Tachycardia

Question 1

How to differentiate whether
1 tachycardia causes the sxs or
2 symptoms are due to tachycardia

Answer 1

1 >150 BPM

2 <150 BPM probably just a response to physiologic stress like fever or dehydration

Question 2

When should cardioversion for tachycardia be done?

1 Sinus tachycardia as physiologic response 150 and symptomatic and unstable

Answer 2

Only do cardioversion in number 4`

Question 3

What defines an unstable patient?

Answer 3

HASIA
Hypotension
Acutely altered mental status
Shock
Ischemic chest discomfort
Acute heart failure

Question 4

Patients with tachycardia and HASIA should be treated with?

Answer 4

SYNCHRONIZED Cardioversion
If regular 100J
Narrow Irregular 200J mono phasic or biphasic
Wide irregular defibrillation dose unsynchronised shock

Question 5

In a stable patient with tachycardia, when are vagal manoeuvres and B blockers and CCBs considered appropriate?

Answer 5

When QRS is NOT wide

Question 6

How does the uniformity of wide complex ventricular tachycardia differ the interventions required?

Answer 6

Monomorphic: Synchronised cardioversion
Polymorphic: Defibrillation doses of UNSYNCHRONISED SHOCKS

Question 7

When does synchronized cardioversion deliver a shock?

Answer 7

At the peak of the QRS wave

Question 8

What are the indications for synchronised shock?

Answer 8

UNSTABLE
1 SVT
2 a fib
3 a flutter
4 regular monomorphic tachycardia with pulses

Question 9

What are the indications for UNsynchronised shock?

Answer 9

Pulseless px
Polymorphic VT/ severe shock when you think a delay in converting rhythm will result in cardiac arrest
UNSURE whether monomorphic VT or Polymorphic VT is present

Question 10

Why is synchronisation done?

Answer 10

Shocking during the depolarisation phase T wave, may cause ventricular fibrillation

Question 11

What drug can be given for stable tachycardia with regular monomorphic tachycardia

Answer 11

Adenosine

Question 12

In stable narrow complex tachycardia with regular rhythm what initial intervention is recommended?

Answer 12

Vagal maneuvers such as valsavla and carotid sinus massage

–> if no response to vagal manoeuvres –> adenosine 6mg as a rapid IV push over 1s followed by 20ml saline flush

Question 13

When should adenosine doses be lowered to 3mg?

Answer 13

Pxs taking carbamazepine and dipyridamole
Central venous administration
Pxs with transplanted hearts

DO NOT GIVE ADENOSINE TO PXS WITH ASTHMA!

Question 14

If narrow complex tachy regular stable terminates with adenosine it is probably due to?

Answer 14

Supraventricular tachycardia

If it DOES NOT:
atrial flutter
ectopic atrial tachycardia
junctional tanchycardia

Question 15

In treating stable patients with tachycardia is there room for awaiting expert opinion?

Answer 15

YES! The patient is stable!