Tachycardia/bradycardia

Question 1

Causes of narrow complex regular tachy

Answer 1

Sinus rhythm
Atrial tachy
Atrial flutter
Atrial sinus reentry tachy

atrioventricular reentry tachy
Atrioventricular nodal
Automatic junction all tachy

Question 2

Causes of narrow irregular complex tachy

Answer 2

AFib
A flutter with variable block
Multi focal atrial tachy

Question 3

Causes of wide complex regular tachy

Answer 3

V tachy
SVT with bundle brunch block
SVT with wolf Parkinson White

Question 4

Causes of wide complex irregular

Answer 4

VFib
AFib with BBB
AFib with WPW

Question 5

Common causes of sinus tachy

Answer 5

Anxiety
Pain
Hypovolemia
Caffeine
Anaemia
Pyrexia
Toxidrome
Pulmonary embolism
Endocrine: hyperthyroidism, adrenal tumour

Question 6

RF for VT

Answer 6

• Age > 35 (positive predictive value of 85%)
• Structural heart disease
• Ischaemic heart disease
• Previous MI
• Congestive heart failure
• Cardiomyopathy
• Family history of sudden cardiac death (suggesting
conditions such as HOCM, congenital long QT syndrome,
Brugada syndrome or arrhythmogenic right ventricular
dysplasia that are associated with episodes of VT)

Question 7

Signs of instability

Answer 7

Altered mental status
Hypotension
Shock
Acute HF/ pulmonary oedema

Question 8

Indications for synchronised cardio version

Answer 8

V Tachy (unstable, and stable but refractory to other treatment modalities)

Question 9

Contraindications to adenosine

Answer 9

Asthma/COPD- causes bronchospasm

Question 10

Contraindications to atropine (in bradycardia mx)

Answer 10

Heart transplants
Hypoxia
Hypothermia
Head injury

Question 11

Management of unstable bradycardia

Answer 11

Atropine 0.5mg IV every 3-5min if necessary (max 3mg)
Transcutaneous pacing
Alternative to pacing: Adrenaline 2-10mcg/kg/min
Dopamine 2-10mcg/kg/min alternative to adrenaline

Glucagon May be useful for severe Brady caused by calcium channel blocker / Beta Blocker overdose
• High dose Insulin: Useful for beta blocker and calcium channel blocker
overdose. Supplement glucose and potassium
• Theophylline: May be of value for bradycardia caused by inferior myocardial
infarction, spinal cord injury or cardiac transplants. Administer 100-200mg
IV slowly over 30 min

Question 12

Bradycardia

Answer 12

Narrow Regular Bradycardia
-Sinus bradycardia
-Complete AV block (junctional escape)
-Junctional bradycardia
-Atrial Flutter with high degree block

Narrow Irregular
-Sinus arrhythmia
-AFib it’s ventricular response
-AFlutter with variable block
-2nd degree AV block Morbitz type 1
-2nd degree AV block Morbitz type 2
-2nd degree Sinoatrial exit block

Wide Regular Complex
-Idioventricukar rhythm
-Sinoventricula rhythm
-Complete AV block
-Regular brady with BBB

Irregular
-2nd degree AV Morbitz type 1
-2nd degree AV Morbitz type 2
-Sinoatrial exit block with BBB
-Irregular bradycardias with bundle branch block

Question 13

Causes of bradycardia