Makindo Medical Notes

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The difficulty may be determining if tachycardia is the cause of the issue needing treatment or a caused by the issue or drugs e.g. salbutamol. Most sinus tachycardias not usually over 140/min in resting patient. Treat the cause e.g. Pneumonia, LVF and review. Context helps.

Introduction

• Sinus tachycardia may be seen due to underlying disease. The max heart rate is 220-age for men and 210 - age for women
• Arrhythmia + Following are signs of Unstable patient: syncope, shock, angina, heart failure/dyspnoea suggest instability needing urgent action
• Narrow complex tachycardias rarely cause collapse and usually benign and patient can usually be discharged when treated
• Wide complex tachycardias may cause collapse and may be due to VT and patients will need admitted and cardiology consult
• Get a 12-lead ECG of the arrhythmia which will be essential to distinguish VT from SVT and can help determine form of SVT or VT.
• Assume however that a broad complex tachycardia is VT unless you have incontrovertible evidence to the contrary. DC cardioversion treats both.

Investigations

• FBC,U&E, Troponin, Lipids, Glucose 12-lead ECG
• Uncertain of the diagnosis of a broad complex tachycardia?

Management

• Stable (Narrow Complex SVT): IV Adenosine (6-12 mg) fast injection + Vagal manoeuvres or Verapamil 5-10 mg slow IV (Avoid if broad complex)
• Stable (AF): IV Digoxin or Amiodarone 300 mg in 60 min followed by 900 mg/24 h until sinus rhythm restored (into central venous catheter)
• Unstable (VT/AF/ SVT): DC cardioversion with sedation. Amiodarone, 300 mg in 30-60 min followed by 900 mg/24 h until sinus rhythm restored (into central venous catheter). The first dose may be given into large vein. Sotalol, 2 mg/kg IV over 30 min
• Unstable (VT) Broad complex. Lidocaine (lignocaine) 100 mg as IV bolus over a few min followed immediately by IV magnesium (See below) infusion of 1-4 mg/min Magnesium sulphate, 8 mmol over 10-15 min
• Unstable (Torsade) Broad complex. Magnesium sulphate, 8 mmol over 10-15 min. Overdrive pacing

Tachycardia (UK)

Tachycardia (AHA)