Tachycardia resident survival guide

Revision as of 17:08, 2 March 2015 by Steven Bellm (talk | contribs)
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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.

[3]}
 
 
 
 
 
 
 
Tachycardia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pulse
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No Pulse
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ACLS
 
 
 
 
 
 
 
Evaluate and treat instability:
12-lead ECG, don't delay therapy
IV/IO access
Ventilation
Oxygenation
Heart rate
Blood pressure
Acute altered mental status
Signs of shock
Ischemic chest discomfort
Acute heart failure
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hemodynamicaly stable
 
 
 
 
 
 
 
Hemodynamicaly unstable
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Synchronized cardioversion:
Consider sedation
If regular narrow complex, consider adenosine
 
 
Check width of QRS
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
QRS
 
{{{ H02 }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
F01
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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.