Tachycardia resident survival guide: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 55: Line 55:
{{familytree | | | G01 | | | | | | | G01=Check duration of QRS }}
{{familytree | | | G01 | | | | | | | G01=Check duration of QRS }}
{{familytree | |,|-|^|.| | | | | | | | | | }}
{{familytree | |,|-|^|.| | | | | | | | | | }}
{{familytree | H01 | | H02 | | | | | | | | | H01=[[Wide complex tachycardia|QRS wider than 0.12 seconds]]| H02=[[Narrow complex tachycardia|QRS narrower than 0.12]]}}
{{familytree | H01 | | H02 | | | | | | | | | H01=[[Wide complex tachycardia|QRS wider than 0.12 seconds]]| H02=[[Narrow complex tachycardia|QRS narrower than 0.12 seconds]]}}
{{familytree | |!| | | |!| | | | | | | | | | | }}
{{familytree | |!| | | |!| | | | | | | | | | | }}
{{familytree | I01 | | I02 | | | | | | | | I01=Consider expert consultation <br> Consider antiarrhythmic infusion <br> Consider adenosine only if monomorphic and regular| I02=Vagal maneuvers <br> Beta-Blockers or calcium channel blocker <br> Consider expert consultation <br> Adenosine if regular}}
{{familytree | I01 | | I02 | | | | | | | | I01=Consider expert consultation <br> Consider antiarrhythmic infusion <br> Consider adenosine only if monomorphic and regular| I02=Vagal maneuvers <br> Beta-Blockers or calcium channel blocker <br> Consider expert consultation <br> Adenosine if regular}}

Revision as of 20:32, 2 March 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: M.Umer Tariq [2]; Priyamvada Singh, M.D. [3]

Tachycardia resident survival guide Microchapters
Overview
Classification
Causes
FIRE
Diagnosis
Treatment
Do's
Dont's

Overview

Tachycardia is a form of cardiac arrhythmia which refers to a rapid beating of the heart. By convention the term refers to heart rates greater than 100 beats per minute in the adult patient. Heart rate typically greater than 150 beats per minute in tachyarrhythmia.[1]

Classification

 
 
 
 
 
 
 
 
 
 
 
Tachycardia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Narrow complex tachycardia (SVT)
 
 
 
 
 
 
 
 
 
 
 
Wide complex tachycardia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The origin of the impulse:
Atria
 
 
 
The origin of the impulse:
AV junction
 
The origin of the impulse:
Atria or AV junction
 
The origin of the impulse:
AV junction
 
The origin of the impulse:
Atria, AV junction or ventricles

Presence of an accessory pathway
 
The origin of the impulse:
Pacemaker
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Atrial fibrillation
Atrial flutter
Ectopic atrial rhythm
Multifocal atrial tachycardia (MAT)
Paroxysmal atrial tachycardia (PAT) with block
Premature atrial contractions (PAC)
Sinus tachycardia
Wandering atrial pacemaker
Sick sinus syndrome
 
AVNRT

AVRT (accessory pathway):
- Wolff-Parkinson-White syndrome (WPW)
- Lown-Ganong-Levine syndrome (LGL)
 
Accelerated junctional rhythm
 
SVTAC
(SVT with aberrant conduction):

Left bundle branch block
Left anterior hemi-block
Lefo posterior hemi-block
Right bundle branch block
Trifascicular block
 
Ventricular tachycardia
Ventricular fibrillation
Ventricular parasystole
 
Wolff-Parkinson-White syndrome (WPW)
Lown-Ganong-Levine syndrome (LGL)
 
Pacemaker-mediated tachycardia
Runaway pacemaker syndrome
Sensor induced tachycardia

Algorithm based on the 2003 ACLS guidelines for the management of tachycardia.[2]

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.

 
 
 
 
 
 
 
Tachycardia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pulse
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No Pulse
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Proceed to ACLS Cardiac Arrest Algorithm
 
 
 
 
 
 
 
Evaluate and treat instability:
12-lead ECG, don't delay therapy
IV/IO access
Ventilation
Oxygenation (if hypoxemic provide supplementary oxygen)
Heart rate
Blood pressure
Acute altered mental status
Signs of shock
Ischemic chest discomfort
Acute heart failure
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hemodynamic stable
 
 
 
 
 
 
 
Hemodynamic unstable
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Synchronized cardioversion:
Consider sedation
If regular narrow complex, consider adenosine
 
 
 
 
 
 
 
Doses/details of synchronized cardioversion:
Narrow regular: 50-100 Joule
Narrow irregular: 120-200 Joule biphasic or 200 Joule monophasic
wide regular 100 Joule
Wide irregular: defibrillation dose (Not synchronized)
Adenosine IV dose:
First dose: 6mg rapid IV push; follow with NS flush
Second dose: 12mg if required
 
 
 
 
 
 
 
 
 
Check duration of QRS
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
QRS wider than 0.12 seconds
 
QRS narrower than 0.12 seconds
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider expert consultation
Consider antiarrhythmic infusion
Consider adenosine only if monomorphic and regular
 
Vagal maneuvers
Beta-Blockers or calcium channel blocker
Consider expert consultation
Adenosine if regular
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Antiarrhythmic infusion for stable wide-QRS tachycardia:
Procainamide IV Dose:
20-50mg/min until arrhythmia suppressed, hypotension ensues, QRS duration increases 50%, or maximum dose 17mg/kg given. Maintenance infusion: 1-4 mg/min. Avoid if prolonged QT or CHF.
Amiodaron IV Dose:
First dose: 150mg over 10 minutes. Repeat as needed if VT recurs. Follow by maintenance infusion by 1mg/min for first 6 hours.
Sotalol IV Dose:
100mg (1.5mg/kg) over 5 minutes. Avoid if prolonged QT.
 
 
 
 
 
 
 
 
 
 

Algorithm based on the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.[3]

References

  1. Neumar, Robert W.; Otto, Charles W.; Link, Mark S.; Kronick, Steven L.; Shuster, Michael; Callaway, Clifton W.; Kudenchuk, Peter J.; Ornato, Joseph P.; McNally, Bryan; Silvers, Scott M.; Passman, Rod S.; White, Roger D.; Hess, Erik P.; Tang, Wanchun; Davis, Daniel; Sinz, Elizabeth; Morrison, Laurie J. (2010-11-02). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): –729-767. doi:10.1161/CIRCULATIONAHA.110.970988. ISSN 1524-4539. PMID 20956224.
  2. Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ; et al. (2003). "ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society". J Am Coll Cardiol. 42 (8): 1493–531. PMID 14563598.
  3. Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW; et al. (2010). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S729–67. doi:10.1161/CIRCULATIONAHA.110.970988. PMID 20956224.