Tachycardias
Status Done
Parent item Conduction of the Heart
Category Cardiovascular Emergency
Complete
Tachycardias are heart rates > 100 bpm and QRS (narrow < 120ms; wide
Define
>120ms) with regular / irregular rhythm
classification 1. supraventricular tachycardias : narrow QRS
- sinus tachycardias
-
atria tachycardias : focal / multifocal
- Afib , AFL (
🫀 🫀
Atrial Fibrillation , Atria Flutter )
-
PSVT: AVNRT , AVRT (narrow QRS)
Tachycardias 1
, - Junctional tachycardias
2.
ventricular tachycardias: wide QRS
-VT
🫀 Ventricular Tachycardias
-
long QT syndrome: torsades de pointes
-
Vfib. VFL
- SVT +
aberrant conduction ( abnormal conduction due to Bundle branch block,
accessory pathway , conduction delay)
palpitations, SOB, chest pain, dizzy, syncope, headache , sweating
s/s * underlying disease condition s/s
* complication: SCD
Atrial Tachycardias (Premature Atrial Contractions)
Focal Atrial Tachycardia (FAT)
Define electrical impulses originating outside from SA node
1. idiopathic (common)
causes/ rf 2. cardiac : HTN, MI, cardiomyopathy, myocarditis , alcohol (> Afib) ,
3. Drugs: digoxin toxicity , cocaine
asymptomatic / general tachycardia signs and symptoms + underlying disease
s/s
c/m
1. PE and Hx
2.
ECG :
- rate and rhythm :atria rate > 100 bpm , regular rhythm
- P wave : same morphology for all (depends on origin) eg. if near SA node =
dx
same as sinus rhythm ; if away from SA node = p wave may be inverted
(II,III,AVF)
- QRS complex: normal , narrow
- isoelectric baseline (P wave), can differ with Afl
3. underlying disease invs
tx 1. self limiting
2.
unstable FAT: electrical cardioconversion
3. Stable FAT:
- vagal maneuvers : coughing ,carotid massage
Tachycardias 2
, - drugs: adenosine ( if suspected) ; CCB(verapamil, diltiazem), BB-metoprolol,
esmolol (confirm)
4. Tx underlying causes
5. persist symptoms: pacemaker/ ablation
💡 pathophysiology : *from a single focal location
1. triggered activity
2. micro-reentry
3. enhanced automaticity
green: normal sinus rhythm ; red: FAT, with constant different P wave morphology
Multifocal Atrial Tachycardia(MAT)
multiple electrical conductions originating outside from SA node ; irregular
Define
SVT >3 morphology of P waves
Tachycardias 3
, 1. commonly ass/ COPD (pneumonia , embolism)
2. cardiac disorders : MI, HF, cardiomyopathies , HTN
causes / rf
3. drugs: theophylline
4. electrolyte imbalances -hypokalaemia , systemic disturbances
s/s asymptomatic / tachycardia s/s + underlying disease symptoms
1. PE and Hx
2.
ECG :
- Rate and rhythm : rate > 100 bpm ; rhythm : irregularly irregular (~ Afib)
- P waves : > 3 types , PR interval variable
dx
- QRS:narrow and normal
- can lead to Afib ***
* MAT have distinct P waves ; Afib no distinct P waves
3. underlying disease invs
1. tx underlying causes
2.
rate control : BB , CCB
tx
3. ablation in refractory cases
** avoid cardioconversion and antiarrhythmic drugs
PSVT : paroxysmal SVT
From time to time ; intermittent
AVNRT:
Define a presence of re-entry circuit within/ adjacent to AV node (most common)
1. Idiopathic
2. cardiac diseases
causes / rf
3. usually associated with PAC
4.risk : caffeine, alcohol, female , drugs
s/s asymptomatic / tachycardia s/s
Tachycardias 4
Status Done
Parent item Conduction of the Heart
Category Cardiovascular Emergency
Complete
Tachycardias are heart rates > 100 bpm and QRS (narrow < 120ms; wide
Define
>120ms) with regular / irregular rhythm
classification 1. supraventricular tachycardias : narrow QRS
- sinus tachycardias
-
atria tachycardias : focal / multifocal
- Afib , AFL (
🫀 🫀
Atrial Fibrillation , Atria Flutter )
-
PSVT: AVNRT , AVRT (narrow QRS)
Tachycardias 1
, - Junctional tachycardias
2.
ventricular tachycardias: wide QRS
-VT
🫀 Ventricular Tachycardias
-
long QT syndrome: torsades de pointes
-
Vfib. VFL
- SVT +
aberrant conduction ( abnormal conduction due to Bundle branch block,
accessory pathway , conduction delay)
palpitations, SOB, chest pain, dizzy, syncope, headache , sweating
s/s * underlying disease condition s/s
* complication: SCD
Atrial Tachycardias (Premature Atrial Contractions)
Focal Atrial Tachycardia (FAT)
Define electrical impulses originating outside from SA node
1. idiopathic (common)
causes/ rf 2. cardiac : HTN, MI, cardiomyopathy, myocarditis , alcohol (> Afib) ,
3. Drugs: digoxin toxicity , cocaine
asymptomatic / general tachycardia signs and symptoms + underlying disease
s/s
c/m
1. PE and Hx
2.
ECG :
- rate and rhythm :atria rate > 100 bpm , regular rhythm
- P wave : same morphology for all (depends on origin) eg. if near SA node =
dx
same as sinus rhythm ; if away from SA node = p wave may be inverted
(II,III,AVF)
- QRS complex: normal , narrow
- isoelectric baseline (P wave), can differ with Afl
3. underlying disease invs
tx 1. self limiting
2.
unstable FAT: electrical cardioconversion
3. Stable FAT:
- vagal maneuvers : coughing ,carotid massage
Tachycardias 2
, - drugs: adenosine ( if suspected) ; CCB(verapamil, diltiazem), BB-metoprolol,
esmolol (confirm)
4. Tx underlying causes
5. persist symptoms: pacemaker/ ablation
💡 pathophysiology : *from a single focal location
1. triggered activity
2. micro-reentry
3. enhanced automaticity
green: normal sinus rhythm ; red: FAT, with constant different P wave morphology
Multifocal Atrial Tachycardia(MAT)
multiple electrical conductions originating outside from SA node ; irregular
Define
SVT >3 morphology of P waves
Tachycardias 3
, 1. commonly ass/ COPD (pneumonia , embolism)
2. cardiac disorders : MI, HF, cardiomyopathies , HTN
causes / rf
3. drugs: theophylline
4. electrolyte imbalances -hypokalaemia , systemic disturbances
s/s asymptomatic / tachycardia s/s + underlying disease symptoms
1. PE and Hx
2.
ECG :
- Rate and rhythm : rate > 100 bpm ; rhythm : irregularly irregular (~ Afib)
- P waves : > 3 types , PR interval variable
dx
- QRS:narrow and normal
- can lead to Afib ***
* MAT have distinct P waves ; Afib no distinct P waves
3. underlying disease invs
1. tx underlying causes
2.
rate control : BB , CCB
tx
3. ablation in refractory cases
** avoid cardioconversion and antiarrhythmic drugs
PSVT : paroxysmal SVT
From time to time ; intermittent
AVNRT:
Define a presence of re-entry circuit within/ adjacent to AV node (most common)
1. Idiopathic
2. cardiac diseases
causes / rf
3. usually associated with PAC
4.risk : caffeine, alcohol, female , drugs
s/s asymptomatic / tachycardia s/s
Tachycardias 4
