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Revision as of 20:12, 25 March 2014 by Amr Marawan (talk | contribs)
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Characterize the symptoms:
❑ Asymptomatic PalpitationsDyspnea
Fatigue Chest discomfort Lightheadedness
Syncope Polyuria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Differential Diagnosis
AV nodal reentrant tachycardia (AVNRT)
Atrioventricular reentrant tachycardia (AVRT)
❑ Junctional tachycardia
Sinus tachycardia
❑ Inappropriate sinus tachycardia
Sinus node re-entry tachycardia
❑ Intraatrial reentrant tachycardia (IART)
❑ Atrial tachycardia
Multifocal atrial tachycardia
Atrial fibrillation
Atrial flutter

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Examine the patient:


General appearance
❑ Diaphoretic
❑ ill-appearing


Vitals
Pulse

❑ Rate
Tachycardia
❑ Rhythm
❑ Regular
❑ Irregularly irregular
❑ Strength
❑ Weak
❑ Alternating in strength

Respiration

Tachypnea

Blood pressure

Hypotension (due to decreased ventricular filling)

Skin
❑ Inspection

Pallor

Neck

❑ Elevated jugular venous pressure

Cardiovascular examination
❑ Auscultation

Heart sounds: showing rapid regualr or irregular pulse, depending on the type of arrhythmia and might be asscoiated with murmurs if there is an underlying cardiac disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Assess hemodynamic stability

❑ Order and monitor the ECG
❑ Assess and support airway, breathing and circulation (ABC)
❑ Give oxygen if needed

❑ Monitor the blood pressure
❑ Monitor the heart rate
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Unstable patient
 
 
 
 
 
 
❑ Stable patient
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If the rythm isn't a sinus tachycardia:
Urgent cardioversion
 
If the rythm is a sinus tachycardia:
Focus your treatment on the underlying condition. If it is due to cardiac ischemia or aortic stenosis, control haert rate by IV metoprolol at the rate of 5mg/2 minutes till full control or till the maximum of 15 mg, thenshift to oral regimen. Don't adminster beta blockers if the patient has significant bradycardia (<50 bpm)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Documented arrhythmia
 
 
 
 
 
Undocumented arrhythmia
(ECG is normal)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Unstable patient
 
Stable patient
 
History suggestive of extra premature beats

❑ Sensation of a pause followed by a strong heart beat OR

❑ Irregularities in heart rhythm
 
History suggestive of paroxysmal arrhythmia

❑ Regular palpitations with sudden onset and termination

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Immediate direct current cardioversion
 
❑ Confirm diagnosis of narrow QRS complex tachycardia
❑ Identify and treat SVT
 
Rule out the following:
Caffeine
Alcohol
Nicotine
Recreational drugs
Hyperthyroidism
 
❑ Refer for an invasive electrophysiological study AND/OR
Catheter ablation
❑ Educate about vagal maneuvers
❑ Consider beta blocker
 


Differential Diagnosis

Type of Arrhythmia Clues
Supraventricular tachycardia Any tachyarrhythmia that is initiated and maintained in atrial tissue or atrioventricular junctional tissue.[1]
Sinus tachycardia Rhythm with heart rate > 100 bpm, originating in SA node due to its increased automaticity.
Sinus node re-entry tachycardia Rare paroxysmal tachycardia arising due to re-entry circuits with in SA node.[2]
Atrial fibrillation Supraventricular tachycardia with irregularly irregular rhythm and absent P waves on EKG.
Atrial flutter Cardiac rhythm characterized by an atrial rate ranging from 240 to 400 beats per minute and regular continuous wave-form.[3]
AVNRT Most common form of PSVT with a heart rate of 140-250 bpm, re-entrant circuit involves two separate anatomical pathways (slow and fast) loacted in perinodal tissue.
AVRT Re-entrant tachycardia occurring due to an accessory pathway in addition to AV node, accessory pathway is essential for the initiation and the maintenance of tachycardia.
Focal atrial tachycardia Focal atria tachycardia refers to a rhythm originating from a single site either in the left or right atrium with an atrial rate of 100-250 bpm.
Nonparoxysmal junctional tachycardia Benign tachycardia occurring due to increased automaticity arising from a high junctional focus.
Multifocal atrial tachycardia Irregular tachycardia characterized by 3 different P wave morphologies on EKG.

References

  1. "ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary". Retrieved 15 August 2013.
  2. Cossú, SF.; Steinberg, JS. "Supraventricular tachyarrhythmias involving the sinus node: clinical and electrophysiologic characteristics". Prog Cardiovasc Dis. 41 (1): 51–63. PMID 9717859.
  3. Dhar S, Lidhoo P, Koul D, Dhar S, Bakhshi M, Deger FT (2009). "Current concepts and management strategies in atrial flutter". South. Med. J. 102 (9): 917–22. doi:10.1097/SMJ.0b013e3181b0f4b8. PMID 19668035. Unknown parameter |month= ignored (help)


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