APPROACH TO THE PATIENT WITH TACHYCARDIA

Tachycardia (> 100 bpm)

Narrow QRS

Wide QRS (> 0.12 s)

Regular rhythm

Irregular rhythm

No relationship between P waves and QRS

Constant relationship between P waves and QRS

> 3 P wave shapes

No distinct P waves

Ventricular Tachycardia

Supraventricular Tachycardia with Aberrant Conduction

Multifocal Atrial Tachycardia

Atrial Fibrillation

WPW

Seen in COPD’ers with pneumonia or respiratory distress; > 100 bpm

Irregularly irregular Atria @ 350-600 bpm Ventricles @ ~160 bpm

Short PR interval Delta wave (QRS) Wide QRS

Sinus Tachycardia

AVNRT

Non-reentrant Atrial Tachycardia

Atrial Flutter

Ventricular Premature Beats

Ventricular Tachycardia

Torsades De Pointes

Ventricular Fibrillation

Atria @ 100-180 bpm Normal P waves Slows with carotid massage.

Atria @ 150-250 bpm Inverted P (II, III, aVF) or Absent P before QRS or P following QRS

Atria @ 130-250 bpm Peaked P waves AV block may increase and does not revert

Atria @ 250-350 bpm Saw-toothed P waves 2:1 AV block most common

Often asymptomatic Not related to P wave Common following acute MI; appearance

100-200 bpm AV dissociation QRS may be mono- or polymorphic

Wide QRS with variant amplitudes “twisting” about baseline. QT prolongation

Chaotic, irregular appearance without discrete QRS forms Causes death rapidly

Abruptly returns to normal with carotid massage.

with carotid massage.

Slows, but does not revert with carotid massage.

of two or three in a row is marker of increased mortality.

Sustained if > 30 sec or requires termination due to severe symptoms.

Quinidine, procainamide, hypocalcemia, hypokalemia, hypomagnesemia

if not treated.