How do I tell sinus tach from SVT?

Sinus tach has visible P waves before each QRS and ramps up; SVT often has hidden or retrograde P waves and onset is abrupt. Rate alone doesn't distinguish — morphology and onset do.

Is sinus tach treated with rate control?

Usually not directly — treat the cause (volume, pain, fever, hypoxia). Slowing a compensatory sinus tach is rarely the right move.

What rate triggers escalation?

Depends on patient and context. A sustained rate > 130–140 in an adult without obvious cause warrants clinician notification.

Sinus tachycardia — an educational nurse reference.

What sinus tach looks like on a strip and why the underlying cause matters more than the number.

Recognizing this rhythm at the bedside means matching pattern, intervals, and clinical context. This page covers the educational pattern; calipers and your clinical judgment carry it across the line.

What RN PocketPal does

Identifying traits

Rate: > 100 bpm (typically 100–150 in adults)
Rhythm: regular
P wave: present, upright in lead II, before every QRS
PR interval: 0.12–0.20 sec
QRS: < 0.12 sec

Verify with

Patient's clinical context: pain, fever, hypovolemia, anxiety, beta-agonist use.
Trend: a rising sinus tach is often the body's first warning of decompensation.
12-lead if onset is sudden or rate is sustained > 150.

Who it’s for

For Nurses and nursing students learning rhythm interpretation.

Ten seconds of this rhythm, from a real recording

111 bpm · 10 seconds · each large grid square is 0.20 seconds. Amplitude is normalised for practice, so the vertical scale is not calibrated millivolts — read rate, regularity, and shape here, not voltage.

What to notice in this strip

The complexes stay regular and narrow; what changes is the spacing — under three large squares between R waves. As the rate climbs, the P wave starts to hide in the preceding T wave.

Counting the rate on a strip like this

The strip above is exactly ten seconds, so counting every QRS complex across it and multiplying by six gives the rate — the method that works whether the rhythm is regular or not. When the rhythm is regular, you can shortcut it: divide 300 by the number of large squares between two R waves.

Rhythms this gets confused with

Known-answer practice — RN PocketPal does not interpret your patient's monitor. To work through strips with the answer revealed after you commit, open Rhythm Practice.

Strip source: MIT-BIH Normal Sinus Rhythm Database v1.0.0, record 16265. Channel 0, 10 s window, resampled to 100 Hz, zero-mean/unit-variance normalized for practice use. Used under the Open Data Commons Attribution License v1.0. Goldberger AL, et al. PhysioBank, PhysioToolkit, and PhysioNet. Circulation. 2000;101(23):e215-e220.

Frequently asked questions

How do I tell sinus tach from SVT?: Sinus tach has visible P waves before each QRS and ramps up; SVT often has hidden or retrograde P waves and onset is abrupt. Rate alone doesn't distinguish — morphology and onset do.
Is sinus tach treated with rate control?: Usually not directly — treat the cause (volume, pain, fever, hypoxia). Slowing a compensatory sinus tach is rarely the right move.
What rate triggers escalation?: Depends on patient and context. A sustained rate > 130–140 in an adult without obvious cause warrants clinician notification.

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Reviewed by RN PocketPal's founding RN. Last reviewed May 8, 2026.