Tachyarrhythmia Flashcards
Supraventricular Tachycardia (SVT)
HR 150 to 250
> Many forms of Arrythmias
- Originate Above the Ventricles
< Occurs somewhere in Atrial and AV node
> SVT — No heart conditions
> Afib —– with heart conditions
SVT
Narrow QRS
Ventricular Activation over Purkinje System
SVT : QRS Wide
> Conduction block in Left or Right Bundle Branch
Activation of ventricles from Accessory pathway
Important to destinquish bw SVT and vT
Sustain VS Non sustained
Non-Sustained short duration
Sustained requires interverntion like cardioversion
Paryxysmal SVT
> ** Episodes sudden onset and termination **
Family of Tachycardia
NO Heart diseases
Afib _ Does HAVE Heart Disease
Sinus Tachycardia
Most common type of SVT
HR 100-150
Response to physiologic stress
**Mechanisms of SVT **
- Physiologic VS Pathologic
**Physiologic **
> Precipitating mechanisms
> Exertion, Stress, or Concurrent Illness **
**Pathologic **
> Subclassification in terms of mechanism
- Reentrant arrhythias
- Large reentry citcuits
- Focal atrial tachycardia
SVT
Risk Factors
> age
CAD
smoking, nicotine, drugs
Imbalance thyroid
DM
Anxiety, or emotional distress
SVT
Signs and Symptoms
> Variable and dependent
- Rate, duration, association heart disease, comorbidities
- Palpitations
- chest pain
- dyspnea
- dinished exertional capacity
- syncope
- Cardiac Arrest —— > Rare
SVT Evaluation
> ** Determined by the type of Arrhythmia **
- Transient Arrhythmias : Ambulatory ECG
-
**Electrophysiology study **
- Confirm mechanism
** Screen for heart disesase **
- SVT No heart disease
- Afib does
SVT > Diagnosis
EKG at the time of the symptoms
Establisheds DX
SVT
Treatment Plan
**Intial Assessment **
- Determine type of Rhythm
- Is immediate therapy needed
-** Electrophysiology STudy **
- Provoke arrhythmia
- Confirming mechanism: Catheter Ablation
- Terminate Arrythmia
**A-fib **
- Evaluation wiht H and P
- Underlying Heart disease
- Cardiac Evaluation : Potential catherirization
Sinus Tachycardia
HR > 100 bpm
- Sympathetic Stimulation and Vagal withdrawal
- Spontaneous depolarization sinus notde Increase
- Rate Increases
- EArliers Activation Shifts Leftward
Produces Taller P waves
Inferior Limb leads
Phydilogic VS NonPhysiologic
< Physiologic >
**Appropriate response **
- Exercies, stress, or Illness
Physiologic VS Nonphysiologic
< Nonphysiologic >
> Inappropriate reate increase
Out of proportion to physiologic stress or exertion
out of propotion increase from just walking
ST: Clinical Findings
**Causes and Risk Factors **
women in 3rd and 4th decade of life
CAd
Exercise
Acute illness
Hypovolemia*
Hyperthyroidism*
Pulnonary insufficiency*
Drugs (albuterol, Hydralizine )
Pneochromocytoma
ST : Clinical Findings
Sign and symptoms
Fatique
dizziness
Dyncope
Palpitations
chest pain
HA
GI Upset *
**ST : **
Physiologic and Nonphysiologic
Dx and treatment
DX: Based on EKG findigns; determine cause
**TX: **tx underlying Cause
* Pharmacologic Interventions : Not always toleratin
* Invasive : Catheter Ablraion
Postural Orthostatic
Tachycardia Syndrome (PODS )
Symptomatic ST to
Postural Change (Supine TO Stand )
PODS
Cause
Consider Automic Dysfunctin
Following Viral Illness
May resolve Spontenious BUT
Take time : 3 to 12 month
PODS
DX
> POstrural change
- Sinus rate increases
- Increases 30 bpm or > 120bpm
- After 10 mints of standing
- Absent Hypotension
PODS > Treatent
- Volume Expansion
- Salt supplementations
- Fludrocortisone PO
- Compression stockings
- Alpha Agonist (midodrine )
- Exercise Traning
Focal Atrial Tachycardia
**Elecrical Abnormality **
> Abnormal Automaticity
> Triggered automaticity
> Small rentry circuit
> Sustained vs non - sutained
Focal ATrial Tachycardia
Non -Sustained
Observed on a 24-hours ECG recoding
Prevalence increases in age
Precursors for Afib /flutter
Absence of structural heart disease
Associated with Atrial fibrosis after cardiac catheter
1:1 contuction to Ventricles
Resele sinus Tachycardia
PR interval shorter then RP interval
Distinguished by P wave morphology
Focal ATricla Tachycadia
P wave morphalpy determien when ST will be
**AT from Atrial Septum **
> Narrowed P wave duratin than NSR
**AT from Left Atrium **
> Monophasic
> Postive P wave V1
> Negative P waves leads I and avL
> Movemet away left atrial free wall
**Superiror **
+P II III aVF
Inferior **
- P II III aVF
AT cristal terminalis : ST
Multifocal Atrial Tachycardia
> 3 or more
Irregualr and multiple P wave morphalogy
Easy get confused wit Atrial fibrillation
Paroxysmal SVT
> **Short Circuit Rhythm **
- Upper cardiac chamber
- Impulse travels throught extra pathway
EKG
- Impulse travels quickly around heart
- Regular but rapid HR
- starts and stops abruptly
- Re-entry tachycardia or SVT
Atrioventicular Nodal Reentry Tachycardia
Overview
Most common form Proxysmal sVT
2nd and 4th decade
W>M
Not fully associate structural heart disease
Arioventicular Nodal Reentry Tac
ANRT
Depends of Severity and Tx
**Acute **
> Depends of severity and freqeuncy
Valsalva Maneuver
BBB or CCB
Ebstein’s anomaly
Rare heart defectc of Tricuspid Valve not formed properly
PRKAG 2 Mutations
Glucogen accumulatio in cardiac tissue
Hypetrophic cardimyopathy
Conduction abnormalities
Danon’s Disease
> Genetic Condition
Cardimyopaty/Skeletal muscles myopathy
Intellectual disabilty
Fabry’s disease
Buildup of particular type of fat
Progressive kidney damage /AMI /Stroke
