Supraventricular Tachycardias

Question 1

ECG findings in atrial flutter

Answer 1

Sawtooth appearance, 300 bpm often

Question 2

Management of atrial flutter

Answer 2

Sensitive to cardioversion, medication less effective

Question 3

Curative treatment of atrial flutter

Answer 3

Radiofrequency ablation of the tricuspid valve isthmus

Question 4

What are the types of SVTs

Answer 4

AV nodal re-entry tachycardia (AVNRT), AV re-entry tachycardias (AVRT), junctional tachycardias, atrial flutter and atrial fibrilation

Question 5

First line acute management of SVTs

Answer 5

Vagal manoeuvres - valsalva manoeuvre and carotid sinus massage

Question 6

Second line acute management of SVTs

Answer 6

IV adenosine - rapid IV bolus of 6mg, then give 12mg, then give further 18 if unsuccessful. Verapamil in asthmatics

Question 7

Third line acute management of SVTs

Answer 7

Electrical cardioversion

Question 8

Prevention of SVT episodes

Answer 8

Beta blockers or radiofrequency ablation

Question 9

Acute management if patient is unstable or showing signs of shock

Answer 9

Synchronised DC cardioversion

Question 10

Asumption of regular broad complex tachycardia

Answer 10

Ventricular tachycardia

Question 11

Treatment of regular broad complex tachycardia

Answer 11

Loading does of amiodarone followed by 24 hour infusion

Question 12

Possible assumptions of irregular broad complex tachycardia

Answer 12

Atrial fibrilation with BBB (stable patient)
Atrial fibrilation with ventricular pre-excitation
Torsades de pointes

Question 13

Treatment of regular narrow complex tachycardias

Answer 13

Vagal manouvres followed by IV adenosine.
If unsuccessful (atrial flutter), then control rate using beta blockers

Question 14

Assumption of irrgular narrow complex tachycardia

Answer 14

Probable atrial fibrilation

Question 15

Treatment of irregular narrow complex tachycardia

Answer 15

<48 hour onset then electrical or chemical cardioversion.
>48 hour then rate control

Question 16

Assumption of narrow complex QRS

Answer 16

AVNRT