Tachyarithmias

Question 1

As a general rule, narrow-QRS complex
tachycardias arise from ____ , while wide-QRS complex ones may be
______.

Answer 1

As a general rule, narrow-QRS complex tachycardias arise from above the ventricles, while wide-QRS complex ones may be supraventricular or ventricular in origin.

Question 2

Name REGULAR tachyarrythmias with Narrow-QRS complex (6)

Answer 2

• Sinus tachycardia
• Atrial tachycardia
• Atrioventricular nodal reentrant tachycardia (AVNRT)
• Atrioventricular reentrant tachycardia (AVRT)
• Atrial flutter
• Junctional tachycardia

Question 3

Name REGULAR tachyarrythmias with Wide-QRS complex (3)

Answer 3

• Ventricular tachycardia
• Antidromic AVRT
• Narrow complex tachycardia with aberrancy

Question 4

Name IRREGULAR tachyarrythmias with Narrow-QRS complex (3)

Answer 4

• Atrial flutter with variable block
• Atrial fibrillation
• Multifocal atrial tachycardia

Question 5

Name IRREGULAR tachyarrythmias with Wide-QRS complex (2)

Answer 5

• Polymorphic ventricular tachycardia
• Narrow complex tachycardia with aberrancy

Question 6

What’s the minimum a mean arterial pressure to Hg necessary to perfuse the brain and the vital organs?

Answer 6

65 mmg Hg

Question 7

In tachyarithmias, what indicates that a patient is unstable and requires cardioversion? (5)

Answer 7

• Hypotension
• pulmonary edema
• acutely altered mental status
• ischemic chest pain
• and extremely rapid ventricular rate (over 220-240 bpm)

Question 8

Name signs and symptoms of tacchyarithmias (5)

Answer 8

• palpitations
• fatigue
• weakness.
• Symptoms may suggest hypoperfusion (lightheadedness, near syncope,
  or syncope)
• or cardiac ischemia (chest pain and dyspnea).

Question 9

Differenciate narrow and wide-QRS complexes

Answer 9

as narrow (0.10 seconds or less) or wide-QRS (greater than 0.10 second) complexes.

Question 10

Describe tx : Tachyarrhythmias (6)

Answer 10

• Monitoring of vital signs
• IV access.
• If the patient is hypoxic or in respiratory distress, supplemental oxygen and airway support are indicated.
• If the patient is unstable, synchronized cardioversion should be performed immediately.
• If time allows, procedural sedation should be given prior to cardioversion.
• In stable patients, a 12-lead ECG should be obtained, and medical therapy can be initiated. It is always important to consider treating the underlying etiology of the dysrhythmia as well.

Question 11

Potential interventions for regular
narrow-complex tachyarrhythmias include what ? (4)

Answer 11

• vagal maneuvers
• adenosine
• beta-blockers
• calcium-channel blockers

Question 12

Name vagal maneuvers (2)

Answer 12

• Valsalva/modified Valsalva (and the newer reverse Valsalva)
• and the diving reflex (ic, ice on a patient’s face).

Question 13

Describe tx : Regular Wide-Complex Tachycardias (3)

Answer 13

• Stable patients with regular wide-complex
• tachycardias may benefit from amiodarone, procainamide, or sotalol.
• Adenosine may be considered for monomorphic regular wide-complex tachycardias; however, this should be avoided if there is any concern for atrial fibrillation (AF) with a pre-excitation pathway (procainamide is preferred if AF with Wolff-Parkinson-White is possible).