narrowcomplextachycardia.pptx

Ecg

1. Narrow complex tachycardia

2. Definition Heart rate >100 bpm! QRS duration <120 ms! Image source: Lifeinthefastlane.com

3. Types of tachycardia Sinus tachycardia: normal P wave followed by normal QRS. Supraventricular tachycardia (SVT): P wave absent or inverted after QRS.

4. Types of tachycardia Atrial fibrillation: absent P wave, irregular QRS complexes. Atrial flutter: atrial rate usually 300 bpm with flutter waves (sawtooth), ventricular rate 150 bpm (2:1 block). Atrial tachycardia: abnormally shaped P waves, may outnumber QRS complexes.

5. Types of tachycardia Multifocal atrial tachycardia: three or more P wave morphologies, irregular QRS complexes. Junctional tachycardia: rate 150- 250 bpm , P wave eaither buried in QRS complex or occurring after QRS complex.

6. Management of SVT Vagal manoeuvres: breath holding valsalva manoeuvre carotid massage

7. Management of SVT Vagal manoeuvres can be used only if the patient is haemodynamically stable.

8. Management of SVT Adenosine iv. is next step: 6 mg iv. bolus into a big vein saline flush recording a rhythm strip after 1-2 min, 12 mg iv. if necessary

9. Adenosine Side effects are transient chest tightness, dyspnoea, headache and flushing. Contraindications: asthma AV block of second and third degree, sinoatrial disease (without pacemaker). Important drug interactions: dipyridamole increase levels, theophylline antagonises adenosine.

10. Management of SVT If adenosine is not effective, verapamil can be used in dose of 5 mg iv. over 2 minutes (over 3 minutes in elderly). Verapamil can not be used if the patient is taking beta blockers. If there is no response, dose of 5 mg iv. can be repeated after 5-10 minutes.

11. Management of SVT Alternatives: atenolol 2,5 mg iv. at 1 mg/min repeated at 5 minutes intervals to a maximum dose of 10 mg sotalol 20-60 mg iv. over 10 minutes in patients with estimated glomerular filtration rate more than 60 DC cardioversion

12. Atrial tachycardia

13. Multifocal atrial tachycardia Most commonly occurs in COPD. There are at least 3 morphologically distinct P waves with irregular P-P intervals. It is very important to correct hypoxia and hypercapnia. If heart rate >110 bpm, verapamil or a BB can be used as well.

14. Image source: lifeinthefastlane.com There are at least 3 morphologically distinct P waves with irregular P-P intervals.

15. Junctional tachycardia AV nodal re-entry tachycardia (AVNRT) AV re-entry tachycardia (AVRT) His bundle tachycardia

16. Junctional tachycardia Vagal manoeuvres in cases of anterograde conduction through the AV node. Adenosine! Beta blockers or amiodarone! Radiofrequency ablation!

17. Wolff - Park i ns o n - White syndrome (WPW) It is caused by congenital accessory conduction pathway between atria and ventricles. ECG: short PR interval, wide QRS complex due to slurred upstroke (delta wave) and ST-T changes.

18. Wolff - Park i ns o n - White syndrome (WPW) WPW type A: positive delta wave in V1. WPW type B: negative delta wave in V1. Delta wave

19. Wolff - Park i ns o n - White syndrome (WPW) Patients may present with SVT. Tachycardia may be due to an AVRT, pre-excited atrial fibrillation or flutter. Electrophysiological testing and ablation of accessory pathway!

20. Long Ganong Levine syndrome It is similar to WPW syndrome, except there is no delta waves!

21. Holiday heart syndrome Binge drinking in a person without any clinical evidence of heart disease may result in acute cardiac rhythm and conduction disturbances. Recreational use of marijuana may have similar effects.

22. Holiday heart syndrome

23. Stop heavy drinking!

24. Literature Oxford Handbook of Clinical Medicine. Longmore M. Wilkinson I. B. Baldwin A. Elizabeth W. Ninth edition. Lifeinthefastlane.com Ecgcore.com