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Evolutionary developmental biology
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Homologous hox genes in such different animals as insects and vertebrates control embryonic development and hence the form of adult bodies. These genes have been highly conserved through hundreds of millions of years of evolution.
Evolutionary developmental biology (informally, evo-devo) is a field of biological research that compares the developmental processes of different organisms to infer the ancestral relationships between them and how developmental processes evolved.
The field grew from 19th century beginnings, where embryology faced a mystery: zoologists did not know how embryonic development was controlled at the molecular level. Charles Darwin noted that having similar embryos implied common ancestry, but little progress was made until the 1970s. Then, recombinant DNA technology at last brought embryology together with molecular genetics. A key early discovery was of homeotic genes that regulate development in a wide range of eukaryotes.
The field is characterised by some key concepts, which took biologists by surprise. One is deep homology, the finding that dissimilar organs such as the eyes of insects, vertebrates and cephalopod molluscs, long thought to have evolved separately, are controlled by similar genes such as pax-6, from the evo-devo gene toolkit. These genes are ancient, being highly conserved among phyla; they generate the patterns in time and space which shape the embryo, and ultimately form the body plan of the organism. Another is that species do not differ much in their structural genes, such as those coding for enzymes; what does differ is the way that gene expression is regulated by the toolkit genes. These genes are reused, unchanged, many times in different parts of the embryo and at different stages of development, forming a complex cascade of control, switching other regulatory genes as well as structural genes on and off in a precise pattern. This multiple pleiotropic reuse explains why these genes are highly conserved, as any change would have many adverse consequences which natural selection would oppose.
New morphological features and ultimately new species are produced by variations in the toolkit, either when genes are expressed in a new pattern, or when toolkit genes acquire additional functions. Another possibility is the Neo-Lamarckian theory that epigenetic changes are later consolidated at gene level, something that may have been important early in the history of multicellular life.
Contents
[hide]
1 History
1.1 Recapitulation
1.2 Evolutionary morphology
1.3 The modern synthesis of the early 20th century
1.4 The lac operon
1.5 The birth of evo-devo and a second synthesis
2 The control of body structure
2.1 Deep homology
2.2 Gene toolkit
2.3 The embryo's regulatory networks
3 The origins of novelty
3.1 Variations in the toolkit
3.2 Consolidation of epigenetic changes
4 Eco-evo-devo
5 See also
6 Notes
7 References
History[edit]
Embryology theories of Ernst Haeckel, who argued for recapitulation[1] of evolutionary development in the embryo, and Karl Ernst von Baer's epigenesis
Further information: History of evolutionary thought
Recapitulation[edit]
Main article: Recapitulation theory
A recapitulation theory of evolutionary development was proposed by Étienne Serres in 1824–26, echoing the 1808 ideas of Johann Friedrich Meckel. They argued that the embryos of 'higher' animals went through or recapitulated a series of stages, each of which resembled an animal lower down the great chain of being. For example, the brain of a human embryo looked first like that of a fish, then in turn like that of a reptile, bird, and mammal before becoming clearly human. The embryologist Karl Ernst von Baer opposed this, arguing in 1828 that there was no linear sequence as in the great chain of being, based on a single body plan, but a process of epigenesis in which structures differentiate. Von Baer instead recognised four distinct animal body plans: radiate, like starfish; molluscan, like clams; articulate, like lobsters; and vertebrate, like fish. Zoologists then largely abandoned recapitulation, though Ernst Haeckel revived it in 1866.[2][3][4][5][6]
Evolutionary morphology[edit]
A. Lancelet (a chordate), B. Larval tunicate, C. Adult tunicate. Kowalevsky saw that the notochord (1) and gill slit (5) are shared by tunicates and vertebrates.
Further information: Morphology (biology) and Body plan
From the early 19th century through most of the 20th century, embryology faced a mystery. Animals were seen to develop into adults of widely differing body plan, often through similar stages, from the egg, but zoologists knew almost nothing about how embryonic development was controlled at the molecular level, and therefore equally little about how developmental processes had evolved.[7] Charles Darwin argued that a shared embryonic structure implied a common ancestor. As an example of this, Darwin cited in his 1859 book On the Origin of Species the shrimp-like larva of the barnacle, whose sessile adults looked nothing like other arthropods; Linnaeus and Cuvier had classified them as molluscs.[8][9] Darwin also noted Alexander Kowalevsky's finding that the tunicate, too, was not a mollusc, but in its larval stage had a notochord and pharyngeal slits which developed from the same germ layers as the equivalent structures in vertebrates, and should therefore be grouped with them as chordates.[8][10] 19th century zoology thus converted embryology into an evolutionary science, connecting phylogeny with homologies between the germ layers of embryos. Zoologists including Fritz Müller proposed the use of embryology to discover phylogenetic relationships between taxa. Müller demonstrated that crustaceans shared the Nauplius larva, identifying several parasitic species that had not been recognised as crustaceans. Müller also recognised that natural selection must act on larvae, just as it does on adults, giving the lie to recapitulation, which would require larval forms to be shielded from natural selection.[8] Two of Haeckel's other ideas about the evolution of development have fared better than recapitulation: he argued in the 1870s that changes in the timing (heterochrony) and changes in the positioning within the body (heterotopy) of aspects of embryonic development would drive evolution by changing the shape of a descendant's body compared to an ancestor's. It took a century before these ideas were shown to be correct.[11][12][13] In 1917, D'Arcy Thompson wrote a book on the shapes of animals, showing with simple mathematics how small changes to parameters, such as the angles of a gastropod's spiral shell, can radically alter an animal's form, though he preferred mechanical to evolutionary explanation.[14][15] But for the next century, without molecular evidence, progress stalled.[8]
The modern synthesis of the early 20th century[edit]
Main article: Modern synthesis
In the so-called modern synthesis of the early 20th century, Ronald Fisher brought together Darwin's theory of evolution, with its insistence on natural selection, heredity, and variation, and Gregor Mendel's laws of genetics into a coherent structure for evolutionary biology. Biologists assumed that an organism was a straightforward reflection of its component genes: the genes coded for proteins, which built the organism's body. Biochemical pathways (and, they supposed, new species) evolved through mutations in these genes. It was a simple, clear and nearly comprehensive picture: but it did not explain embryology.[8][16]
The lac operon[edit]
The lac operon. Top:Repressed, Bottom:Active
1: RNA Polymerase, 2: Repressor, 3: Promoter, 4: Operator, 5: Lactose, 6–8: protein-encoding genes, controlled by the switch, that cause lactose to be digested
Main article: Lac operon
In 1961, Jacques Monod, Jean-Pierre Changeux and François Jacob discovered the lac operon in the bacterium Escherichia coli. It was a cluster of genes, arranged in a feedback control loop so that its products would only be made when "switched on" by an environmental stimulus. One of these products was an enzyme that splits a sugar, lactose; and lactose itself was the stimulus that switched the genes on. This was a revelation, as it showed for the first time that genes, even in an organism as small as a bacterium, were subject to fine-grained control. The implication was that many other genes were also elaborately regulated.[17]
The birth of evo-devo and a second synthesis[edit]
In 1977, a revolution in thinking about evolution and developmental biology began, with the arrival of recombinant DNA technology in genetics, and the papers Ontogeny and Phylogeny by Stephen J. Gould and Evolution by Tinkering by François Jacob. Gould laid to rest Haeckel's interpretation of evolutionary embryology, while Jacob set out an alternative theory.[8] This led to a second synthesis,[18][19] at last including embryology as well as molecular genetics, phylogeny, and evolutionary biology to form evo-devo.[20][21] In 1978, Edward B. Lewis discovered homeotic genes that regulate embryonic development in Drosophila fruit flies, which like all insects are arthropods, one of the major phyla of invertebrate animals.[22] Bill McGinnis quickly discovered homeotic gene sequences, homeoboxes, in animals in other phyla, in vertebrates such as frogs, birds, and mammals; they were later also found in fungi such as yeasts, and in plants.[23][24] There were evidently strong similarities in the genes that controlled development across all the eukaryotes.[25] In 1980, Christiane Nüsslein-Volhard and Eric Wieschaus described gap genes which help to create the segmentation pattern in fruit fly embryos;[26][27] they and Lewis won a Nobel Prize for their work in 1995.[23][28]
Later, more specific similarities were discovered: for example, the Distal-less gene was found in 1989 to be involved in the development of appendages or limbs in fruit flies,[29] the fins of fish, the wings of chickens, the parapodia of marine annelid worms, the ampullae and siphons of tunicates, and the tube feet of sea urchins. It was evident that the gene must be ancient, dating back to the last common ancestor of bilateral animals (before the Ediacaran Period, which began some 635 million years ago). Evo-devo had started to uncover the ways that all animal bodies were built during development.[30][31]
The control of body structure[edit]
Deep homology[edit]
Further information: Deep homology
Roughly spherical eggs of different animals give rise to extremely different bodies, from jellyfish to lobsters, butterflies to elephants. Many of these organisms share the same structural genes for body-building proteins like collagen and enzymes, but biologists had expected that each group of animals would have its own rules of development. The surprise of evo-devo is that the shaping of bodies is controlled by a rather small percentage of genes, and that these regulatory genes are ancient, shared by all animals. The giraffe does not have a gene for a long neck, any more than the elephant has a gene for a big body. Their bodies are patterned by a system of switching which causes development of different features to begin earlier or later, to occur in this or that part of the embryo, and to continue for more or less time.[7]
The puzzle of how embryonic development was controlled began to be solved using the fruit fly Drosophila melanogaster as a model organism. The step-by-step control of its embryogenesis was visualized by attaching fluorescent dyes of different colours to specific types of protein made by genes expressed in the embryo.[7] A dye such as green fluorescent protein, originally from a jellyfish, was typically attached to an antibody specific to a fruit fly protein, forming a precise indicator of where and when that protein appeared in the living embryo.[32]
The pax-6 gene controls development of eyes of different types across the animal kingdom.
Using such a technique, in 1994 Walter Gehring found that the pax-6 gene, vital for forming the eyes of fruit flies, exactly matches an eye-forming gene in mice and humans. The same gene was quickly found in many other groups of animals, such as squid, a cephalopod mollusc. Biologists including Ernst Mayr had believed that eyes had arisen in the animal kingdom at least 40 times, as the anatomy of different types of eye varies widely.[7] For example, the fruit fly's compound eye is made of hundreds of small lensed structures (ommatidia); the human eye has a blind spot where the optic nerve enters the eye, and the nerve fibres run over the surface of the retina, so light has to pass through a layer of nerve fibres before reaching the detector cells in the retina, so the structure is effectively "upside-down"; in contrast, the cephalopod eye has the retina, then a layer of nerve fibres, then the wall of the eye "the right way around".[33] The evidence of pax-6, however, was that the same genes controlled the development of the eyes of all these animals, suggesting that they all evolved from a common ancestor.[7] Ancient genes had been conserved through millions of years of evolution to create dissimilar structures for similar functions, demonstrating deep homology between structures once thought to be purely analogous.[34][35] This has caused a radical revision of the meaning of homology in evolutionary biology.[34][35][36]
Gene toolkit[edit]
Expression of homeobox (Hox) genes in the fruit fly
Main article: Evo-devo gene toolkit
A small fraction of the genes in an organism's genome control the organism's development. These genes are called the developmental-genetic toolkit. They are highly conserved among phyla, meaning that they are ancient and very similar in widely separated groups of animals. Differences in deployment of toolkit genes affect the body plan and the number, identity, and pattern of body parts. Most toolkit genes are parts of signalling pathways: they encode transcription factors, cell adhesion proteins, cell surface receptor proteins and signalling ligands that bind to them, and secreted morphogens that diffuse through the embryo. All of these help to define the fate of undifferentiated cells in the embryo. Together, they generate the patterns in time and space which shape the embryo, and ultimately form the body plan of the organism. Among the most important toolkit genes are the Hox genes. These transcription factors contain the homeobox protein-binding DNA motif, also found in other toolkit genes, and create the basic pattern of the body along its front-to-back axis.[36] Hox genes determine where repeating parts, such as the many vertebrae of snakes, will grow in a developing embryo or larva.[7] Pax-6, already mentioned, is a classic toolkit gene.[37] Homeobox genes are also found in plants, implying they are common to all eukaryotes.[38][39][40]
The embryo's regulatory networks[edit]
A gene regulatory network
Further information: Regulation of gene expression and Transcriptional regulation
The protein products of the regulatory toolkit are reused not by duplication and modification, but by a complex mosaic of pleiotropy, being applied unchanged in many independent developmental processes, giving pattern to many dissimilar body structures.[36] The loci of these pleiotropic toolkit genes have large, complicated and modular cis-regulatory elements. For example, while a non-pleiotropic rhodopsin gene in the fruit fly has a cis-regulatory element just a few hundred base pairs long, the pleiotropic eyeless cis-regulatory region contains 6 cis-regulatory elements in over 7000 base pairs.[36] The regulatory networks involved are often very large. Each regulatory protein controls "scores to hundreds" of cis-regulatory elements. For instance, 67 fruit fly transcription factors controlled on average 124 target genes each.[36] All this complexity enables genes involved in the development of the embryo to be switched on and off at exactly the right times and in exactly the right places. Some of these genes are structural, directly forming enzymes, tissues and organs of the embryo. But many others are themselves regulatory genes, so what is switched on is often a precisely-timed cascade of switching, involving turning on one developmental process after another in the developing embryo.[36]
Gene product distributions along the long axis of the early embryo of a fruit fly
Such a cascading regulatory network has been studied in detail in the development of the fruit fly embryo. The young embryo is oval in shape, like a rugby ball. A small number of genes produce messenger RNAs that set up concentration gradients along the long axis of the embryo. In the early embryo, the bicoid and hunchback genes are at high concentration near the anterior end, and give pattern to the future head and thorax; the caudal and nanos genes are at high concentration near the posterior end, and give pattern to the hindmost abdominal segments. The effects of these genes interact; for instance, the Bicoid protein blocks the translation of caudal's messenger RNA, so the Caudal protein concentration becomes low at the anterior end. Caudal later switches on genes which create the fly's hindmost segments, but only at the posterior end where it is most concentrated.[41][42]
Gap genes in the fruit fly are switched on by genes such as bicoid, setting up stripes across the embryo which start to pattern the body's segments.
The Bicoid, Hunchback and Caudal proteins in turn regulate the transcription of gap genes such as giant, knirps, Krüppel, and tailless in a striped pattern, creating the first level of structures that will become segments.[26] The proteins from these in turn control the pair-rule genes, which in the next stage set up 7 bands across the embryo's long axis. Finally, the segment polarity genes such as engrailed split each of the 7 bands into two, creating 14 future segments.[41][42]
This process explains the accurate conservation of toolkit gene sequences, which has resulted in deep homology and functional equivalence of toolkit proteins in dissimilar animals (seen, for example, when a mouse protein controls fruit fly development). The interactions of transcription factors and cis-regulatory elements, or of signalling proteins and receptors, become locked in through multiple usages, making almost any mutation deleterious and hence eliminated by natural selection.[36]
The origins of novelty[edit]
See also: History of evolutionary thought § 21st century
Among the more surprising and, perhaps, counterintuitive (from a neo-Darwinian viewpoint) results of recent research in evolutionary developmental biology is that the diversity of body plans and morphology in organisms across many phyla are not necessarily reflected in diversity at the level of the sequences of genes, including those of the developmental genetic toolkit and other genes involved in development. Indeed, as Gerhart and Kirschner have noted, there is an apparent paradox: "where we most expect to find variation, we find conservation, a lack of change".[43] So, if the observed morphological novelty between different clades does not come from changes in gene sequences (such as by mutation), where does it come from? Novelty may arise by mutation-driven changes in gene regulation.[36][44][45][46]
Variations in the toolkit[edit]
Heliconius erato
Heliconius melpomene
Different species of Heliconius butterfly have independently evolved similar patterns, apparently both facilitated and constrained by the available developmental-genetic toolkit genes controlling wing pattern formation.
Variations in the toolkit may have produced a large part of the morphological evolution of animals. The toolkit can drive evolution in two ways. A toolkit gene can be expressed in a different pattern, as when the beak of Darwin's large ground-finch was enlarged by the BMP gene,[47] or when snakes lost their legs as distal-less became under-expressed or not expressed at all in the places where other reptiles continued to form their limbs.[48] Or, a toolkit gene can acquire a new function, as seen in the many functions of that same gene, distal-less, which controls such diverse structures as the mandible in vertebrates,[49][50] legs and antennae in the fruit fly,[51] and eyespot pattern in butterfly wings.[52] Given that small changes in toolbox genes can cause significant changes in body structures, they have often enabled the same function convergently or in parallel. distal-less generates wing patterns in the butterflies Heliconius erato and Heliconius melpomene, which are Müllerian mimics. In so-called facilitated variation,[53] their wing patterns arose in different evolutionary events, but are controlled by the same genes.[54] Developmental changes can contribute directly to speciation.[55]
Consolidation of epigenetic changes[edit]
Main article: Transgenerational epigenetic inheritance
Further information: Extended Evolutionary Synthesis
Evolutionary innovation may sometimes begin in Lamarckian style with epigenetic alterations of gene regulation or phenotype generation, subsequently consolidated by changes at the gene level. Epigenetic changes include modification of DNA by reversible methylation,[56] as well as nonprogrammed remoulding of the organism by physical and other environmental effects due to the inherent plasticity of developmental mechanisms.[57] The biologists Stuart A. Newman and Gerd B. Müller have suggested that organisms early in the history of multicellular life were more susceptible to this second category of epigenetic determination than are modern organisms, providing a basis for early macroevolutionary changes.[58]
Eco-evo-devo[edit]
Ecological evolutionary developmental biology (eco-evo-devo) integrates research from developmental biology and ecology to examine their relationship with evolutionary theory.[59] Researchers study concepts and mechanisms such as developmental plasticity, epigenetic inheritance, genetic assimilation, niche construction and symbiosis.[60][61]
See also[edit]
Arthropod head problem
Cell signaling
Evolution & Development (journal)
Human evolutionary developmental biology
Just So Stories (as seen by evolutionary developmental biologists)
Notes[edit]
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Jump up ^ Depew, M.J.; Lufkin, T.; Rubenstein, J.L. (October 2002). "Specification of jaw subdivisions by DLX genes". Science. 298 (5592): 381–385. PMID 12193642. doi:10.1126/science.1075703.
Jump up ^ Panganiban, Grace; Rubenstein, John L. R. (2002). "Developmental functions of the Distal-less/Dlx homeobox genes". Development. 129: 4371–4386.
Jump up ^ Beldade, P.; Brakefield, P.M.; Long, A.D. (2002). "Contribution of Distal-less to quantitative variation in butterfly eyespots". Nature. 415 (6869): 315–318. PMID 11797007. doi:10.1038/415315a.
Jump up ^ Gerhart, John; Kirschner, Marc (2007). "The theory of facilitated variation". Proceedings of the National Academy of Sciences. 104 (suppl1): 8582–8589. Bibcode:2007PNAS..104.8582G. PMC 1876433  . PMID 17494755. doi:10.1073/pnas.0701035104.
Jump up ^ Baxter, S.W.; Papa, R.; Chamberlain, N.; Humphray, S.J.; Joron, M.; Morrison, C.; ffrench-Constant, R.H.; McMillan, W.O.; Jiggins, C.D. (2008). "Convergent Evolution in the Genetic Basis of Mullerian Mimicry in Heliconius Butterflies". Genetics. 180 (3): 1567–1577. PMC 2581958  . PMID 18791259. doi:10.1534/genetics.107.082982.
Jump up ^ Pennisi, E. (2002). "Evolutionary Biology:Evo-Devo Enthusiasts Get Down to Details". Science. 298 (5595): 953–955. PMID 12411686. doi:10.1126/science.298.5595.953.
Jump up ^ Jablonka, Eva; Lamb, Marion (1995). Epigenetic Inheritance and Evolution: The Lamarckian Dimension. Oxford, New York: Oxford University Press. ISBN 978-0-19-854063-2.
Jump up ^ West-Eberhard, M-J. (2003). Developmental plasticity and evolution. New York: Oxford University Press. ISBN 978-0-19-512235-0.
Jump up ^ Müller, Gerd B.; Newman, Stuart A., eds. (2003). Origination of Organismal Form: Beyond the Gene in Developmental and Evolutionary Biology. MIT Press.
Jump up ^ Abouheif, E.; Favé, M.-J.; Ibarrarán-Viniegra, A. S.; Lesoway, M. P.; Rafiqi, A. M.; Rajakumar, R. (2014). "Eco-Evo-Devo: The Time Has Come". In Landry, C.R.; Aubin-Horth, N. Ecological Genomics: Ecology and the Evolution of Genes and Genomes. pp. 107–125. ISBN 978-94-007-7346-2. doi:10.1007/978-94-007-7347-9_6.
Jump up ^ Schlichting, C.D. (2009). "An Uneven Guide to Eco-Devo". BioScience. 59 (11): 1000–1001. doi:10.1525/bio.2009.59.11.12.
Jump up ^ Gilbert, S. F.; Bosch, T. C. G.; Ledón-Rettig, C. (2015). "Eco-Evo-Devo: developmental symbiosis and developmental plasticity as evolutionary agents". Nature Reviews Genetics. 16 (10): 611–622. PMID 26370902. doi:10.1038/nrg3982.
References[edit]
Secord, James A. (2000), Victorian sensation: the extraordinary publication, reception, and secret authorship of Vestiges of the natural history of creation, Chicago: University of Chicago Press, ISBN 978-0-226-74410-0
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Tachycardia
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Tachycardia
Synonyms
Tachyarrhythmia
ECG showing sinus tachycardia with a rate of about 100 beats per minute
Pronunciation
Tachycardia /tækiˈkɑːrdiə/, tachyarrhythmia /tækiəˈrɪðmiə/
Specialty
Cardiology
Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate.[1] In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults.[1] Heart rates above the resting rate may be normal (such as with exercise) or abnormal (such as with electrical problems within the heart).
Contents
[hide]
1 Definition
2 Causes
3 Differential diagnosis
3.1 Sinus
3.2 Ventricular
3.3 Supraventricular
3.3.1 Atrial fibrillation
3.3.2 AV nodal reentrant tachycardia
3.3.3 AV reentrant tachycardia
3.3.4 Junctional tachycardia
4 Management
4.1 Unstable
5 Terminology
6 References
7 External links
Definition[edit]
The upper threshold of a normal human resting heart rate is based on age. Cutoff values for tachycardia in different age groups are fairly well standardized; typical cutoffs are listed below:[2]
1–2 days: Tachycardia > 159 beats per minute (bpm)
3–6 days: Tachycardia >166 bpm
1–3 weeks: Tachycardia >182 bpm
1–2 months: Tachycardia >179 bpm
3–5 months: Tachycardia >186 bpm
6–11 months: Tachycardia >169 bpm
1–2 years: Tachycardia >151 bpm
3–4 years: Tachycardia >137 bpm
5–7 years: Tachycardia >133 bpm
8–11 years: Tachycardia >130 bpm
12–15 years: Tachycardia >119 bpm
>15 years – adult: Tachycardia >100 bpm
Heart rate is considered in the context of the prevailing clinical picture. For example: in sepsis >90 bpm is considered tachycardia.
When the heart beats excessively or rapidly, the heart pumps less efficiently and provides less blood flow to the rest of the body, including the heart itself. The increased heart rate also leads to increased work and oxygen demand by the heart, which can lead to rate related ischemia.[3]
Relative tachycardia involves a greater increase in rate than would be expected in a given illness state.[citation needed]
Causes[edit]
Some causes of tachycardia include:
Adrenergic storm
Alcohol
Amphetamine
Anaemia
Antiarrhythmic agents
Anxiety
Atrial fibrillation
Atrial flutter
Atrial tachycardia
AV nodal reentrant tachycardia
Brugada syndrome
Caffeine
Cocaine
Exercise
Fear
Fever
Hypoglycemia
Hypovolemia
Hyperthyroidism
Hyperventilation
Infection
Junctional tachycardia
Methamphetamine
Multifocal atrial tachycardia
Nicotine
Pacemaker mediated
Pain
Pheochromocytoma
Sinus tachycardia
Tricyclic antidepressants
Wolff–Parkinson–White syndrome
Differential diagnosis[edit]
12 lead electrocardiogram showing a ventricular tachycardia (VT)
An electrocardiogram (ECG) is used to classify the type of tachycardia. They may be classified into narrow and wide complex based on the QRS complex.[4] Presented order of most to least common, they are:[4]
Narrow complex
Sinus tachycardia, which originates from the sino-atrial (SA) node, near the base of the superior vena cava
Atrial fibrillation
Atrial flutter
AV nodal reentrant tachycardia
Accessory pathway mediated tachycardia
Atrial tachycardia
Multifocal atrial tachycardia
Junctional tachycardia
Wide complex
Ventricular tachycardia, any tachycardia that originates in the ventricles
Any narrow complex tachycardia combined with a problem with the conduction system of the heart, often termed "supraventricular tachycardia with aberrancy"
A narrow complex tachycardia with an accessory conduction pathway, often termed "supraventricular tachycardia with pre-excitation" (e.g. Wolff–Parkinson–White syndrome)
Pacemaker-tracked or pacemaker-mediated tachycardia
Tachycardias may be classified as either narrow complex tachycardias (supraventricular tachycardias) or wide complex tachycardias. Narrow and wide refer to the width of the QRS complex on the ECG. Narrow complex tachycardias tend to originate in the atria, while wide complex tachycardias tend to originate in the ventricles. Tachycardias can be further classified as either regular or irregular.
Sinus[edit]
Main article: Sinus tachycardia
The body has several feedback mechanisms to maintain adequate blood flow and blood pressure. If blood pressure decreases, the heart beats faster in an attempt to raise it. This is called reflex tachycardia. This can happen in response to a decrease in blood volume (through dehydration or bleeding), or an unexpected change in blood flow. The most common cause of the latter is orthostatic hypotension (also called postural hypotension). Fever, hyperventilation, diarrhea and severe infections can also cause tachycardia, primarily due to increase in metabolic demands.
An increase in sympathetic nervous system stimulation causes the heart rate to increase, both by the direct action of sympathetic nerve fibers on the heart and by causing the endocrine system to release hormones such as epinephrine (adrenaline), which have a similar effect. Increased sympathetic stimulation is usually due to physical or psychological stress. This is the basis for the so-called fight-or-flight response, but such stimulation can also be induced by stimulants such as ephedrine, amphetamines or cocaine. Certain endocrine disorders such as pheochromocytoma can also cause epinephrine release and can result in tachycardia independent of nervous system stimulation. Hyperthyroidism can also cause tachycardia.[5] The upper limit of normal rate for sinus tachycardia is thought to be 220 bpm minus age.
Ventricular[edit]
Main article: Ventricular tachycardia
Ventricular tachycardia (VT or V-tach) is a potentially life-threatening cardiac arrhythmia that originates in the ventricles. It is usually a regular, wide complex tachycardia with a rate between 120 and 250 beats per minute.
Both of these rhythms normally last for only a few seconds to minutes (paroxysmal tachycardia), but if VT persists it is extremely dangerous, often leading to ventricular fibrillation.
Supraventricular[edit]
Main article: Supraventricular tachycardia
This is a type of tachycardia that originates from above the ventricles, such as the atria. It is sometimes known as paroxysmal atrial tachycardia (PAT). Several types of supraventricular tachycardia are known to exist.
Atrial fibrillation[edit]
Atrial fibrillation is one of the most common cardiac arrhythmias. In general, it is an irregular, narrow complex rhythm. However, it may show wide QRS complexes on the ECG if a bundle branch block is present. At high rates, the QRS complex may also become wide due to the Ashman phenomenon. It may be difficult to determine the rhythm's regularity when the rate exceeds 150 beats per minute. Depending on the patient's health and other variables such as medications taken for rate control, atrial fibrillation may cause heart rates that span from 50 to 250 beats per minute (or even higher if an accessory pathway is present). However, new onset atrial fibrillation tends to present with rates between 100 and 150 beats per minute.
AV nodal reentrant tachycardia[edit]
AV nodal reentrant tachycardia (AVNRT) is the most common reentrant tachycardia. It is a regular narrow complex tachycardia that usually responds well to the Valsalva maneuver or the drug adenosine. However, unstable patients sometimes require synchronized cardioversion. Definitive care may include catheter ablation.
AV reentrant tachycardia[edit]
AV reentrant tachycardia (AVRT) requires an accessory pathway for its maintenance. AVRT may involve orthodromic conduction (where the impulse travels down the AV node to the ventricles and back up to the atria through the accessory pathway) or antidromic conduction (which the impulse travels down the accessory pathway and back up to the atria through the AV node). Orthodromic conduction usually results in a narrow complex tachycardia, and antidromic conduction usually results in a wide complex tachycardia that often mimics ventricular tachycardia. Most antiarrhythmics are contraindicated in the emergency treatment of AVRT, because they may paradoxically increase conduction across the accessory pathway.
Junctional tachycardia[edit]
Junctional tachycardia is an automatic tachycardia originating in the AV junction. It tends to be a regular, narrow complex tachycardia and may be a sign of digitalis toxicity.
Management[edit]
The management of tachycardia depends on its type (wide complex versus narrow complex), whether or not the person is stable or unstable, and whether the instability is due to the tachycardia.[4] Unstable means that either important organ functions are affected or cardiac arrest is about to occur.[4]
Unstable[edit]
In those that are unstable with a narrow complex tachycardia, intravenous adenosine may be attempted.[4] In all others immediate cardioversion is recommended.[4]
Terminology[edit]
The word tachycardia came to English from New Latin as a neoclassical compound built from the combining forms tachy- + -cardia, which are from the Greek ταχύς tachys, "quick, rapid" and καρδία, kardia, "heart". As a matter both of usage choices in the medical literature and of idiom in natural language, the words tachycardia and tachyarrhythmia are usually used interchangeably, or loosely enough that precise differentiation is not explicit. Some careful writers have tried to maintain a logical differentiation between them, which is reflected in major medical dictionaries[6][7][8] and major general dictionaries.[9][10][11] The distinction is that tachycardia be reserved for the rapid heart rate itself, regardless of cause, physiologic or pathologic (that is, from healthy response to exercise or from cardiac arrhythmia), and that tachyarrhythmia be reserved for the pathologic form (that is, an arrhythmia of the rapid rate type). This is why five of the aforementioned dictionaries do not enter cross-references indicating synonymy between their entries for the two words (as they do elsewhere whenever synonymy is meant), and it is why one of them explicitly specifies that the two words not be confused.[8] But the prescription will probably never be successfully imposed on general usage, not only because much of the existing medical literature ignores it even when the words stand alone but also because the terms for specific types of arrhythmia (standard collocations of adjectives and noun) are deeply established idiomatically with the tachycardia version as the more commonly used version. Thus SVT is called supraventricular tachycardia more than twice as often as it is called supraventricular tachyarrhythmia; moreover, those two terms are always completely synonymous—in natural language there is no such term as "healthy/physiologic supraventricular tachycardia". The same themes are also true of AVRT and AVNRT. Thus this pair is an example of when a particular prescription (which may have been tenable 50 or 100 years earlier) can no longer be invariably enforced without violating idiom. But the power to differentiate in an idiomatic way is not lost, regardless, because when the specification of physiologic tachycardia is needed, that phrase aptly conveys it.
References[edit]
^ Jump up to: a b Awtry, Eric H.; Jeon, Cathy; Ware, Molly G. (2006). Blueprints cardiology (2nd ed.). Malden, Mass.: Blackwell. p. 93. ISBN 9781405104647.
Jump up ^ Custer JW, Rau RE, eds. Johns Hopkins: The Harriet Lane Handbook. 18th ed. Philadelphia, PA: Mosby Elsevier Inc; 2008. Data also available through eMedicine: Pediatrics, Tachycardia.
Jump up ^ Harrison's Principles of Internal Medicine, 17th Edition
^ Jump up to: a b c d e f Neumar RW, Otto CW, Link MS, et al. (November 2010). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S729–67. doi:10.1161/CIRCULATIONAHA.110.970988. PMID 20956224.
Jump up ^ Barker RL, Burton JR, Zieve, PD eds. Principles of Ambulatory Medicine. Sixth Edition. Philadelphia, PA: Lippinocott, Wilkins & Williams 2003
Jump up ^ Elsevier, Dorland's Illustrated Medical Dictionary, Elsevier.
Jump up ^ Merriam-Webster, Merriam-Webster's Medical Dictionary, Merriam-Webster.
^ Jump up to: a b Wolters Kluwer, Stedman's Medical Dictionary, Wolters Kluwer.
Jump up ^ Houghton Mifflin Harcourt, The American Heritage Dictionary of the English Language, Houghton Mifflin Harcourt.
Jump up ^ Merriam-Webster, Merriam-Webster's Collegiate Dictionary, Merriam-Webster.
Jump up ^ Merriam-Webster, Merriam-Webster's Unabridged Dictionary, Merriam-Webster.
External links[edit]
Classification
V · T · D
ICD-10: I47-I49, R00.0
ICD-9-CM: 427, 785.0
MeSH: D013610
[show]
v
t
e
Symptoms and signs relating to the cardiovascular system (R00–R03, 785)
Chest pain
Referred pain
Angina
Aerophagia
Auscultation
Heart sounds
Split S2
S3
S4
Gallop rhythm
Heart murmur
Systolic
Diastolic
Continuous
Pericardial friction rub
Heart click
Bruit
carotid
Pulse
Tachycardia
Bradycardia
Pulsus tardus et parvus
Pulsus paradoxus
doubled
Pulsus bisferiens
Dicrotic pulse
Pulsus bigeminus
Pulsus alternans
Pulse deficit
Vascular disease
Gangrene
Other
Palpitations
Apex beat
Cœur en sabot
Jugular venous pressure
Cannon A waves
Hyperaemia
Shock
Cardiogenic
Hypovolemic
Distributive
Septic
Neurogenic
[show]
v
t
e
Cardiovascular disease (heart) (I00–I52, 390–429)
Ischaemic
Coronary disease
Coronary artery disease (CAD)
Coronary artery aneurysm
Spontaneous coronary artery dissection (SCAD)
Coronary thrombosis
Coronary vasospasm
Myocardial bridge
Active ischemia
Angina pectoris
Prinzmetal's angina
Stable angina
Acute coronary syndrome
Myocardial infarction
Unstable angina
Sequelae
hours
Hibernating myocardium
Myocardial stunning
days
Myocardial rupture
weeks
Aneurysm of heart / Ventricular aneurysm
Dressler syndrome
Layers
Pericardium
Pericarditis
Acute
Chronic / Constrictive
Pericardial effusion
Cardiac tamponade
Hemopericardium
Myocardium
Myocarditis
Chagas disease
Cardiomyopathy
Dilated
Alcoholic
Hypertrophic
Restrictive
Loeffler endocarditis
Cardiac amyloidosis
Endocardial fibroelastosis
Arrhythmogenic right ventricular dysplasia
Endocardium /
valves
Endocarditis
infective endocarditis
Subacute bacterial endocarditis
non-infective endocarditis
Libman–Sacks endocarditis
Nonbacterial thrombotic endocarditis
Valves
mitral
regurgitation
prolapse
stenosis
aortic
stenosis
insufficiency
tricuspid
stenosis
insufficiency
pulmonary
stenosis
insufficiency
Conduction /
arrhythmia
Bradycardia
Sinus bradycardia
Sick sinus syndrome
Heart block: Sinoatrial
AV
1°
2°
3°
Intraventricular
Bundle branch block
Right
Left
Left anterior fascicle
Left posterior fascicle
Bifascicular
Trifascicular
Adams–Stokes syndrome
Tachycardia
(paroxysmal and sinus)
Supraventricular
Atrial
Multifocal
Junctional
AV nodal reentrant
Junctional ectopic
Ventricular
Accelerated idioventricular rhythm
Catecholaminergic polymorphic
Torsades de pointes
Premature contraction
Atrial
Junctional
Ventricular
Pre-excitation syndrome
Lown–Ganong–Levine
Wolff–Parkinson–White
Flutter / fibrillation
Atrial flutter
Ventricular flutter
Atrial fibrillation
Familial
Ventricular fibrillation
Pacemaker
Ectopic pacemaker / Ectopic beat
Multifocal atrial tachycardia
Pacemaker syndrome
Parasystole
Wandering pacemaker
Long QT syndrome
Andersen–Tawil
Jervell and Lange-Nielsen
Romano–Ward
Cardiac arrest
Sudden cardiac death
Asystole
Pulseless electrical activity
Sinoatrial arrest
Other / ungrouped
hexaxial reference system
Right axis deviation
Left axis deviation
QT
Short QT syndrome
T
T wave alternans
ST
Osborn wave
ST elevation
ST depression
Strain pattern
Cardiomegaly
Ventricular hypertrophy
Left
Right / Cor pulmonale
Atrial enlargement
Left
Right
Other
Cardiac fibrosis
Heart failure
Diastolic heart failure
Cardiac asthma
Rheumatic fever
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