Tachyarrhythmia's (A)

Definition “Heart rhythm with a ventricular rate of 100bpm or greater”

Classification Sinus Vs non sinus (P wave preceding QRS = sinus)

Atrial vs ventricular arrythmia (Narrow QRS= atrial vis versa)
Narrow vs wide QRS complex
Regular vs irregular rhythm

Aetiology Cardiac: IHD, Cardiomyopathy, pericarditis,

Non-Cardiac: caffeine, smoking, alcohol, pneumonia
Drugs: BB, digoxin, L-Dopa, tricyclics
Metabolic: Potassium, Calcium, sodium deranged, hyperthyroid, metabolic
acidosis

History Often Asymptomatic

Palpitations, fatigue, pre-syncope, chest discomfort, dyspnoea

Examination Signs of HF (elevated JVP, oedema), murmur

Investigations 12 lead ECG, ambulatory ECG, Exercise testing

Baseline bloods + drug levels, TFTs

Atrial fibrillation “Disorganised electrical activity overriding the normal activity of the SA
node resulting in uncoordinated, rapid, irregular atrial contraction”
Causes: Pulmonary, infraction, rhematic heart disease, anaemia, toxins,
ethanol, sepsis (PIRATES)
ECG: Absent P waves, irregularly irregular rhythm, Narrow QRS
Rate control:
Ventricular filling dependent on gravity, hence slower heart rates allow more
time available for ventricular filling
1st BB, 2nd CCB, if sedentary digoxin
AVOID: new AF, Reversable cause. HF caused by AF
Rhythm control (i.e., cardioversion)
If haemodynamically unstable immediate electrical DC
<48 hr = pharmacological (Amiodarone / Flecainide)
>48hr = electrical (requires 3 weeks of anticoagulation)
Anticoagulation
Guided by CHADVASc score (2+ = anticoagulated)
NOACs i.e., apixaban, dabigatran, rivaroxaban

Supraventricular “Rapid, regular arterial rhythm caused by electrical signals re-entering the
tachycardia
 arteria from the ventricles”
Causes: CAD, CHF, Digoxin toxicity, alcohol dependence, catecholamine
ingestion
ECG: Narrow complex tachycardia
Management:
Vagal manoeuvres – Carotid sinus massage/ Valsalva manoeuvre (blow into
an empty syringe)
IV adenosine – Rapid IV bolus (Contraindicated in asthma)
Electrical cardioversion
Prevention: Beta blockers / Radio-frequency ablation

Ventricular “Ventricular rhythm faster than 100bpm lasting 30 seconds+”

tachycardia
Causes: Haemodynamic instability,
ECG: Wide QRS>120ms at a rate >100bpm
Morphic VT: Caused by myocardial infraction
Polymorphic VT: Torsade's de pointes, can progress to arrest, occurs in
prolonged QT (Hypokalaemia, hypo magnesia, hypocalcaemia, macrolide
ABx, antipsychotics, amiodarone
Management
Haemodynamically unstable: Synchronised DC cardioversion
If stable: Amiodarone/lidocaine infusion
Torsade de points: 2g magnesium sulphate

Ventricular Cause: MI, VT, Cardiomyopathy, cardiac tamponade, Aortic stenosis, Aortic
fibrillation dissection, tension pneumothorax, PE, hypothermia, sepsis
ECG: chaotic deflections of varying aptitude with No identifiable P waves,
QRS or T waves, 150-500bpm
Management (FATAL UNLESS TREATED
SHOCKABLE RHYTHM

Differentials Regular narrow complex tachycardia:

Irregular Narrow complex tachycardia