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Clinical Medicine > Tachycardia > Flashcards

Tachycardia Flashcards

1
Q

Name four examples of Narrow Complex Tachycardia?

A
  • Sinus tachycardia
  • Supraventricular tachycardia
  • Atrial fibrillation
  • Atrial flutter
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2
Q

Name two examples of Wide Complex Tachycardia?

A
  • Ventricular tachycardia

- Ventricular fibrillation

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3
Q

Name at least 8 Etiologies of Sinus Tachycardia?

A
  • Exercise
  • Anxiety
  • Pain
  • Exposure to stimulants (caffeine)
  • Volume depletion
  • Anemia
  • Hypoxia (low systemic oxygen)
  • Hyperthyroidism
  • Pulmonary embolism
  • Pericarditis
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4
Q

Symptoms of Sinus Tachycardia?

A
  • Asymptomatic
  • Heart palpitations
  • Shortness of breath

patients with heart disease (coronary artery disease):

  • Heart palpitations
  • Shortness of breath
  • Chest discomfort
  • Lightheadedness
  • Fatigue
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5
Q

Treatment for Sinus Tachycardia?

A

No specific treatment for:

  • Dehydration – IV fluid
  • Pain – pain medication
  • Pulmonary embolism – anticoagulation
  • Sepsis – treat source (i.e pneumonia– antibiotics)
  • Anxiety – consider anxiolytics
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6
Q

Supraventricular Tachycardia?

A
  • Regular, rapid rhythm
  • Narrow complex (originates above the ventricle)
  • No discernible p waves
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7
Q

Symptoms of SVT?

A

-Sudden onset racing heart (palpitations)
-Lightheadedness, pre-syncope, syncope
-Shortness of breath
-Anxiety
-If underlying heart disease; chest pain or pressure
Often self limiting, ends abruptly as well

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8
Q

Management of persistent SVT on stable patient?

A
  • Vagal maneuvers
  • Carotid massage (listen for bruit- risk of stroke esp >50yrs)
  • Adenosine (initial dose 6mg IVP, then 12mg IVP, then 12mg IVP)
  • Calcium channel blocker or beta-blocker
  • For patients with frequent attacks – consult electrophysiology cardiologist (EP), -> confirm aberrant pathway, -> radiofrequency catheter ablation
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9
Q

Management of persistent SVT on unstable patient?

A

vagal maneuvers, then if unsuccessful immediate DC cardioversion

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10
Q

Direct Current (DC) Cardioversion?

A
  • Medical procedure which converts cardiac arrhythmia to normal sinus rhythm using electricity
  • Two electrode pads are placed on the patient (chest & back), Electrode pads are connected to a machine via cables, The cardioverter delivers a shock which causes momentary depolarization of most cardiac cells allowing the sinus node to resume normal pacemaker activity.
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11
Q

Sustained Ventricular Tachycardia?

A
  • Life threatening
  • Fast, wide complex rhythm
  • Frequently associated with syncope
  • Usual rate ~ 160-240bpm
  • Duration of at least 30 seconds
  • Frequent complication of myocardial infarction & dilated cardiomyopathy
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12
Q

Symptoms of Sustained Ventricular Tachycardia?

A
  • Heart palpitations
  • Lightheadedness
  • Chest pain
  • Short of breath
  • Diaphoresis (drenching sweat)
  • Near syncope
  • Syncope
  • Sustained loss of consciousness
  • Pulseless (death)
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13
Q

Treatment of acute ventricular tachycardia if pulse is present?

A
  • If v-tach causes hypotension, heart failure, myocardial ischemia then synchronized DC cardioversion
  • If the patient is stable then Amiodarone 150mg IV bolus followed by continuous infusion
  • Implantable cardioverter-defibrillator (ICDs)
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14
Q

Treatment of acute ventricular tachycardia if pulseless is present?

A
  • CPR
  • Defibrillation
  • Epinephrine
  • ICD
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15
Q

Torsades de pointes (type of vtach)?

A

Triggered by hypokalemia, hypomagnesemia, drugs that prolong the QTc

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16
Q

Medications that prolong QTc?

A
  • Antiarrhythmic agents
  • Antipsychotics
  • Antibiotics
  • Antidepressants
17
Q

Antiarrhythmic agents?

A
  • Amiodarone
  • Flecainide
  • Sotalol
18
Q

Antipsychotics?

A
  • Chlorpromazine
  • Haloperidol
  • Olanzapine
  • Quetiapine
  • Risperidone
19
Q

Antibiotics?

A
  • Macrolides (Azithromycin)

- Quinolones (Levofloxacin, Ciprofloxacin)

20
Q

Antidepressants?

A
  • Citalopram

- Tricyclic antidepressants

21
Q

Treatment for Torsade de Pointe?

A

-Unstable patients: prompt defibrillation

-Stable patients: Intravenous magnesium (first line),
Temporary transvenous overdrive pacing if no response to magnesium

22
Q

Ventricular Fibrillation?

A
  • Often associated with severe coronary artery disease (CAD) and caused by acute MI (ACS)
  • Sudden death may be initial manifestation of coronary disease in 20% of patients
  • Patients are pulseless & unresponsive
23
Q

Causes of Ventricular Fibrillation?

A
  • Myocardial ischemia and infarction
  • Heart Failure
  • Hypoxemia or hypercapnia
  • Hypotension/shock
  • Electrolyte imbalances
  • Stimulants (drugs, caffeine)
  • Often preceded by Vtach
24
Q

Treatment for ventricular fibrillation?

A
  • CPR
  • Defibrillation
  • if pulse regained then coronary arteriography (cardiac catheterization) to view and treat coronary artery disease
  • Implantable cardioverter-defibrillator for long-term management

Clinical Medicine (23 decks)

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