Tachycardia Flashcards
physical exam for tachycardia
- general: respiratory distress, pain, sweating
- vitals: fever common
- CV: rhythm, murmurs/sounds, JVD
- pulm: auscultate for crackles/wheezes
- Abd: distended or tender
- lymph: enlarged LN
- extremities: clubbing, cyanosis, edem
examples of narrow complex tachycardia
- sinus tach
- AV node re-entrant (AVNRT/SVT)
- AV reciprocating (AVRT) - orthodromic
- multifocal atrial tachycardia (MAT)
- a.fib/flutter
examples od wide complex tachycardia
- AVRT - antidromic (i.e. WPW)
- v tach/fib –> Torsade de Pointe
etiology of sinus tach
- exercise
- pain
- stimulants
- anemia
- anxiety
- vol. depletion
- hypoxia
- hyperthyroidism
- PE
- pericarditis
symptoms of sinus tach
- asx
- heart palpitations
- SOB
- In pts w heart dz: palpitations, SOB, chest discomfort, lightheadedness, fatigue
treatment of sinus tach
- IV fluids
- pain rx
- anticoags
- tx septic source
- anxiolytics
define SVT
- regular, rapid rhythm
- narrow QRS
- no p waves*
examples of SVT
- AVNRT
- AVRT
- junctional tachycardia
etiologies of SVT
- conduction abnormalities
symptoms of SVT
- sudden onset palpitations w/ abrupt cessation
- syncope
- SOB
- anxiety
management of stable SVT
- vagal maneuvers
- carotid massage
- adenosine
- CCB or BB
- ablation for frequent attacks
management of unstable SVT
- vagal maneuvers
- immediate DC cardioversion
MC cause of SVT
AVNRT
describe AVNRT
re-entrant circuit around AV node
What triggers AVNRT?
- exertion
- ETOH
- caffine
describe the HR in AVNRT
- 140-280 bpm
- regular
differentiate the types of AVRT
- narrow QRS = orthodromic; through AV
- wide QRS = antidromic; not through AV ==> ddx w/ vtach
i.e. WPW
tx of stable orthodromic narrow AVRT
- vagal maneuvers
- adenosine
- CCB
- BB
tx of unstable orthodromic AVRT
DC cardioversion
tx of antidromic AVRT
- unstable = DC cardioversion
- stable = procainamide
^^ both subsequently get ablation
tx of antiromic AVRT in a conscious patient
tx like stable vtach
- amiodarone
describe WPW
- pre-excitation syndrome with accessory pathway
- symptomatic
- most commonly PSVT
- w/ a.fib –> rapid ventricular respiration –> v. fib –> death
- delta waves w/ decr PR interval
management of normal rate and stable WPW
- ablation
- BB, adenosine, procainmide, amiodarone
management of fast rate WPW
- unstable = DC cardioversion
- stable = procainamide
^^ both eventually get ablation
describe MAT
- 3+ different p wave morphologies
- 100-150bpm
ddx:
treatment of MAT
- CCB
- flecainide or propafenone
describe sustained vtach
- fast, wide complex rhythm
- > 30s duration
- with structural heart disease
- syncope
- 3+ consecutive ventricular premature beats
- 160-240bpm, moderately regular
- frequent complication of MI & dilated cardiomyopathy
symptoms of vtach
- asx (rare)
- palpitations
- sense of impending doom
- chest discomfort
- SOB, diaphoresis, syncope
- LOC
treatment of vtach
- w/pulse = DC cardioversion, amiodarone, implantable cardioverter-defibrillator (ICD)
- w/o pulse = ACLS
describe NSVT
- 3+ consecutive ventricular beats
- ## rate > 120bpm
treatment of NSVT
- infrequent = optimize electrolytes, BB, manage underlying
- frequent = amiodarone
describe Torsades de Pointe
- triggered by hypoK, hypoMg, + drugs that prolong QTc (i.e. antiarrhythmics, abx, antipsychotics, antidepressants
treatment of Torsades de Pointe
- unstable = DC cardioversion
- stable = IV Mg
describe v.fib
- low amplitude on EKG
- associated w/ CAD and MI
- sudden death may be initial (and only!) manifestation of coronary dz
- pulseless and unresponsive
treatment of v.fib
- CPR
- defibrillation
- arteriography
- ICD
