physician has no electrocardiograph: 2) the patient has tachycardia and the physician can take an electrocardiogramm; 3) the patient discloses a history suggestive of tachycardia or arrhythmia. In the first situation the heart rate and rhythm must be carefully observed immediately, as well as jugular venous pulse and heart sounds and murmurs; then the effects of respiration, change in posture, and carotid sinus pressure should be evaluated; finally, a complete physical examination should be carried out and the patient's history taken; for the latter, questions should be asked concerning past episodes, intake of digitalis or other drugs, possible reasons for hypokalemia, and presence of any disease that might play a role. In the second situation, the ECG should be recorded at once by the physician himself (first V1-2 and DII); the subsequent workup is the same as for the first situation. In the third situation a highly detailed patient's history is of the utmost importance. If recurring episodes take place, their ECG recording should be tried by all possible means: the most important factor is the physicians readiness to do so. A hospital stay for observation of an epidose is usually fruitless, as is an exercise ECG. 24 h recording may be useful, as may endocavitary recording and stimulation tests. Any tachycardia should be correctly related to the natural history of the patient's disease.