Tachycardia (narrow)

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Evaluation

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 (SVT) 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

Management

See also ACLS: Tachycardia

A fib/flutter

  • Rate control: Dilt, MTP, Digoxin
    • Dig usually only helpful when already with a block (e.g. 2:1)
  • Cardioversion: Sotalol, electric
  • See Atrial Fibrillation (RVR)

AVNRT (SVT)

  • Vagal, adenosine, beta-blockers, calcium-channel blockers, dixogin, electric, procainamide, amio, sotalol

Junctional

Remove the cause, Amiodarone, beta-blockers, calcium-channel blockers

MAT

  • Diltiazem
  • Beta blockers often contraindicated (MAT occurs frequently with pulmonary disease)

See Also

Authors

Michael Holtz