Tachycardia Algorithm Review

Romulo B. Babasa III, MD

Case Scenario

An 34-year-old came into the ER complaining of chest tightness and palpitations, which roused her from sleep. She had cold, clammy skin and pallor. Vital signs were HR = 154 bpm; BP =100/70 mm Hg; RR = 24 rpm. Full and equal pulses. Rhythm: see next slide.
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34-Year-Old Woman: Tachycardia

Identify A, B, and C Which one is most likely A to be her rhythm?

C
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Rhythms to Learn

Sinus tachycardia Narrow QRS Regular Supraventricular tachycardia (SVT) Junctional tachycardia Ectopic atrial tachycardia Wolff-Parkinson-White (WPW) Irregular Atrial fibrillation Atrial flutter

Rhythms to Learn

Wide QRS Regular Ventricular Tachycardia Irregular Torsades de Pointes

Sinus Tachycardia

Supraventricular Tachycardia

Paroxysmal SVT

Junctional Tachycardia

Atrial Tachycardia

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WPW Syndrome

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Atrial Fibrillation

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Atrial Flutter

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Ventricular Tachycardia

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Ventricular Tachycardia

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Torsades de Pointes

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Tachycardia Algorithm (1 of 2)

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Synchronized Cardioversion
The purpose of cardioversion is to deliver a precisely timed electrical current to the heart to convert an organized rhythm to a more hemodynamically stable rhythm Supraventricular tachycardia, atrial flutter, atrial fibrillation, and WPW syndrome
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Defibrillation
The purpose of defibrillation is to deliver a randomly timedigh-energy electrical current to the heart that is fibrillating to restore a normal sinus rhythm Ventricular tachycardia, ventricular fibrillation

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Tachycardia Algorithm (1 of 2)

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Tachycardia Algorithm (2 of 2)

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Narrow QRS Tachycardia

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Vagal Maneuvres
These maneuvres increase the vagal tone that have been shown to slow conduction and prolong the refractory period in the AV node: Carotid sinus massage exert pressure on the carotid sinus and baroreceptors against the transverse process of C6 Valsalva maneuvre
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Adenosine

Endogenous nucleoside produced by the degradation of adenosine triphosphate (ATP) Slows cardiac conduction and restores sinus rhythm by transient AV nodal block Rapidly metabolized by most cells Very short half-life (<10 seconds)

Adenosine

Onset of action: 20-30 seconds Duration of action: 60-90 seconds Indication: - for emergency treatment of SVT (supraventricular tachycardia)

Adenosine

Dosage: - initial dose of 6mg rapid IV bolus (1-2 sec) - may be repeated 2x with 12mg after 1-2 mins - followed immediately by a 10-20ml fluid flush - elevate the arm to maximize distribution - if infused slowly, can cause systemic vasodilation and a reflexive tachycardia

Adenosine

Pediatric dose: 0.1-0.2 mg/kg Possible adverse effects: - well tolerated because they last <1minute - most common: - dyspnea, vertigo, headache, numbness - facial flushing, chest pain, palpitation

Narrow QRS Tachycardia

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Wide QRS Tachycardia

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Amiodarone

Antiarrhythmic agent (Class III) Delays repolarization by prolonging the action potential duration and effective refractory period. Amiodarone slows the heart by impairing SA nodal function, depressing AV nodal conduction, modifying the automaticity of spontaneously firing fibers in the Purkinje system, and prolonging the refractory period in an accessory pathway (e.g., WPW syndrome).

Amiodarone

Dosage: - VF/pulseless VT: 300mg IV bolus may be repeated with 150mg - other dysrhythmias: 150mg IV in 100ml D5W x 10 minutes infusion: 1 mg/min for 6 hours 0.5 mg/min thereafter - Pediatric dose: 5mg/kg over 20-60 minutes

THANK YOU
Good luck satin lahat!
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