Tachycardia

Summary: <br> Basic Approach<br> <br> <br> <br> * Step 1: Is this SINUS tachycardia? * P before every QRS? * Treat the underlying condition* Step 2: Is this a NARROW and REGULAR rhythm?* SVT* Treat with vagal maneuvers or adenosine* Another new trend is treating with calcium channel blockers!! * ORTHOdromic Wolf Parkinson White* Treat with adenosine* Atrial flutter with fixed block* Treat with AV blockers (diltiazem)* Slows the heart rate* Step 3: Is this a NARROW and IRREGULAR tachycardia?* Almost always atrial fibrillation* Treat with AV blockers (diltiazem)* Other (less common) diagnoses* Atrial flutter with variable block* Multifocal atrial tachycardia* Step 4: Is this a WIDE and REGULAR tachycardia?* Assume ventricular tachycardia until proven otherwise* Treatment is immediate cardioversion if unstable* May try chemical cardioversion if stable* Procainamide* Amiodarone* Lidocaine* Other diagnoses* ANTIdromic Wolf Parkinson White* Narrow complex tachycardias PLUS aberrancy* Step 5: Is this a WIDE and IRREGULAR tachycardia?* Atrial fibrillation with bundle branch block* Extremely fast and bizarre in appearance? * Consider atrial fibrillation with Wolf Parkinson White<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Calcium Channel Blockers for Stable SVT <a href="https://www.aliem.com/calcium-channel-blockers-stable-svt-alternative-to-adenosine/">(ALiEM)</a>* Atrial Fibrillation in WPW – Pearls and Pitfalls<a href="http://blog.clinicalmonster.com/2018/02/22/bored-review-atrial-fibrillation-wpw-syndrome/"> (County EM)</a><br>