Arrythmias

Question 1

Define supraventricular tachycardia

Answer 1

A narrow complex tachycardia (arises above the level of the bundle of his)

Question 2

Define ventricular tachycardia

Answer 2

Broad qrs complex tachycardias that originate below the bundle of his

Question 3

Key ecg findings for Monomorphic VT

Answer 3

• QRS complex shape is consistent in each lead

- regular rhythm

Question 4

Key ecg findings for Polymorphic VT

Answer 4

Can resemble VF but there is a pulse present

QRS morphology changes from beat to beat

Question 5

Management of VT

Answer 5

Prepare for arrest
Blue call
Pain relief if needed
Raise legs if hypotension but don’t give fluid

Question 6

Associated symptoms to VT

Answer 6

Hypotension
Tloc
Tachycardia

Question 7

Polymorphic VT- Key ecg findings for Torsades de Pointes

Answer 7

Qrs complexes that ‘twist’ around the isoelectric line

Resembles audio wave shaping (a pattern of large then small heigh complexes)

Question 8

Key ecg findings for AVNRT (svt)

Answer 8

No clear P waves

Qrs shape is normal to sinus rhythm but complexes are narrow (unless there is also a block)

Question 9

Explain patho for AVNRT

Answer 9

there are two pathrways that run through the AV node that have different refractory periods.

These can stimulate each other to set off, causing a loop within the AV node and down to the ventricles at a much faster rate.

Question 10

Associated symptoms of SVT

Answer 10

Sudden onset of rapid palpitations
breathlessness
light-headedness
Hypotension 
TLOC

Question 11

How to manage SVT

Answer 11

Valsalva manoeuvre:

Pinch your nose closed, close your mouth and try to exhale as if inflating a balloon. Bear down as if you’re having a bowel movement.

Do this for 15 seconds.

Once completed lay patient down with legs in the air for 45 seconds.

OR.

Pt supine and blow into a 20 ml syringe to push the plunger

Question 12

Key ecg findings for AVRT (svt)

Answer 12

A retrograde (pointed) P wave that shortly follows the QRS

The QRS shape is the same as normal sinus rhythm

Question 13

Explain patho for AVRT

Answer 13

There are two pathways (normal av and accessory)

The electrical activity can pass from the AV node through the accessory or back up it from or to the ventricles

Question 14

Wolff-Parkinson white syndrome (a form of AVRT): explain patho

Answer 14

The accessory pathway can cause impulses to travel towards the ventricles or away from them (towards the atria) or in both directions creating the ‘bundle of kent’

Question 15

Key ecg findings for WPW

Answer 15

Short PR interval 
A delta (slurred) initial portion of QRS
Broad QRS