Tachycardia

Question 1

physical exam for tachycardia

Answer 1

• general: respiratory distress, pain, sweating
• vitals: fever common
• CV: rhythm, murmurs/sounds, JVD
• pulm: auscultate for crackles/wheezes
• Abd: distended or tender
• lymph: enlarged LN
• extremities: clubbing, cyanosis, edem

Question 2

examples of narrow complex tachycardia

Answer 2

• sinus tach
• AV node re-entrant (AVNRT/SVT)
• AV reciprocating (AVRT) - orthodromic
• multifocal atrial tachycardia (MAT)
• a.fib/flutter

Question 3

examples od wide complex tachycardia

Answer 3

• AVRT - antidromic (i.e. WPW)

- v tach/fib –> Torsade de Pointe

Question 4

etiology of sinus tach

Answer 4

• exercise
• pain
• stimulants
• anemia
• anxiety
• vol. depletion
• hypoxia
• hyperthyroidism
• PE
• pericarditis

Question 5

symptoms of sinus tach

Answer 5

• asx
• heart palpitations
• SOB
• In pts w heart dz: palpitations, SOB, chest discomfort, lightheadedness, fatigue

Question 6

treatment of sinus tach

Answer 6

• IV fluids
• pain rx
• anticoags
• tx septic source
• anxiolytics

Question 7

define SVT

Answer 7

• regular, rapid rhythm
• narrow QRS
• no p waves*

Question 8

examples of SVT

Answer 8

• AVNRT
• AVRT
• junctional tachycardia

Question 9

etiologies of SVT

Answer 9

• conduction abnormalities

Question 10

symptoms of SVT

Answer 10

• sudden onset palpitations w/ abrupt cessation
• syncope
• SOB
• anxiety

Question 11

management of stable SVT

Answer 11

• vagal maneuvers
• carotid massage
• adenosine
• CCB or BB
• ablation for frequent attacks

Question 12

management of unstable SVT

Answer 12

• vagal maneuvers

- immediate DC cardioversion

Question 13

MC cause of SVT

Answer 13

AVNRT

Question 14

describe AVNRT

Answer 14

re-entrant circuit around AV node

Question 15

What triggers AVNRT?

Answer 15

• exertion
• ETOH
• caffine

Question 16

describe the HR in AVNRT

Answer 16

• 140-280 bpm

- regular

Question 17

differentiate the types of AVRT

Answer 17

• narrow QRS = orthodromic; through AV
• wide QRS = antidromic; not through AV ==> ddx w/ vtach

i.e. WPW

Question 18

tx of stable orthodromic narrow AVRT

Answer 18

• vagal maneuvers
• adenosine
• CCB
• BB

Question 19

tx of unstable orthodromic AVRT

Answer 19

DC cardioversion

Question 20

tx of antidromic AVRT

Answer 20

• unstable = DC cardioversion
• stable = procainamide
  ^^ both subsequently get ablation

Question 21

tx of antiromic AVRT in a conscious patient

Answer 21

tx like stable vtach

- amiodarone

Question 22

describe WPW

Answer 22

• pre-excitation syndrome with accessory pathway
• symptomatic
• most commonly PSVT
• w/ a.fib –> rapid ventricular respiration –> v. fib –> death
• delta waves w/ decr PR interval

Question 23

management of normal rate and stable WPW

Answer 23

• ablation

- BB, adenosine, procainmide, amiodarone

Question 24

management of fast rate WPW

Answer 24

• unstable = DC cardioversion
• stable = procainamide
  ^^ both eventually get ablation

Question 25

describe MAT

Answer 25

- 3+ different p wave morphologies - 100-150bpm ddx:

Question 26

treatment of MAT

Answer 26

- CCB | - flecainide or propafenone

Question 27

describe sustained vtach

Answer 27

- fast, wide complex rhythm - >30s duration - with structural heart disease - syncope - 3+ consecutive ventricular premature beats - 160-240bpm, moderately regular - frequent complication of MI & dilated cardiomyopathy

Question 28

symptoms of vtach

Answer 28

- asx (rare) - palpitations - sense of impending doom - chest discomfort - SOB, diaphoresis, syncope - LOC

Question 29

treatment of vtach

Answer 29

- w/pulse = DC cardioversion, amiodarone, implantable cardioverter-defibrillator (ICD) - w/o pulse = ACLS

Question 30

describe NSVT

Answer 30

- 3+ consecutive ventricular beats - rate > 120bpm -

Question 31

treatment of NSVT

Answer 31

- infrequent = optimize electrolytes, BB, manage underlying | - frequent = amiodarone

Question 32

describe Torsades de Pointe

Answer 32

- triggered by hypoK, hypoMg, + drugs that prolong QTc (i.e. antiarrhythmics, abx, antipsychotics, antidepressants

Question 33

treatment of Torsades de Pointe

Answer 33

- unstable = DC cardioversion | - stable = *IV Mg*

Question 34

describe v.fib

Answer 34

- low amplitude on EKG - associated w/ CAD and MI - sudden death may be initial (and only!) manifestation of coronary dz - pulseless and unresponsive

Question 35

treatment of v.fib

Answer 35

- CPR - defibrillation - arteriography - ICD