Tachyarrhythmias & ACLS Flashcards
Ddx of irregular SVT?
AF or MAT is MC. Consider AFlutter.
Ddx of regular SVT?
AVNRT.
AVRT (WPW).
AFlutter.
Consider ectopic atrial tachycardia.
4 different types of AF based on timing?
-Paroxysmal terminates within 1 week with or without intervention.
-Persistent lasts longer than 1 week.
-Long-standing persistent lasts longer than 1 year.
-Permanent is sustained without further attempts at rhythm control.
Treatment of unstable SVT? Be specific.
SYNCHRONIZED cardioversion. Biphasic, 120-200J.
Treatment for AF-RVR with HF?
Amio, digoxin
Treatment for AF-RVR with accessory pathway?
Ibutilide, procainamide. Do not use digoxin, amiodarone, CCBs.
Options for pharmacologic cardioversion of AF?
-Ibutelide (4% risk of Torsades, avoid with HF)
-Amio (less effective)
-Procainamide (even less effective)
Duration of AC after DCCV for AF?
4 weeks. Pretreat with either 3 weeks of DOAC, or with TEE to confirm no thrombus.
Prognosis of post-cardiac surgery AF?
Excellent. 90% self-resolves in 6-8 weeks.
Treatment for MAT (Multifocal Atrial Tachycardia)?
Rate control with BB, CCB, Dig. Rhythm control with procainamide, amio.
-Don’t use DCCV as it is ineffective.
Pathophysiology of AVNRT?
Retrograde conduction pathway in the AV-Node that is faster than the anterograde pathway.
EKG findings of AVNRT?
Short R-P interval and long P-R interval.
Treatment of AVNRT or AVRT?
AV-Node blockers: Adenosine, CCBs, BB.
-Second line is Dig, amio, procainamide.
-Consider A or V Overdrive pacing.
-Vagal maneuvers and DCCV also options.
EKG findings of AVRT?
Delta-wave: slurred up-slope of QRS. AVRT=WPW.
Two types of AVNRT? Which type is more common?
Orthodromic Reciprocating Tachycardia (95%) vs Antidromic.
Tx AVRT?
Avoid AVNodal blockers. Use Procainamide. Consider chemical cardioversion with ibutelide or DCCV.
Definition of fusion / capture beat?
conduction of a sinus beat (usually unexpected sinus beat). Narrow QRS.
QRS durations for LBBB and RBBB?
-LBBB > 160ms.
-RBBB > 140ms.
Clues to diagnose SVT w/ abbarancy (4)?
-Termintes with vagal tone
-Critical rate at which QRS widens (i.e., rate-related BBB)
-Alternating BBB.
-Long-Short Syndrome (AKA Asherman’s Phenemenon) related to R-R distance.
Tx of unstable VT w/ a pulse?
-Regular -> DCCV, 100J
-Irregular -> Defib, 200J
Tx of stable VT w/ a pulse?
(Should this say SVT?)
-Adenosine if regular. Procainamide, amio. Ventricular overdrive pacing.