Narrow complex tachycardia resident survival guide: Difference between revisions
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== Management== | == Management== | ||
Figure 1: Differential diagnosis for narrow QRS tachycardia.<ref name="circ.ahajournals.org">{{Cite web | last = | first = | title = ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary | url = http://circ.ahajournals.org/content/108/15/1871 | publisher = | date = | accessdate = 15 August 2013 }}</ref> | '''Figure 1: Differential diagnosis for narrow QRS tachycardia.'''<ref name="circ.ahajournals.org">{{Cite web | last = | first = | title = ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary | url = http://circ.ahajournals.org/content/108/15/1871 | publisher = | date = | accessdate = 15 August 2013 }}</ref> | ||
{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=PE diagnosis Algorithm.}} | ||
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Patients with focal junctional tachycardia may mimic the pattern of slow-fast [[AVNRT]] and may show AV dissociation and/or marked irregularity in the junctional rate.<br>AV indicates atrioventricular; [[AVNRT]], [[atrioventricular nodal reciprocating tachycardia]]; [[MAT]], [[multifocal atrial tachycardia]]; ms, miliseconds; PJRT, permanent form of junctional reciprocating tachycardia; QRS, ventricular activation on ECG. | Patients with focal junctional tachycardia may mimic the pattern of slow-fast [[AVNRT]] and may show AV dissociation and/or marked irregularity in the junctional rate.<br>AV indicates atrioventricular; [[AVNRT]], [[atrioventricular nodal reciprocating tachycardia]]; [[MAT]], [[multifocal atrial tachycardia]]; ms, miliseconds; PJRT, permanent form of junctional reciprocating tachycardia; QRS, ventricular activation on ECG. | ||
'''Figure 2: Responses of narrow complex tachycardias to adenosine.'''<ref name="circ.ahajournals.org">{{Cite web | last = | first = | title = ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary | url = http://circ.ahajournals.org/content/108/15/1871 | publisher = | date = | accessdate = 15 August 2013 }}</ref> | |||
{{familytree/start}} | |||
{{familytree | | | | | | | | | A01 | | | | | |A01=Regular narrow [[QRS complex]] tachycardia}} | |||
{{familytree | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | | B01 | | | | | |B01=IV adenosine}} | |||
{{familytree | |,|-|-|-|v|-|-|-|^|-|-|-|v|-|-|-|.| | }} | |||
{{familytree | |!| | | |!| | | | | | | |!| | | |!| | | }} | |||
{{familytree | C01 | | C02 | | | | | | C03 | | C04 |C01=No change in rate|C02=Gradual slowing then reacceleration of rate |C03=Sudden termination|C04=Persisting atrial tachycardia with transient high-grade AV block}} | |||
{{familytree | |!| | | |!| | | | | | | |!| | | |!| }} | |||
{{familytree | C01 | | C02 | | | | | | C03 | | C04 | | | | | |C01=Inadequate dose/delivery<br>Condiser VT (fascicular or hight septal origin)|C02=Sinus tachycardia<br>Focal AT<br>Nonparoxysmal junctional tachycardia|C03=[[AVNRT]]<br>[[AVRT]]<br>Sinus node re-entry<br>Focal AT|C04=[[Atrial flutter]]<br>AT }} | |||
{{familytree/end}} | |||
AT indicates atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reciprocating tachycardia; AVRT, atrioventricular reciprocating tachycardia; IV, intravenous; QRS, ventricular activation on ECG; VT, ventricular tachycardia. | |||
==References== | ==References== | ||
Revision as of 15:00, 19 August 2013
| File:Critical Pathways.gif |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hilda Mahmoudi M.D., M.P.H.[2]
Definition
Causes
Life Threatening Causes
Life-threatening causes include conditions which result in death or permanent disability within 24 hours if left untreated.
Common Causes
Management
Figure 1: Differential diagnosis for narrow QRS tachycardia.[1]
| Narrow QRS tachycardia (QRS duration less than 120 ms) | |||||||||||||||||||||||||||||||||||||||||||
| Regular tachycardia? | |||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||
| Visible P waves? | Atrial fibrillation Atrial tachycardia/flutter with variable AV conduction MAT | ||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||
| Atrial rate greater than ventricular rate? | |||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||
| Atrial flutter or atrial tachycardia | Analyze RP interval | ||||||||||||||||||||||||||||||||||||||||||
| Short (RP shorter than PR) | Long (RP longer than PR) | ||||||||||||||||||||||||||||||||||||||||||
| RP shorter than 70 ms | RP longer than 70 ms | Atrial tachycardia PJRT Atypical AVNRT | |||||||||||||||||||||||||||||||||||||||||
| AVNRT | AVRT AVNRT Atrial tachycardia | ||||||||||||||||||||||||||||||||||||||||||
Patients with focal junctional tachycardia may mimic the pattern of slow-fast AVNRT and may show AV dissociation and/or marked irregularity in the junctional rate.
AV indicates atrioventricular; AVNRT, atrioventricular nodal reciprocating tachycardia; MAT, multifocal atrial tachycardia; ms, miliseconds; PJRT, permanent form of junctional reciprocating tachycardia; QRS, ventricular activation on ECG.
Figure 2: Responses of narrow complex tachycardias to adenosine.[1]
| Regular narrow QRS complex tachycardia | |||||||||||||||||||||||||||||||||||||||||||||||
| IV adenosine | |||||||||||||||||||||||||||||||||||||||||||||||
| No change in rate | Gradual slowing then reacceleration of rate | Sudden termination | Persisting atrial tachycardia with transient high-grade AV block | ||||||||||||||||||||||||||||||||||||||||||||
| Inadequate dose/delivery Condiser VT (fascicular or hight septal origin) | Sinus tachycardia Focal AT Nonparoxysmal junctional tachycardia | AVNRT AVRT Sinus node re-entry Focal AT | Atrial flutter AT | ||||||||||||||||||||||||||||||||||||||||||||
AT indicates atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reciprocating tachycardia; AVRT, atrioventricular reciprocating tachycardia; IV, intravenous; QRS, ventricular activation on ECG; VT, ventricular tachycardia.
References
- ↑ 1.0 1.1 "ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary". Retrieved 15 August 2013.