Tachycardia

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Basic Approach

• 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

Additional Reading

• Calcium Channel Blockers for Stable SVT (ALiEM)
• Atrial Fibrillation in WPW – Pearls and Pitfalls (County EM)