Narrow Complex Tachy

Question 1

A flutter vs A tach

Answer 1

if AV nodal block, Flutter is >250, a tach is

Question 2

P lost in QRS or pseudo S wave in II aVF =

Answer 2

AVNRT

Question 3

P wave before QRS =

Answer 3

AT

Question 4

P wave after QRS

Answer 4

OAVRT

Question 5

Tx AVRNT

Answer 5

Vagal
Adenosine 6mg followed by flush
run 12lead rhythm strip during attempts

Question 6

OAVRT findings

Answer 6

P wave after QRS

Electrical alternans

Question 7

Tx OAVRT

Answer 7

Vagal maneuvers or adenosine (except if a fib)

avoid BB, CCB, digoxin

Question 8

A tach tx

Answer 8

adenosine creates block that might help Dx
slow rate with BB or CCB
Terminate with sync cardioversion

Question 9

findings + tx accelerated jxnl rhythm

Answer 9

dig tox
rate 70-130
no p waves
may have regularized a fib
often stable
Tx: admit to tele, hold Dig

Question 10

A flutter findings

Answer 10

Twin peaks in AVR, valleys in II,

saw tooth best seen in II III avF and V1

Question 11

A flutter tx

Answer 11

• slow rate by increasing block (esmolol boluls +drip, metropolol 5mg IV q 5min up to x4)
• Dilt IVB+drip 0.25mg/kg then 5-15mg/min
• Dig if hypotensive or poor EF
• shock if

Question 12

multi focal a tach findings

Answer 12

x2 pwave morphologies + PR intervals

regular 100-180

Question 13

Tx multifocal atach

Answer 13

treat COPD, stop theophyline
slow with CCB
cannot shock