Wide complex tachycardia resident survival guide: Difference between revisions
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===Therapeutic Approach=== | ===Therapeutic Approach=== | ||
Shown below is an algorithm depicting the management of wide complex tachycardia according to 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.<ref name="circ.ahajournals.org">{{Cite web | last = | first = | title = Part 7.3: Management of Symptomatic Bradycardia and Tachycardia | url = http://circ.ahajournals.org/content/112/24_suppl/IV-67.full | publisher = | date = | accessdate = 2 March 2014 }}</ref> | |||
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{{familytree | | | | F01 | | F02 | | F03 | | F04 | | F05 | | F06 | F01=Attempt vagal maneuvers <br>- Give [[amiodarone]] 150 mg IV over 10 min<br><br>- Repeat [[amiodarone]] as needed for a maximal dose of 2.2g/24h<br><br>- Prepare for elective synchronized [[cardioversion]]| F02=- Give [[adenosine]] 6 mg rapid IV push<br><br>- If no [[conversion]] give 12 mg IV push<br><br>- May repeat 12 mg dose once| F03=- Consider expert consultation<br><br>- Control rate e.g [[diltiazem]] or [[beta blocker]]s<br>Use [[beta blocker]]s with caution in [[pulmonary disease]]s or [[CHF]]| F04= - Consider expert consultation<br><br>- Avoid AV nodal blocking agents<br>e.g [[adenosine]], [[digoxin]], [[diltiazem]] and [[verapamil]]<br><br>- Consider [[amiodarone]] 150 mg IV over 10 min| F05= Consider expert consultation| F06=Load with [[Magnesium]] 1-2 g over 5-60 min, then infusion}} | {{familytree | | | | F01 | | F02 | | F03 | | F04 | | F05 | | F06 | F01=Attempt vagal maneuvers <br>- Give [[amiodarone]] 150 mg IV over 10 min<br><br>- Repeat [[amiodarone]] as needed for a maximal dose of 2.2g/24h<br><br>- Prepare for elective synchronized [[cardioversion]]| F02=- Give [[adenosine]] 6 mg rapid IV push<br><br>- If no [[conversion]] give 12 mg IV push<br><br>- May repeat 12 mg dose once| F03=- Consider expert consultation<br><br>- Control rate e.g [[diltiazem]] or [[beta blocker]]s<br>Use [[beta blocker]]s with caution in [[pulmonary disease]]s or [[CHF]]| F04= - Consider expert consultation<br><br>- Avoid AV nodal blocking agents<br>e.g [[adenosine]], [[digoxin]], [[diltiazem]] and [[verapamil]]<br><br>- Consider [[amiodarone]] 150 mg IV over 10 min| F05= Consider expert consultation| F06=Load with [[Magnesium]] 1-2 g over 5-60 min, then infusion}} | ||
{{familytree/end}} | {{familytree/end}} | ||
==Do's== | ==Do's== | ||
Revision as of 01:56, 2 March 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Definition
Wide complex tachycardia is characterized by a heart rate more than 100 beats per minute associated with a QRS interval of more than 120 ms. When wide complex tachycardia is present, it is important to determine whether the tachycardia is of a supraventricular or a ventricular origin.[1]
Causes
Life Threatening Causes
Common Causes
Management
Diagnostic Approach
Characterize the symptoms:
Characterize the timing of the symptoms: | ||||||||||||||||||||
Identify possible triggers:
| ||||||||||||||||||||
❑ Examine the patient | ||||||||||||||||||||
❑ Order an EKG | ||||||||||||||||||||
Therapeutic Approach
Shown below is an algorithm depicting the management of wide complex tachycardia according to 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.[2]
| Wide complex tachycardia QRS ≥ 120ms | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Do the following simultaneously: - Assess and support ABC's as needed - Give oxygen - Monitor ECG, BP, oxymetry -Establish IV access - Identify and treat reversible causes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Is the patient stable? Unstable signs include: - Chest pain - Congestive heart failure - Hypotension - Loss of consciousness - Seizures | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Is the rhythm regular? | Immediate synchronized cardioversion - Give IV sedation if the patient is conscious - Consider expert consultation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Regular rhythm | Irregular rhythm | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ventricular tachycardia or uncertain rhythm? | SVT with aberrancy? | Afib with aberrancy? | Pre-excited Afib (Afib + WPW)? | Recurrent polymorphic VT? | Torsade de pointes? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Attempt vagal maneuvers - Give amiodarone 150 mg IV over 10 min - Repeat amiodarone as needed for a maximal dose of 2.2g/24h - Prepare for elective synchronized cardioversion | - Give adenosine 6 mg rapid IV push - If no conversion give 12 mg IV push - May repeat 12 mg dose once | - Consider expert consultation - Control rate e.g diltiazem or beta blockers Use beta blockers with caution in pulmonary diseases or CHF | - Consider expert consultation - Avoid AV nodal blocking agents e.g adenosine, digoxin, diltiazem and verapamil - Consider amiodarone 150 mg IV over 10 min | Consider expert consultation | Load with Magnesium 1-2 g over 5-60 min, then infusion | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- Refer the patient to an arrhythmia specialist in case the tachycardia causes syncope or dyspnea as well as the wide complex tachycardia is of unknown cause.[1]
- Place an ambulatory 24 hour Holter when the tachycardia is frequent and transient.[1]
Dont's
References
- ↑ 1.0 1.1 1.2 Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ; et al. (2003). "ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society". J Am Coll Cardiol. 42 (8): 1493–531. PMID 14563598.
- ↑ "Part 7.3: Management of Symptomatic Bradycardia and Tachycardia". Retrieved 2 March 2014.