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| style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center | '''Type of [[Arrhythmia]]'''||style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center | '''Clues''' | | style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center | '''Type of [[Arrhythmia]]'''||style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center | '''[[EKG]]''' (lead II)† ||style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center | '''Clues''' | ||
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|'''[[Supraventricular tachycardia]]'''||Any [[tachyarrhythmia]] that is initiated and maintained in atrial tissue or atrioventricular junctional tissue.<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> | |'''[[Supraventricular tachycardia]]'''||[[Image:SVT.png|300px|link=Narrow complex tachycardia resident survival guide]]||Any [[tachyarrhythmia]] that is initiated and maintained in atrial tissue or atrioventricular junctional tissue.<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> | ||
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| '''[[Sinus tachycardia]]'''||Rhythm with heart rate > 100 bpm, originating in [[SA node]] due to its increased automaticity. | | '''[[Sinus tachycardia]]'''||[[Image:Sinus tachycardia.png|300px|link=Narrow complex tachycardia resident survival guide]]||Rhythm with heart rate > 100 bpm, originating in [[SA node]] due to its increased automaticity. | ||
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| '''[[SANRT|Sinus node re-entry tachycardia]]'''||Rare paroxysmal tachycardia arising due to re-entry circuits with in [[SA node]].<ref name="Cossú-">{{Cite journal | last1 = Cossú | first1 = SF. | last2 = Steinberg | first2 = JS. | title = Supraventricular tachyarrhythmias involving the sinus node: clinical and electrophysiologic characteristics. | journal = Prog Cardiovasc Dis | volume = 41 | issue = 1 | pages = 51-63| month = | year = | doi = | PMID = 9717859 }}</ref> | | '''[[SANRT|Sinus node re-entry tachycardia]]'''|| ||Rare paroxysmal tachycardia arising due to re-entry circuits with in [[SA node]].<ref name="Cossú-">{{Cite journal | last1 = Cossú | first1 = SF. | last2 = Steinberg | first2 = JS. | title = Supraventricular tachyarrhythmias involving the sinus node: clinical and electrophysiologic characteristics. | journal = Prog Cardiovasc Dis | volume = 41 | issue = 1 | pages = 51-63| month = | year = | doi = | PMID = 9717859 }}</ref> | ||
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|'''[[Atrial fibrillation]]'''|| Supraventricular tachycardia with irregularly irregular rhythm and absent P waves on [[EKG]]. | |'''[[Atrial fibrillation]]'''||[[Image:atrial fibrillation.png|300px|link=Narrow complex tachycardia resident survival guide]]|| Supraventricular tachycardia with irregularly irregular rhythm and absent P waves on [[EKG]]. | ||
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|'''[[Atrial flutter]]'''||Cardiac rhythm characterized by an atrial rate ranging from 240 to 400 beats per minute and regular continuous wave-form.<ref name="pmid19668035">{{cite journal |author=Dhar S, Lidhoo P, Koul D, Dhar S, Bakhshi M, Deger FT |title=Current concepts and management strategies in atrial flutter |journal=South. Med. J. |volume=102 |issue=9 |pages=917–22 |year=2009 |month=September |pmid=19668035 |doi=10.1097/SMJ.0b013e3181b0f4b8 |url=}}</ref> | |'''[[Atrial flutter]]'''||[[Image:atrial flutter.png|300px|link=Narrow complex tachycardia resident survival guide]]||Cardiac rhythm characterized by an atrial rate ranging from 240 to 400 beats per minute and regular continuous wave-form.<ref name="pmid19668035">{{cite journal |author=Dhar S, Lidhoo P, Koul D, Dhar S, Bakhshi M, Deger FT |title=Current concepts and management strategies in atrial flutter |journal=South. Med. J. |volume=102 |issue=9 |pages=917–22 |year=2009 |month=September |pmid=19668035 |doi=10.1097/SMJ.0b013e3181b0f4b8 |url=}}</ref> | ||
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| '''[[AVNRT]]'''||Most common form of [[PSVT]] with a heart rate of 140-250 bpm, re-entrant circuit involves two separate anatomical pathways (slow and fast) loacted in perinodal tissue. | | '''[[AVNRT]]'''||[[Image:AVNRT.png|300px|link=Narrow complex tachycardia resident survival guide]]||Most common form of [[PSVT]] with a heart rate of 140-250 bpm, re-entrant circuit involves two separate anatomical pathways (slow and fast) loacted in perinodal tissue. | ||
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| '''[[AVRT]]'''|| Re-entrant tachycardia occurring due to an accessory pathway in addition to [[AV node]], accessory pathway is essential for the initiation and the maintenance of tachycardia. | | '''[[AVRT]]'''||[[Image:AVRT.png|300px|link=Narrow complex tachycardia resident survival guide]]|| Re-entrant tachycardia occurring due to an accessory pathway in addition to [[AV node]], accessory pathway is essential for the initiation and the maintenance of tachycardia. | ||
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| '''[[Focal atrial tachycardia]]'''||Focal atria tachycardia refers to a rhythm originating from a single site either in the left or right atrium with an atrial rate of 100-250 bpm. | | '''[[Focal atrial tachycardia]]'''||[[Image:focal atrial tachycardia.png|300px|link=Narrow complex tachycardia resident survival guide]]||Focal atria tachycardia refers to a rhythm originating from a single site either in the left or right atrium with an atrial rate of 100-250 bpm. | ||
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|'''Nonparoxysmal junctional tachycardia'''||Benign tachycardia occurring due to increased automaticity arising from a high junctional focus. | |'''Nonparoxysmal junctional tachycardia'''||[[Image:JTS.png|300px|link=Narrow complex tachycardia resident survival guide]]||Benign tachycardia occurring due to increased automaticity arising from a high junctional focus. | ||
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| '''[[Multifocal atrial tachycardia]]'''|| Irregular tachycardia characterized by 3 different P wave morphologies on [[EKG]]. | | '''[[Multifocal atrial tachycardia]]'''||[[Image:MAT.png|300px|link=Narrow complex tachycardia resident survival guide]]|| Irregular tachycardia characterized by 3 different P wave morphologies on [[EKG]]. | ||
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† [[EKG]] strips is a courtesy from ECGpedia. | |||
==References== | ==References== |
Revision as of 16:51, 26 March 2014
Characterize the symptoms:
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Identify possible triggers: | |||||||||||||||||||||||||||||||||||||||||||||||
Differential Diagnosis | |||||||||||||||||||||||||||||||||||||||||||||||
Examine the patient: General appearance Vitals
Skin
Neck
Cardiovascular examination
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❑ Assess hemodynamic stability
❑ Order and monitor the ECG | |||||||||||||||||||||||||||||||||||||||||||||||
❑ Unstable patient | ❑ Stable patient | ||||||||||||||||||||||||||||||||||||||||||||||
❑ If the rythm isn't sinus tachycardia: Urgent cardioversion | ❑ If the rythm is sinus tachycardia: Focus your treatment on the underlying condition. If it is due to cardiac ischemia or aortic stenosis, control heart rate by IV metoprolol at the rate of 5 mg/2 minutes till full control or till the maximum of 15 mg, then shift to oral regimen. Don't adminster beta blockers if the patient has significant bradycardia (<50 beats per minute) | Documented arrhythmia | Undocumented arrhythmia (ECG is normal) | ||||||||||||||||||||||||||||||||||||||||||||
❑ Confirm diagnosis of narrow QRS complex tachycardia (heart rate > 100 beats per minute associated with a QRS complex duration < 120 milliseconds) ❑ Identify and treat SVT | History suggestive of extra premature beats ❑ Sensation of a pause followed by a strong heart beat OR | History suggestive of paroxysmal arrhythmia ❑ Regular palpitations with sudden onset and termination | |||||||||||||||||||||||||||||||||||||||||||||
❑ Refer for an invasive electrophysiological study AND/OR ❑ Catheter ablation ❑ Educate about vagal maneuvers ❑ Consider beta blocker | |||||||||||||||||||||||||||||||||||||||||||||||
Differential Diagnosis
Type of Arrhythmia | EKG (lead II)† | Clues |
Supraventricular tachycardia | Any tachyarrhythmia that is initiated and maintained in atrial tissue or atrioventricular junctional tissue.[1] | |
Sinus tachycardia | Rhythm with heart rate > 100 bpm, originating in SA node due to its increased automaticity. | |
Sinus node re-entry tachycardia | Rare paroxysmal tachycardia arising due to re-entry circuits with in SA node.[2] | |
Atrial fibrillation | Supraventricular tachycardia with irregularly irregular rhythm and absent P waves on EKG. | |
Atrial flutter | Cardiac rhythm characterized by an atrial rate ranging from 240 to 400 beats per minute and regular continuous wave-form.[3] | |
AVNRT | Most common form of PSVT with a heart rate of 140-250 bpm, re-entrant circuit involves two separate anatomical pathways (slow and fast) loacted in perinodal tissue. | |
AVRT | Re-entrant tachycardia occurring due to an accessory pathway in addition to AV node, accessory pathway is essential for the initiation and the maintenance of tachycardia. | |
Focal atrial tachycardia | Focal atria tachycardia refers to a rhythm originating from a single site either in the left or right atrium with an atrial rate of 100-250 bpm. | |
Nonparoxysmal junctional tachycardia | Benign tachycardia occurring due to increased automaticity arising from a high junctional focus. | |
Multifocal atrial tachycardia | Irregular tachycardia characterized by 3 different P wave morphologies on EKG. |
† EKG strips is a courtesy from ECGpedia.
References
- ↑ "ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary". Retrieved 15 August 2013.
- ↑ Cossú, SF.; Steinberg, JS. "Supraventricular tachyarrhythmias involving the sinus node: clinical and electrophysiologic characteristics". Prog Cardiovasc Dis. 41 (1): 51–63. PMID 9717859.
- ↑ Dhar S, Lidhoo P, Koul D, Dhar S, Bakhshi M, Deger FT (2009). "Current concepts and management strategies in atrial flutter". South. Med. J. 102 (9): 917–22. doi:10.1097/SMJ.0b013e3181b0f4b8. PMID 19668035. Unknown parameter
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