Tachyarrhythmias

Question 1

What is the management of unstable tachyarrhythmia?

Answer 1

1) Synchronised DC cardioversion- up to 3 attempts
2) If unsuccessful then amiodarone 300mg over 20 mins and repeat shock

Question 2

What is the management of stable tachyarrythmia?

Answer 2

1) Differentiate between broad and narrow complex

Question 3

What is the management of narrow complex tachycardia?

Answer 3

QRS <120ms

Irregular?
- likely AF trial BB or RR CCB
- Consider Amiodarone or digoxin if signs of HF

Regular (SVT)
1) Vagal maneouvres
2) Adenosine 6mg
3) Adenosine 12mg
4) Adenosine 18mg
5) Verapamil or BB

Question 4

What is the management of broad complex tachycardia?

Answer 4

Irregular
- probably AF with bundle branch block
- BB or RL-CCB

Regular
- VT with pulse
- Amiodarone 300mg over 10-60mins
- if ineffective then synchronised DC cardioversion

Question 5

What is Atrial Flutter?

Answer 5

Rapid succession of atrial depolarisation (sawtooth on ECG)

Management
1) Rate control- BB or RL-CCB
2) Anticoagulation as per AF
3) Definitive management- radiofrequency ablation

Question 6

What is multifocal atrial tachycardia?

Answer 6

Irregular tachycardia caused by impulses generating from 3 or more different sites

Treat with RL-CCB

Question 7

What is Torsades Des Pointes?

Answer 7

Following severe Qt prolongation leading to tachycardia

ECG
- rapid irregular QRS complexes

Question 8

What are the causes of torsades des pointes?

Answer 8

Inherited cardiac disease
Drugs e.g. erythromycin, TCAs, Chloroquine
Electrolyte abnormalities e.g. hypocalcaemia, hypokalaemia, hypomagnesia

Treat with 2g MgSO4 push

Question 9

What is the management of WPW?

Answer 9

Radiofrequency ablation of accessory pathway