Tachycardia

Question 1

Tachyarrhythmia presentation

Answer 1

asymptomatic
SOB
palpitations
pre-syncope
chest pain
collapse
cardiac arrest

Question 2

What is a palpitation?

Answer 2

abnormal awareness of heartbeat (not necessarily an abnormal heartbeat)

Question 3

What questions should you consider when you are presented with a tachyarrhythmia?

Answer 3

fast or sloe
broad or narrow QRS
regular or irregular
are there P waves

Question 4

AF ECG

Answer 4

narrow complex
irregularly irregular
no organised P waves
irregular baseline

Question 5

Define tachycardia

Answer 5

heart rate > 100bpm

Question 6

List some narrow complex tachycardias

Answer 6

<120ms
sinus tachycardia
AF
atrial flutter
focal atrial tachycardia
AVNRT
AVRT

Question 7

List some broad complex tachycardias

Answer 7

ventricular tachycardia
‘SVT’ with aberrations
pre-excited tachycardia
pacemaker-associated tachycardia

Question 8

What is the typical rate of atrial flutter?

Answer 8

150bpm
(normally an exact division of 300)

Question 9

Atrial flutter ECG

Answer 9

narrow complex
regular
organised atrial activity
‘sawtooth’ appearance

Question 10

Adenosine MOA

Answer 10

blocks AV node

Question 11

AVNRT ECG

Answer 11

atrioventricular nodal reentry tachycardia
inverted retrograde P wave
(no normal P waves)
carotid sinus pressure may cause reversion to sinus rhythm
rate usually 150-180 bpm
narrow QRS

Question 12

Wolff-Parkinson-White ECG

Answer 12

short PR interval (<120ms)
broad QRS
delta wave (slurred upstroke to QRS complex)

[pre-excitation syndrome]

Question 13

What is an accessory pathway?

Answer 13

an extra piece of heart muscle tissue that connects directly between the atria and the ventricles, bypassing the AV node altogether

Question 14

How do accessory pathways show on ECG in sinus rhythm?

Answer 14

broad QRS + pre-excitation (delta waves)

Question 15

w do accessory pathways show on ECG in tachycardia?

Answer 15

narrow QRS + no pre-excitation

Question 16

What arrhythmias occur above the AV node?

Answer 16

atrial fibrillation
atrial flutter
focal atrial tachycardias

Question 17

What arrhythmias involve the AV node?

Answer 17

AV nodal re-entry tachycardia (AVNRT)
AV re-entry tachycardia (AVRT)

Question 18

What arrhythmia occurs below the AV node?

Answer 18

ventricular tachycardia

Question 19

Management of tachyarrhythmias

Answer 19

management of thrombo-embolic risk
rate control (beta blocker, rate-slowing CCB, digoxin)
termination of re-entrant arrhythmia (massage carotid sinus, valsalva manoeuvre, ineffective = give adenosine)
anti-arrhythmic therapy
interventional electrophysiological procedures (AVRT, AVNRT, flutter, fibrillation, FAT)