Tachycardia

Question 1

Broad complex tachycardia is assumed to be ventricular in origin but what else can it be?

Answer 1

Supraventricular rhythm with aberrant conduction e.g. atrial fibrillation with RBBB

Question 2

If patient with any tachycardia has adverse signs signs, what treatment is indicated?

Answer 2

Cardioversion (synchronized DC shock)

Question 3

History of alcohol abuse + torsades de point on ECG- likely diagnosis?

Answer 3

Hypokalaemia

Question 4

Syndrome caused by a congenital accessory conducting pathway between the atria and ventricles, leading to AV re-entry tachycardia

Answer 4

Wolff-Parkinson White syndrome

Question 5

ECG features of WPW? (2)

Answer 5

Short PR interval

Wide QRS with slurred upstroke (delta wave)

Question 6

Which pattern of axis deviation is normally associated with WPW?

Answer 6

Usually LAD

Question 7

Definitive treatment for WPW?

Answer 7

Radiofrequency ablation of the accessory pathway

Question 8

Sudden onset of a narrow complex tachycardia, typically an atrioventricular nodal re-entry tachycardia

Answer 8

Supraventricular tachycardia

Question 9

Acute management of SVT? (3)

Answer 9

Vagal manouevres e.g. Valsalva
Intravenous adenosine
Electrical cardioversion

Question 10

IV adenosine is contraindicated in…

What alternative should be used?

Answer 10

Asthma

Verapamil

Question 11

Dosage of adenosine in SVT?

Answer 11

6mg, then 12mg, then 12mg

Question 12

Management of regular, broad complex tachycardia?

a) adverse signs
b) no adverse signs

Answer 12

a) cardioversion

b) Loading dose of amiodarone followed by 24 hour infusion

Question 13

Broad complex tachycardia with an irregular rhythm is either…

Answer 13

AF with BBB- treat as for narrow complex

Polymorphic VT (e.g. Torsades de point)

Question 14

Treatment of Polymorphic VT

Answer 14

IV magnesium

Question 15

Broad-complex tachycardia originating from a ventricular ectopic focus?

Answer 15

Ventricular tachycardia

Question 16

Why does ventricular tachycardia need to be managed immediately?

Answer 16

Potential to precipitate ventricular fibrillation

Question 17

Two main types of ventricular tachycardia?

Answer 17

Monomorphic VT- usually caused by MI

Polymorphic VT

Question 18

What is torsades de point and what is it usually precipitated by?

Answer 18

Type of polymorphic VT; QT prolongation

Question 19

Inherited condition associated with delayed repolarization of the ventricles?

Answer 19

Long QT syndrome

Question 20

Why is long QT syndrome important to recognise?

Answer 20

May lead to ventricular tachycardia and collapse/sudden death

Question 21

Management of long QT (4)

Answer 21

Avoid drugs which prolong QT
Avoid other precipitants
Beta blockers
ICD

Question 22

Most important metabolic cause of ventricular tachycardia?

Answer 22

Hypokalaemia

Question 23

Medical therapy for WPW syndrome? (3)

Answer 23

Sotalol
Amiodarone
Flecainide

Question 24

Digoxin overdose usually causes what heart arrythmia?

Answer 24

Ventricular tachyardia

Question 25

How is digoxin overdose managed?

Answer 25

Digibind (digoxin antidote)

Question 26

History: syncopal episodes

ECG: biphasic T waves, saddle-shaped ST segments

Answer 26

Brugada syndrome

Question 27

Treatment of Brugada syndrome?

Answer 27

ICD