Tachycardia: Difference between revisions
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→Differentiation between SVT and VT
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===Definitions:=== | ===Definitions:=== | ||
'''Tachycardia:''' heartrate above 100 bpm | '''Tachycardia:''' | ||
: heartrate above 100 bpm | |||
'''Small complex tachycardia:''' QRS duration < 120 ms. | '''Small complex tachycardia:''' | ||
A small complex tachycardia is most likely to be a SVT. However, also a septal VT or His-tachycardia can appear as a small complex tachycardia. | : QRS duration < 120 ms. | ||
: A small complex tachycardia is most likely to be a SVT. However, also a septal VT or His-tachycardia can appear as a small complex tachycardia. | |||
'''Broad complex tachycardia:''' | |||
: QRS duration > 120 ms. | |||
: A broad complex tachycardia can be due to a SVT with aberration, pre-exited tachycardia (eg antidrome re-entry tachycardia) or VT. | |||
===Differentiation:=== | ===Differentiation:=== | ||
(Figure 1, small complex tachy algorithm) | (Figure 1, small complex tachy algorithm) | ||
(Figure 2, broad complex tachy algorithm) | (Figure 2, broad complex tachy algorithm) | ||
===Treatment:=== | ===Treatment:=== | ||
'''Haemodynamical instability (high heartrate, low blood pressure):''' electrical cardioversion | '''Haemodynamical instability (high heartrate, low blood pressure):''' | ||
* electrical cardioversion | |||
'''Haemodynamical stability in a regular small complex tachycardia:''' | '''Haemodynamical stability in a regular small complex tachycardia:''' | ||
* Carotid massage (after palpation and ausculatation of carotid arteries for exclusion of carotid occlusion/stenosis) | |||
* Vasalva manoevre | |||
* Adenosine bolus (if patient is not asthmatic or having COPD) | |||
* Verapamil (if patient is not having systolic heart failure) | |||
* Beta-blocker (if patient is not having systolic heart failure) | |||
'''Haemodynamical stability in a regular monomorphic broadcomplex tachycardia (systolic blood pressure >100 mmHg:''' | '''Haemodynamical stability in a regular monomorphic broadcomplex tachycardia (systolic blood pressure >100 mmHg:''' | ||
* Procaïnamide | |||
* Amiodaron | |||