SVT, VT Flashcards
SVT
Young, no heart defects
ECG:
No p wave
Narrow QRS
Regular rhythm
PSVT - characteristic copious urine passage
Mx of SVT
- Vagal stimulation
- Adenosine-1st line(breaks down fast)
6mg over first 10secs
12mg over 2 mins
18mg over 2 mins - Verapamil - 2nd line
5-10mg over 2 mins
Repeat after 30mins - Metaprolol - 2nd line
2.5-5mg over 2mins
Repeat in 10 mins - DC cardioversion - unstable pt
- Overdrive pacemaker
C/I of adenosine
- Asthma
Causes bronchospasm - COPD
- Heart failure
- Heart block
- Severe hypotension
Which SVT drug is better in a hypotensive pt?
Adenosine»_space; verapamil
(adenosine causes lesser hypotension comparetively)
Avoid verapamil in which cases
- When using B-blockers
- Wider QRS (>0.14sec or >3small sq)
Drugs for SVT maintenance
B-blockers - 1st line
Add Flecanide (anti-arrhythmatic)
Curative rx for SVT
Radiofrequency catheter ablation
Underlying causes of AF
- MI
- Thyrotoxicosis
- HTN
- Mitral valve disease
- Pericarditis
- DM
- Chronic alcohol dependence- cardiomyopathy
- Alcohol binge
Mx of atrial fibrillation/flutter
ECH and TFT(thyroid)
Unstable - DC shock, Overdrive pacemaker
Stable:
B-blocker, CCB …
Rhythm control - Sotalol, flecainide, Amiodarone
Thromboembolism - CHA2DS2 VASc score
ECG in VT
- Wide QRS
- No p wave
- *Regular rhythm
(Irregular in VF)
Types of VT
- MONOMORPHIC - Re-enrant/single focal VT
- POLYMORPHIC- Focal (multiple) VT
D/t:
Drugs
Electrolyte imbalance
Ischemia
Torsades de pointes
Polymorphic VT
Looks like its twisted around itself
Regular rhythm
ECG in VF
- Extremely irregular rhythm
- No p wave
- HR: 300-600
Mx of VT/VF
No pulse - VF -Defibrillation
Pulse+
Stable pt - Amiodarone
Unstable pt - DC cardioversion
Mx of torsades de pointes
MgSO4 (1st line)
If not better
Isoproterenol/Lidocaine (2nd line)
Pulseless arrest algorithm
No pulse - start CPR
●Shockable (VF/VT)..
1 Shock..
CPR x 5cycles
VF/VT+
1Shock
CPR x5cycles
+ Epinephrine 1mg every 2-3min
(OR) Vasopressin 40U
VF/VT+
1 Shock
CPR x5 cycles
+ Amiodarone/lidocaine
+MgSo4 if Torsades de pointes+
●Non shockable (asystole/PEA)
CPR x5cycles
+ IV Epinephrine 1mg
(OR) IV Vasopressin 40U
CPR x5…
Repeat
WPW syndrome
ECG: Delta wave, wide QRS, tachy
Rx: Amiodarone
C/I: BB, CCB, adenosine, digoxin
