Tachyarrhythmia

From Anvita Health Wiki

Contents 1 More Specific Terms 2 Introduction 3 Procedure 4 More General Terms 5 References

More Specific Terms

• fibrillation
• narrow complex tachycardia
• wide complex tachycardia

Introduction

• Tachycardia is defined as a heart rate in excess of 100/min. Tachycardias may be classified as supraventricular ( SVT) or ventricular (VT) depending of the origin of the initial depolarization. This distinction is important since the prognosis & therapeutic modalities differ. However, initial evaluation may only characterize the tachyarrhythmia as narrow complex ( QRS <120 ms) or wide complex ( QRS >120 ms).

Procedure

*            ALGORITHM FOR MANAGEMENT OF TACHYCARDIA

• Hemodynamically unstable

• signs/symptoms related to tachycardia

• hypotension
• congestive heart failure
• altered mental status
• ischemic chest pain
• myocardial infarction

• ventricular rate > 150 & rhythm not sinus tachycardia
• immediate cardioversion

• Hemodynamically stable

• atrial flutter or fibrillation

• calcium channel blocker

• verapamil
• diltiazem

• beta blocker
• digoxin

• paroxysmal supraventricular tachycardia (PSVT)

• consider vagal maneuvers

• carotid sinus massage is most common maneuver, contra- indicated in elderly & patients with carotid bruits, bilateral carotid sinus massage should never be performed

• adenosine 6 mg IV push, if no response in 1-2 min, 12 mg IV push (may repeat once)
• normal or elevated blood pressure

• verapamil 2.5-5 mg IV, then 5-10 mg IV
• diltiazem
• beta-blocker
• digoxin
• synchronized cardioversion

• low or unstable blood pressure

• synchronized cardioversion

• wide-complex tachycardia of uncertain type

• lidocaine 1.0-1.5 mg/kg IV, then 0.5-0.75 mg/kg push every 5-10 min for max of 3 mg/kg, if successful start infusion at 2-4 mg/min
• adenosine 6 mg IV push, if no response in 1-2 min, 12 mg IV push (may repeat once)
• procainamide 20-30 mg/min IV for a maximum of 17 mg/kg
• synchronized cardioversion

• ventricular tachycardia

• lidocaine 1.0-1.5 mg/kg IV, then 0.5-0.75 mg/kg push every 5-10 min for max of 3 mg/kg, if successful start infusion at 2-4 mg/min
• procainamide 20-30 mg/min IV for a maximum of 17 mg/kg
• synchronized cardioversion

More General Terms

• cardiac arrhythmia

References

1. ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2005 [1]

tachyarrhythmia (tachycardia)