SVT, VT

Question 1

SVT

Answer 1

Young, no heart defects

ECG:
No p wave
Narrow QRS
Regular rhythm

PSVT - characteristic copious urine passage

Question 2

Mx of SVT

Answer 2

1. Vagal stimulation
2. Adenosine-1st line(breaks down fast)
   6mg over first 10secs
   12mg over 2 mins
   18mg over 2 mins
3. Verapamil - 2nd line
   5-10mg over 2 mins
   Repeat after 30mins
4. Metaprolol - 2nd line
   2.5-5mg over 2mins
   Repeat in 10 mins
5. DC cardioversion - unstable pt
6. Overdrive pacemaker

Question 3

C/I of adenosine

Answer 3

1. Asthma
   Causes bronchospasm
2. COPD
3. Heart failure
4. Heart block
5. Severe hypotension

Question 4

Which SVT drug is better in a hypotensive pt?

Answer 4

Adenosine&raquo_space; verapamil

(adenosine causes lesser hypotension comparetively)

Question 5

Avoid verapamil in which cases

Answer 5

1. When using B-blockers
2. Wider QRS (>0.14sec or >3small sq)

Question 6

Drugs for SVT maintenance

Answer 6

B-blockers - 1st line

Add Flecanide (anti-arrhythmatic)

Question 7

Curative rx for SVT

Answer 7

Radiofrequency catheter ablation

Question 8

Underlying causes of AF

Answer 8

1. MI
2. Thyrotoxicosis
3. HTN
4. Mitral valve disease
5. Pericarditis
6. DM
7. Chronic alcohol dependence- cardiomyopathy
8. Alcohol binge

Question 9

Mx of atrial fibrillation/flutter

Answer 9

ECH and TFT(thyroid)

Unstable - DC shock, Overdrive pacemaker

Stable:
B-blocker, CCB …
Rhythm control - Sotalol, flecainide, Amiodarone

Thromboembolism - CHA2DS2 VASc score

Question 10

ECG in VT

Answer 10

1. Wide QRS
2. No p wave
3. *Regular rhythm

(Irregular in VF)

Question 11

Types of VT

Answer 11

1. MONOMORPHIC - Re-enrant/single focal VT
2. POLYMORPHIC- Focal (multiple) VT

D/t:
Drugs
Electrolyte imbalance
Ischemia

Question 12

Torsades de pointes

Answer 12

Polymorphic VT
Looks like its twisted around itself
Regular rhythm

Question 13

ECG in VF

Answer 13

1. Extremely irregular rhythm
2. No p wave
3. HR: 300-600

Question 14

Mx of VT/VF

Answer 14

No pulse - VF -Defibrillation

Pulse+
Stable pt - Amiodarone
Unstable pt - DC cardioversion

Question 15

Mx of torsades de pointes

Answer 15

MgSO4 (1st line)

If not better

Isoproterenol/Lidocaine (2nd line)

Question 16

Pulseless arrest algorithm

Answer 16

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

Question 17

WPW syndrome

Answer 17

ECG: Delta wave, wide QRS, tachy
Rx: Amiodarone

C/I: BB, CCB, adenosine, digoxin