Junctional tachycardia: Difference between revisions
Farmersj333 (talk | contribs) |
Farmersj333 (talk | contribs) |
||
Line 27: | Line 27: | ||
**Avoid administration in the setting of aberrancy | **Avoid administration in the setting of aberrancy | ||
**JET will concomitant 3 degree AVB is rare | **JET will concomitant 3 degree AVB is rare | ||
*Consider JET underlying causes to include | |||
**Electrolyte abnormalities | |||
**Acidosis | |||
**Cardiovascular surgery within 24-48 hrs | |||
==Management== | ==Management== |
Revision as of 23:37, 21 December 2020
Background
- Rare
- Cardiac impulses originate at the AV junction
- AV node
- Bundle of His
- Also referred to as Junctional Ectopic Tachycardia (JET) or Congenital Ectopic Tachycardia (CJET) if present at birth
- Rate exceeds the upper limit seen in normal sinus rhythm
- In adults, >100 bpm
- In pediatric patients it varies by age until age 8 or 9 (see pediatric vital signs)
Clinical Features
- Clinical features vary widely, diagnosis usually made via ECG
- Past medical hx may include recent cardiovascular surgery
Differential Diagnosis
Narrow-complex tachycardia
- Regular
- AV Node Independent
- Sinus tachycardia
- Atrial tachycardia (uni-focal or multi-focal)
- Atrial fibrillation
- Atrial flutter
- Idiopathic fascicular left ventricular tachycardia
- AV Node Dependent
- AV Node Independent
- Irregular
- Multifocal atrial tachycardia (MAT)
- Sinus tachycardia with frequent PACs, PJCs, PVCs
- Atrial fibrillation
- Atrial flutter with variable conduction
- Digoxin Toxicity
Evaluation
- ECG findings
- P waves
- may be antegrade, retrograde, or absent depending on depolarization of the atrial relative to the ventricles
- QRS complexes
- Narrow in the absence of aberrancy
- P waves
- May be distinguished from AVNRT via Adenosine administration
- If JET is present, atrial depolarization will briefly terminate and reveal AV dissociation
- If AVNRT is present, conversion to sinus rhythm will likely occur
- Avoid administration in the setting of aberrancy
- JET will concomitant 3 degree AVB is rare
- Consider JET underlying causes to include
- Electrolyte abnormalities
- Acidosis
- Cardiovascular surgery within 24-48 hrs