Tachycardia: Difference between revisions

	Tachycardia Microchapters
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	Tachycardia;
	Rhythm strip showing a run of ventricular tachycardia (VT)

VisualWikitext

Latest revision as of 19:11, 15 June 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: M.Umer Tariq [2]

Overview

Classification

Tachycardia

Narrow complex tachycardia (SVT)

Wide complex tachycardia

The origin of the impulse:
Atria

The origin of the impulse:
AV junction

The origin of the impulse:
Atria or AV junction

The origin of the impulse:
AV junction

The origin of the impulse:
Atria, AV junction or ventricles

Presence of an accessory pathway

The origin of the impulse:
Pacemaker

Atrial fibrillation
Atrial flutter
Ectopic atrial rhythm
Multifocal atrial tachycardia (MAT)
Paroxysmal atrial tachycardia (PAT) with block
Premature atrial contractions (PAC)
Sinus tachycardia
Wandering atrial pacemaker
Sick sinus syndrome

AVNRT

AVRT (accessory pathway):
- Wolff-Parkinson-White syndrome (WPW)
- Lown-Ganong-Levine syndrome (LGL)

Accelerated junctional rhythm

SVTAC
(SVT with aberrant conduction):

Left bundle branch block
Left anterior hemi-block
Lefo posterior hemi-block
Right bundle branch block
Trifascicular block

Ventricular tachycardia
Ventricular fibrillation
Ventricular parasystole

Wolff-Parkinson-White syndrome (WPW)
Lown-Ganong-Levine syndrome (LGL)

Pacemaker-mediated tachycardia
Runaway pacemaker syndrome
Sensor induced tachycardia

Pathophysiology

Causes

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Treatment

Case Studies

Case #1

Template:WikiDoc Sources

@@ Line 1: / Line 1: @@
-==Treatments==
+__NOTOC__
-Treatment of tachycardia is usually directed at chemical conversion (with [[antiarrythmics]]), electrical conversion (giving external shocks to convert the heart to a normal rhythm) or use of drugs to simply control heart rate (for example as in [[atrial fibrillation]]).
+{{Infobox_Disease |
+  Name           = Tachycardia |
+  Image          = Tachycardia 0001.jpg|
+  Caption        = Rhythm strip showing a run of [[ventricular tachycardia]] (VT)|
+}}
+{{Tachycardia}}
+{{CMG}}; '''Associate Editor-In-Chief:''' {{MUT}}
-The treatment modality used depends on the type of tachycardia and the hemodynamic stability of the patient.  If the tachycardia originates from the sinus node (sinus tachycardia), treatment of the underlying cause of sinus tachycardia is usually sufficient.  On the other hand, if the tachycardia is of a potentially lethal origin (ie: ventricular tachycardia) treatment with anti arrhythmic agents or with electrical cardioversion may be required. Below is a brief discussion of some of the main tachyarrhythmias and their treatments.
+==[[Tachycardia overview|Overview]]==
-The electrocardiac management of atrial fibrillation and atrial flutter is either through medications or electrical cardioversion. Pharmacologic management of these arrhythmias typically involves diltiazem or verapamil as well as beta-blocking agents such as atenolol. The decision to use electrical cardioversion depends heavily on the hemodynamic stability of the presenting patient; in general those patients who are unable to sustain their systemic functions are electrically converted although conversion to a normal sinus rhythm can be performed with amiodarone. An interesting type of atrial fibrillation which must be carefully managed is when it appears in combination with Wolff-parkinson White. In this case, calcium channel blockers, beta-blockers and digoxin must be avoided to prevent precipitation of ventricular tachycardia. Here, procainamide or quinidine are often used. Of note: patients who have been in atrial fibrillation for more than 48 hours should not be converted to normal sinus rhythm unless they have been anti-coagulated to an INR of 2-3 for at least 4 weeks.
+==[[Tachycardia classification|Classification]]==
+{{familytree/start |summary=Tachycardia}}
+{{familytree | | | | | | | | | | | | A01 | | | A01=Tachycardia}}
+{{familytree | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | }}
+{{familytree | | | | | B01 | | | | | | | | | | | | B02 | | B01= '''[[SVT|Narrow complex tachycardia (SVT)]]'''| B02= '''[[Wide complex tachycardia]]''' }}
+{{familytree | | | |,|-|^|-|-|-|.| | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | }}
+{{familytree | | | C01 | | | | C02 | | C03 | | C04 | | C05 | | C06 | | C01= '''<u>The origin of the impulse:</u><br>Atria'''| C02= '''<u>The origin of the impulse:</u><br>AV junction'''| C03='''<u>The origin of the impulse:</u><br>Atria or AV junction''' | C04= '''<u>The origin of the impulse:</u><br>AV junction'''| C05= '''<u>The origin of the impulse:</u><br>Atria, AV junction or ventricles<br><br> Presence of an [[accessory pathway]]'''| C06= '''<u>The origin of the impulse:</u><br>Pacemaker'''}}
+{{familytree | |,|-|^|-|.| | | |!| | | |!| | | |!| | | |!| | | |!| | }}
+{{familytree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | D01= [[Atrial fibrillation]] <br> [[Atrial flutter]] <br> [[Ectopic Atrial Rhythm|Ectopic atrial rhythm]] <br> [[Multifocal Atrial Tachycardia (MAT)|Multifocal atrial tachycardia (MAT)]] <br> [[Paroxysmal Atrial Tachycardia (PAT) with Block|Paroxysmal atrial tachycardia (PAT) with block]] <br> [[Premature Atrial Contractions (PACs)|Premature atrial contractions (PAC)]] <br> [[Sinus Tachycardia|Sinus tachycardia]] <br> [[Wandering atrial pacemaker]]<br> [[Sick sinus syndrome]]| D02= [[AVNRT]] <br><br> [[AVRT]] ([[accessory pathway]]):<br>- [[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White syndrome (WPW)]]<br>- [[Lown-Ganong-Levine syndrome|Lown-Ganong-Levine syndrome (LGL)]]|D03=[[Accelerated junctional rhythm]]| D04= '''[[Wide complex tachycardias|SVTAC]]'''<br>'''([[Wide complex tachycardias|SVT with aberrant conduction]]):<br><br>'''[[Left Bundle Branch Block|Left bundle branch block]] <br> [[LAHB|Left anterior hemi-block]] <br> [[Left posterior fascicular block electrocardiogram|Lefo posterior hemi-block]] <br> [[Right Bundle Branch Block|Right bundle branch block]] <br> [[Trifascicular block]]| D05= [[Ventricular tachycardia]] <br> [[Ventricular fibrillation electrocardiogram|Ventricular fibrillation]] <br> [[Ventricular Parasystole|Ventricular parasystole]] | D06= [[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White syndrome (WPW)]]<br>[[Lown-Ganong-Levine syndrome|Lown-Ganong-Levine syndrome (LGL)]]| D07= [[Pacemaker-mediated tachycardia]] <br> [[Runaway pacemaker syndrome]]<br> [[Sensor induced tachycardia]]}}
+{{familytree/end}}
-In the case of narrow complex tachycardias (juntional, atrial or paroxysmal), the treatment in general is to first give the patient adenosine (to slow conduction through the AV node) and then perform vagal maneuvers to slow the rhythm. If this does not convert the patient, amiodarone, calcium channel blockers or beta-blockers are commonly employed to stabilize the patient. Again as in atrial fibrillation, if a patient is unstable, the decision to electrially cardiovert him/her should be made.
+==[[Tachycardia pathophysiology|Pathophysiology]]==
-With wide complex tachyarrhythmias or ventricular tachyarrhythmias, in general most are highly unstable and cause the patient significant distress and would be electrically converted. However one notable exception is monomorphic ventricular tachycardia which patients may tolerate but can be treated pharmacologically with amiodarone or lidocaine.
+==[[Tachycardia causes|Causes]]==
-Above all, the treatment modality is tailored to the individual, and varies based on the mechanism of the tachycardia (where it is originating from within the heart), on the duration of the tachycardia, how well the individual is tolerating the fast heart rate, the likelihood of recurrence once the rhythm is terminated, and any co-morbid conditions the individual is suffering from.
+==[[Tachycardia risk factors|Risk Factors]]==
-==ACC / AHA Guidelines- Recommendations for Permanent Pacemakers That Automatically Detect and Pace to Terminate Tachycardias (DO NOT EDIT) <ref name="Epstein"> Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 2820–2840. PMID 18483207 </ref>==
+==[[Tachycardia natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
-{{cquote|
-===Class IIa===
-. Permanent [[pacemaker|pacing]] is reasonable for symptomatic recurrent [[SVT]] that is reproducibly terminated by pacing when [[catheter ablation]] and/or drugs fail to control the [[arrhythmia]] or produce intolerable side effects. ''(Level of Evidence: C)''
-===Class III===
+==Diagnosis==
-. Permanent [[pacemaker|pacing]] is not indicated in the presence of an accessory pathway that has the capacity for rapid anterograde conduction. ''(Level of Evidence: C)''}}
+[[Tachycardia history and symptoms| History and Symptoms]] | [[Tachycardia physical examination |Physical Examination]] | [[Tachycardia laboratory findings|Laboratory Findings]] | [[Tachycardia electrocardiogram|Electrocardiogram]] | [[Tachycardia chest x ray|Chest X Ray]] | [[Tachycardia echocardiography|Echocardiography]] | [[Tachycardia MRI|MRI]] |[[Tachycardia other imaging findings|Other Imaging Findings]] | [[Tachycardia other diagnostic studies|Other Diagnostic Studies]]
-==Sources==
+==Treatment==
-* The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities <ref name="Epstein"> Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 2820–2840. PMID 18483207 </ref>
+[[Tachycardia medical therapy|Medical Therapy]] | [[Tachycardia surgery|Surgery]] | [[Tachycardia primary prevention|Primary Prevention]] | [[Tachycardia secondary prevention|Secondary Prevention]] | [[Tachycardia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Tachycardia future or investigational therapies|Future or Investigational Therapies]]
+==Case Studies==
+[[Tachycardia case study one|Case #1]]
+{{Electrocardiography}}
+{{Circulatory system pathology}}
+[[es:Taquicardia]]
+[[fr:Tachycardie]]
+[[ja:頻脈]]
+[[pt:Taquicardia]]
+[[ru:Тахикардия]]
+[[pl:Tachykardia]]
+[[tr:Taşikardi]]
+{{WikiDoc Help Menu}}
+{{WikiDoc Sources}}
+[[Category:Cardiology]]
+[[Category:Medical signs]]
+[[Category:Signs and symptoms]]
+[[Category:Emergency medicine]]
+[[Category:Arrhythmia]]
+[[Category:Electrophysiology]]

v t e Electrocardiography
Overview	History of the EKG • EKG interpretation basics • Normal sinus rhythm
EKG Complexes	P wave • QRS complex • ST Segment • T wave • T wave alternans • Tombstone T wave • U wave Osborn wave • H wave • K wave • Delta wave NSSTW changes
EKG Intervals	PR Interval • QRS Interval • ST Interval • QT Interval
Conduction System & Bradycardia	Cardiac pacemaker • SA node • AV node• Bundle of His • Purkinje fibers • Sinus bradycardia • First Degree AV Block • Second Degree AV Block • Complete or Third-Degree AV Block • Concealed conduction • AV Junctional Rhythms • LBBB • LAHB • LPHB • RBBB • Trifascicular block
Atrial Arrhythmias	Sinus tachycardia • Premature Atrial Contractions (PACs) • Ectopic Atrial Rhythm • Paroxysmal Atrial Tachycardia (PAT) • Paroxysmal Atrial Tachycardia (PAT) with Block • Multifocal Atrial Tachycardia (MAT) • Atrial Flutter • Atrial Fibrillation • Wandering atrial pacemaker
Ventricular Arrhythmias	Differential Diagnosis of Tachycardia with a Wide QRS Complex • Accelerated Idioventricular Rhythm • Ventricular Parasystole • Premature Ventricular Contractions (PVCs) • Ventricular tachycardia • Ventricular Fibrillation • Sudden cardiac death
EKG Abnormalities in Disease States	Hypertrophy & Dilatation • Right atrial enlargement • Left atrial enlargement • Biatrial enlargement • Left Ventricular Hypertrophy • Right Ventricular Hypertrophy • Biventricular Hypertrophy • Acute myocardial infarction • NSTEMI • STEMI • Tombstone ST elevation • Right ventricular myocardial infarction • Atrial infarction Pre-excitation Syndromes • Wolff-Parkinson-White Syndrome • Lown Ganong Levine Syndrome • Mahaim Type Preexcitation Cardiomyopathies • Arrhythmogenic Right Ventricular Dysplasia • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy Drug Effects on the EKG • Adenosine • β-blockers • Digitalis • Quinidine • Procainamide • Disopyramide • Lidocaine • Tocainide and Mexiletine • Phenytoin • Encainide, Flecainide and Propafenone • Amiodarone • Bretylium • Ca Channel Blockers • Phenothiazines • Tricyclic Antidepressants • Lithium Congenital Heart Disease • Dextrocardia • Atrial Septal Defect • Ventricular Septal Defect • Tetralogy of Fallot • Conjoined Twins or Siamese Twins • Congenital heart block Electrolyte Disturbances • Hyperkalemia • Hypokalemia • Hypercalcemia • Hypocalcemia • Nonspecific Changes Other Heart Diseases • Pericarditis • Myocarditis • Tamponade • Heart Transplantation • Sick Sinus Syndrome • Long QT Syndrome Inherited Disease • Brugada Syndrome Systemic Diseases • CNS Disease • Cardiac Tumors Heart Transplantation • EKG Changes in patient with Heart Transplantation Exogenous Effects • Hypothermia • Chest Trauma • Insect Bites • Electric Injuries
Technical Issues and Potential Errors in Interpretation	Artifacts • Lead Placement Errors • The EKG in a Patient with a Pacemaker • EKG in athletes


Tachycardia
Rhythm strip showing a run of ventricular tachycardia (VT)