Scribd Logo
Upload

Welcome to Scribd!

  • 50 views

    Approach To Tachyarrhythmia: SVT - VT - VF - Torsa de Pointes

    Uploaded by

    Amir Izzuddin Suib
    1. A 52-year-old man with diabetes and hypertension presented with palpitations and shortness of breath for 2 hours. He appeared drowsy, tachypneic, and unstable. 2. The initial steps are to assess ABCs, provide supplemental oxygen, start IV access, attach a defibrillator/ECG monitor to assess rhythm, and look for serious signs and symptoms. 3. Based on the ECG characteristics like heart rate, QRS width, and rhythm regularity, the arrhythmia can be classified as supraventricular tachycardia, ventricular tachycardia, polymorphic ventricular tachycardia, ventricular fibrillation, or torsades de

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content

    You might also like

    Approach To Tachyarrhythmia: SVT - VT - VF - Torsa de Pointes

    Uploaded by

    Amir Izzuddin Suib
    50 views17 pages
    1. A 52-year-old man with diabetes and hypertension presented with palpitations and shortness of breath for 2 hours. He appeared drowsy, tachypneic, and unstable. 2. The initial steps are to assess ABCs, provide supplemental oxygen, start IV access, attach a defibrillator/ECG monitor to assess rhythm, and look for serious signs and symptoms. 3. Based on the ECG characteristics like heart rate, QRS width, and rhythm regularity, the arrhythmia can be classified as supraventricular tachycardia, ventricular tachycardia, polymorphic ventricular tachycardia, ventricular fibrillation, or torsades de

    Original Description:

    Approach to Tachy

    Original Title

    Approach to Tachy

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    1. A 52-year-old man with diabetes and hypertension presented with palpitations and shortness of breath for 2 hours. He appeared drowsy, tachypneic, and unstable. 2. The initial steps are to assess ABCs, provide supplemental oxygen, start IV access, attach a defibrillator/ECG monitor to assess rhythm, and look for serious signs and symptoms. 3. Based on the ECG characteristics like heart rate, QRS width, and rhythm regularity, the arrhythmia can be classified as supraventricular tachycardia, ventricular tachycardia, polymorphic ventricular tachycardia, ventricular fibrillation, or torsades de

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pptx, pdf, or txt
    50 views17 pages

    Approach To Tachyarrhythmia: SVT - VT - VF - Torsa de Pointes

    Uploaded by

    Amir Izzuddin Suib
    1. A 52-year-old man with diabetes and hypertension presented with palpitations and shortness of breath for 2 hours. He appeared drowsy, tachypneic, and unstable. 2. The initial steps are to assess ABCs, provide supplemental oxygen, start IV access, attach a defibrillator/ECG monitor to assess rhythm, and look for serious signs and symptoms. 3. Based on the ECG characteristics like heart rate, QRS width, and rhythm regularity, the arrhythmia can be classified as supraventricular tachycardia, ventricular tachycardia, polymorphic ventricular tachycardia, ventricular fibrillation, or torsades de

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pptx, pdf, or txt
    of 17

    Approach to

    Tachyarrhythmia

    SVT - VT VF Torsa de Pointes

    conductio
    basic
    anatom system
    n

    A 52 years old Malay


    gentleman, U/L DM and HTN
    came to ED HSM with chief
    complaints of palpitation and
    SOB for last 2 hour. Clinically
    patient
    look
    drowsy,
    tachypneic and was straight
    away push to red zone. So,
    what youre gonna do next?

    Management Approach
    Assess

    Management Approach

    Assess, clear and support ABCs


    Supplemental Oxygen
    IV access
    Attach defibrillator/ECG monitor and assess rhythm
    Tachycardia = >100bpm
    Wide complex: QRS >120ms, Narrow complex: QRS
    <120ms
    Assess vital sign, brief targeted history, and physical
    examination
    Obtain 12-lead ECG when available
    Look for serious sign and symptom (Hypotension, Altered
    mental status, SOB, Ischemic chest pain, Acute heart

    General approach
    Heart rate?
    Additional beats or missing beats?
    Broad or narrow
    Narrow: AV junction or above
    Broad: BBB, venricles or accessory
    pathway

    Uniform or multiform
    P waves?
    P = QRS Origin above AV junction.
    Likely due to sinus or atrial tachycardia
    P > QRS Suggest conduction block at
    AV junction

    Tachycardia
    Wide complexes

    Narrow complexes
    Regular
    Sinus
    tachycardia
    Atrial tacycardia
    Atrial flutter
    with fixed
    conduction
    Supraventricular
    tacycardia :
    - AV nodal re-entry
    tachycardia
    - AV re-entrant
    tachycardia( ortho
    dromic)
    - Junctional
    tachycardia

    Irregular

    Regular

    Irregular

    Atrial fibrillation
    Atrial flutter
    with variable
    conduction
    Multifocal atrial
    tachycardia

    Monomorphic
    ventricular
    tachycardia
    Supraventricular
    tachycardia with
    aberrant
    conduction
    AV re-entrant
    tachycardia
    (antidromic)
    Any regular
    tachycardia withh
    BBB or
    preexcitation

    Atrial fibrillation
    with WPW
    Polymorphic
    ventricular
    tachycardia
    Any irregular
    tachycardia with
    BBB or preexcitation
    Ventricular
    fibrillation

    Supraventricular Tachycardia (SVT)

    Defining criteria
    Rate

    120- 150 per minute

    QRS complex

    Normal and narrow

    Rhythm

    Regular

    P wave

    Seldom seen due to rapid rate


    because p wave hidden in the
    preceeding T waves

    Non pharmacological method


    Vagal manoeuvres
    Supine position preferred
    Possible technique
    Blow into 20ml syringe
    Straining like

    Maintain for 30 seconds and released after that

    Carotid sinus massage

    Not in elderly (atherosclerotic and risk of stroke)


    Ascultate for carotid bruit
    Record ecg lead during the procedure
    Circular motion 5-10 seconds.
    Stop if patient experience giddiness or unilateral weakness
    Watch ECG monitor for conversion to sinus rhythm
    If unsuccessful, you may repeat once after 1 minute, then retry on the
    opposite site

    Chemical cardioversion
    Adenosine

    Explain transient chest discomfort, flushing, nausea


    Record ECG lead during procedure
    IV access large proximal vein with 3 way connector
    Raised the arm arm and rapidly deliver 6mg IV push followed by 20ml saline flush
    May repeat up to 2x with 12mg after 1-2 minutes between attempts
    May cause VF, performed in monitored area with a defibrillator available

    Verapamil
    Constant infusion 1mg/min, max 20mg

    Diltiazem
    Constant infusion 2.5mg/min, max 50mg

    * If patient become unstable at anytime, synchronized electrical cardioversion should


    be perfom (50j, 100j, 150j, 200j)
    * Once converted, repeat vital sign and obtain 12-lead ECG

    Monomorphic VT

    Defining
    criteria
    Rate

    >100 per minute, typically 120-250 per minute

    QRS complex

    Wide and bizarre, PVC like complexes > 0.12sec

    Rhythm

    Regular ventricular rate

    P wave

    Seldomly seen but present

    Fusion beats

    Occasional chance capture of a conducted P wave


    Resulting QRS hybrid complex, part normal and
    part ventricle

    Nonsustained VT

    Last <30 sec

    Polymorphic VT

    Defining criteria
    Rate

    150 to 250 per minute

    QRS complex

    Display classic spindle node


    pattern

    Rhythm

    Irregular ventricular rhythm

    P wave

    Non-existent

    Ventricular fibrillation

    Defining criteria
    Rate

    150-300 per minute

    QRS complex

    Unable to determine, no recognizable P,QRS or T wave

    Rhythm

    Indeterminate

    Amplitude

    Can be described as
    Fine ( peak to trough 2 to < 5 mm)
    Medium ( 5 to <10mm)
    Coarse ( 10 to <15mm)
    Very coarse ( >15mm)

    Torsades De pointes

    Defining criteria
    Rate

    150 to 250 per minute

    QRS complex

    QRS showed continually changing of


    axis
    (turning of point)

    QT interval

    Prolonged

    Rhythm

    Irregular ventricular rhythm

    P wave

    Non existent

    You might also like