Tachydysrhythmias
Rule of thumb: Max HR = 220 – age; if it’s faster than that, it’s likely a dysrhythmia - Amal Mattu
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Amal Mattu – Tachydysrhythmias in the ICU You GOTTA Know!
In order to interpret tachydysrhythmias, you need to ask only THREE questions:
- Is the QRS narrow or wide
- Is the QRS regular or irregular
- Are there P waves (what’s the atrium doing)?
Notice that each of these possibilities only end in 3 possible diagnoses!
Resources
Pre-excitation syndromes
This page covers the pathophysiology and ECG features of pre-excitation syndromes in sinus rhythm. The two main forms of tachyarrhythmias that occur due to accessory pathways are discussed separately — see atrioventricular re-entry tachycardia (AVRT) and atrial fibrillation/flutter in pre-excitation.
Tachycardias – Approach, WIDER Mnemonic for Wide SVT DDx, VT vs SVT
If the patient has a non-sinus tachycardia but is stable, then further analysis of the ECG can identify the specific arrhythmia and guide management—based on QRS width, regularity and atrial activity.
Narrow Complex Tachycardias
The differential for narrow complex tachycardia is extremely important as it is the most commonly seen abnormal EKG in the emergency department. It includes rhythms such as sinus tachycardia, AVnRT, AVRT, atrial flutter, ectopic atrial tachycardia (EAT), atrial fibrillation, atrial flutter, and multifocal atrial tachycardia (MAT).
A Simplified Approach to Tachydysrhythmias
Tachydysrhythmias are defined as any abnormal cardiac rhythm with a rate greater than 100 beats per minute. The tachydysrhythmias include a large number of diagnoses including atrial (atrial fibrillation/flutter, supraventricular tachycardia (SVT), multifocal atrial tachycardia (MFAT)) and ventricular dysrhythmias (ventricular tachycardia (VT), ventricular fibrillation (VF) and Torsades de Pointes).
Ep 112 Tachydysrhythmias with Amal Mattu and Paul Dorion
In this EM Cases main Episode 112 Tachydysrhythmias with Amal Mattu and Paul Dorion we discuss a potpurri of clinical goodies for the recognition and management of both wide and narrow complex tachydysrhythmias...
Management of tachyarrhythmias: Out of Breath
Today in a general nutshell: Stable = meds first Unstable = shock first. Heart rates >140 are generally considered to be pathologic as this is when cardiac output begins to decrease.
Tachycardia DDx
Tachycardias are classified as regular or irregular, narrow complex or wide complex
Amal Mattu – Tachydysrhythmias in the ICU You GOTTA Know!
Dr. Amal Mattu is a master of many things, one of them being the EKG. We were fortunate enough to have him teach about something that are seen all the time, regardless of where you work (ED, ICU, outpatient office). The lecture was jam packed with pearls as usual.
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