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“Unstable” Arrhythmias
  • Arrhythmias that cause
    • Hypotension
    • Pulmonary Edema
    • Chest Pain
    • Altered Mental Status
Supraventricular Tachycardia (SVT)
  • Stable
    • Vagal maneuver
    • Adenosine
    • Beta blocker or calcium channel blocker
  • Unstable
    • SYNCHRONIZED cardioversion
Monomorphic Ventricular Tachycardia (VT)
  • Stable
    • Amiodarone
    • Procainamide
    • Lidocaine
  • Unstable
    • SYNCHRONIZED cardioversion
  • Pulseless
    • Defibrillation

Polymorphic Ventricular Tachycardia (aka Torsades de Pointes)

  • Known complication of prolonged QTc
    • Side effect of multiple medications
      • Antipsychotics
      • Methadone
      • Ondansetron
  • Give Magnesium Sulfate
High yield EKG patterns
  • Long QTc
  • Wolf Parkinson White (WPW)
  • Brugada Pattern
Atrial Fibrillation
  • Stable
    • Patient presents immediately after onset (<24-48 hours)
      • Synchronized cardioversion
      • Rhythm control medications
        • Amiodarone
        • Procainamide
        • Flecanide
  • Patient does not present immediately (or unknown onset)
    • Rate control
      • Beta blockers
        • Metoprolol
      • Calcium channel blocker
        • Diltiazem
    • Anticoagulation (heparin)
  • Unstable
    • Synchronized cardioversion
  • Atrial fibrillation with extremely fast rate (200+) is common in WPW
  • Atrial fibrillation with slow rate is common with Digoxin toxicity
Bradycardia
  • AV Blocks
    • 1st Degree
    • 2nd degree (type 1)
    • 2nd degree (type 2)
    • 3rd degree
  • If symptomatic and stable…
    • Atropine
  • If they become unstable…
    • Transcutaneous or transvenous pacing
Additional Reading