Narrow-complex tachycardia
Revision as of 07:57, 12 March 2011 by Rossdonaldson1 (talk | contribs)
| Differential | A.Rhythm | A.rate | A.morphology | Vagal/adenosine |
| A Fib | Irregular | >350 | Fibrillatory (V1) | Incr. AV block |
| A Flutter | Regular | >250, <350 | Sawtooth (II, III, AVF) | Incr. AV block |
| A Tach | Regular | >100 | Neg in II, III, AVF | Nothing |
| AVNRT | Regular | >160 | No p's | --> NSR |
| Junctional | Regular | >100, <150 | No p's or retrograde p's | Nothing |
| MAT | Irregular | >100 | >3 p shapes | Transient slowing |
| Sinus | Regular |
>100 <180 |
Normal | Transient slowing |
Flutter vs coarse AFib: determine atrial regularity by taking big bites
TREATMENT:
Digoxin usually only helpful when already c a block (i.e. AF c 2:1 block) NOT c an SVT c 1:1 conduction.
AFib: IV Beta-block> IV digoxin > CCB (diltiazem) > Type IA to covert to SR
*CARDIOVERSION if UNSTABLE* start c 80joules
AFlutter: same as AFib
AT: same as AFib
AVNRT: CSM > adenosine > then Beta blockers > CCB > Digoxin PO. Consider eCV (not if low LVEF), ?procanamide , amio, sotalol.
Junctional: remove the cause, Amiodarone(, Beta-blocker, CCB).
ST: B blocker > CCB > Digoxin
MAT: Verapamil/ Diltiazem. CAREFUL of Beta-blockers b/c usually in pts with pulmonary dz. Amiodarone