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TACHYARRHYTHMIA  Dr Syed Raza
Initial Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Should you use electrical therapy? ,[object Object],[object Object],[object Object],[object Object]
What’s the rhythm? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Narrow Complex Tachycardia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Looking at the PR-RP intervals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],RP PR RP PR RP<PR  (Short RP) RP>PR  (Long RP)
 
 
Atrial tachycardia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
ATRIAL FLUTTER
 
 
 
 
 
ATRIAL FIBRILLATION WITH RAPID VENTRICULAR RESPONSE
 
 
 
ATRIO-VENTRICULAR NODAL RE ENTERANT TACHYCARDIA  ( AVNRT)
AV Nodal Reentrant Tachycardia (AVNRT) ,[object Object],[object Object],[object Object],[object Object],[object Object]
“ pseudo-R’”
 
 
ATRIOVENTRICULAR RE ENTERANT TACHYCARDIA (AVRT)
 
 
Atrioventricular Reciprocating Tachycardia (AVRT) ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Therapies  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Acute therapies for SVT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
Definition ,[object Object],VT (80%) SVT (20%) Stewart RB. Ann Intern Med 1986
Definitions ,[object Object],[object Object],[object Object],[object Object]
Importance of diagnosis of WCT ,[object Object],[object Object],[object Object]
Differential Diagnosis of WCT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Distinguishing VT from SVT with aberrancy  ,[object Object],[object Object],[object Object],[object Object]
Distinguishing VT from SVT with aberrancy ,[object Object],[object Object]
Distinguishing VT from SVT with aberrancy ,[object Object]
EKG features highly suggestive  of VT: ,[object Object],[object Object],[object Object]
EKG features moderately suggestive of VT: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Physical findings highly suggestive of VT: ,[object Object],[object Object],[object Object],[object Object]
SVT vs VT   Clinical history Medication Drug-induced tachycardia  -> Torsade de pointes Diuretics Digoxin-induced arrhythmia -> [digoxin] ≥2ng/l or normal if hypokalemia Age  -  ≥ 35 ys -> VT (positive predictive value of 85%) Underlying heart disease Previous MI  -> 98% VT Pacemakers or ICD Increased risk of ventricular tachyarrhythmia
WIDE  QRS
 
Step 4: LBBB - type wide QRS complex SVT VT small R wave notching of S wave R wave >40ms fast downslope of S wave no Q wave Q wave > 70ms V1 V6
 
Fusion beat and capture beat
Concordance and Northwest Axis
MIMICS  OF  VT ,[object Object],[object Object],[object Object]
Previous MI
Previous RBBB
Wide complex SVT from bypass tract
Torsade de Pointes ,[object Object],[object Object],[object Object]
Torsade de Pointes EKG Characteristics: Irregular wide-complex  tachycardia The morphology, amplitude, and  axis of the QRS complexes cycle  through a sinusoidal pattern No discernable P waves
 
 
Tachycardia algorithm AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Ciurculation 2005
Tachycardia algorithm

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Tachyarrhythmia