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Tachydysrhythmias

Tachydysrhythmias is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Any disturbance of the heart's rhythm resulting in a rate >100 bpm
  • Sinus tachycardia:
    • Narrow complex regular rhythm at a rate of 100–150 bpm
    • Max. rate typically 220 minus age
    • Functional response to physiologic stress caused by increased catecholamine tone or decreased vagal stimulation
  • Supraventricular tachycardia (SVT):
    • A narrow complex tachycardia that originates above the His bundle
  • Regular SVT:
    • Atrial tachycardia
    • Junctional tachycardia:
      • Regular tachycardia without preceding depolarization waves
  • Irregular SVT:
    • Atrial fibrillation (AF)
    • Atrial flutter
    • Multifocal atrial tachycardia
  • Ventricular tachycardia (VT):
    • ≥3 consecutive ventricular ectopic beats at a rate of 100 bpm
    • Most common initiating rhythm in sudden death in patients with previous MI
  • Torsades de pointes:
    • Paroxysmal form of VT with undulating axis and prolonged baseline QT interval
    • Secondary to either congenital or acquired abnormalities of ventricular repolarization
    • Often the result of drug therapy or electrolyte disturbances
  • VF:
    • Oscillations without evidence of discrete QRST morphology
    • Accounts for 80–85% of sudden cardiac deaths
    • Frequently results from degeneration of sustained VT

Etiology

  • Sinus tachycardia:
    • Acute MI
    • Anemia
    • Anxiety
    • CHF
    • Drug intoxication
    • Hyperthyroidism
    • Hypovolemia
    • Hypoxia
    • Infection
    • Pain
    • Pericardial tamponade
    • Pulmonary embolus
  • Atrial tachycardia:
    • Precipitated by a premature atrial or ventricular contraction
    • Electrolyte disturbances
    • Drug toxicity
    • Hypoxia
  • Junctional tachycardia:
    • AV nodal re-entry
    • Myocardial ischemia
    • Structural heart disease
    • Pre-excitation syndromes
    • Drug and alcohol toxicity
  • AF:
    • HTN
    • Coronary artery disease
    • Hyper-/Hypothyroidism
    • Alcohol intake
    • Mitral valve disease
    • Chronic obstructive pulmonary disease
    • Pulmonary embolus
    • Wolf–Parkinson–White (WPW) syndrome
    • Hypoxia
    • Digoxin toxicity
    • Chronic pericarditis
    • Idiopathic AF
  • Atrial flutter:
    • Ischemic heart disease
    • Valvular heart disease
    • CHF
    • Myocarditis
    • Cardiomyopathies
    • Pulmonary embolus
    • Electrolyte abnormalities
    • Recent cardiac surgery
  • Multifocal atrial tachycardia:
    • Hypoxic effects of chronic lung disease
    • Theophylline toxicity
  • VT:
    • Dilated cardiomyopathy
    • Cardiac ischemia
    • Hypoxia
    • Cardiac scarring/fibrosis
    • After cardiac surgery or congenital anomaly repair
    • Digoxin toxicity
    • Long QT syndrome
    • Electrolyte abnormalities
  • Torsades de pointes:
    • Drug toxicity (antiarrhythmic class IA and III agents, antipsychotics, antibiotics, etc.)
    • Hypokalemia
    • Hypomagnesemia
    • Congenital QT prolongation
  • VF:
    • Acute MI (most common)
    • Chronic ischemic heart disease
    • Hypoxia
    • Acidosis
    • Anaphylaxis
    • Electrocution
    • Shock
    • Hypokalemia
    • Initiation of quinidine therapy
    • Massive hemorrhage

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Citation

Rosen, Peter, et al., editors. "Tachydysrhythmias." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307402/all/Tachydysrhythmias.
Tachydysrhythmias. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307402/all/Tachydysrhythmias. Accessed April 25, 2019.
Tachydysrhythmias. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307402/all/Tachydysrhythmias
Tachydysrhythmias [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307402/all/Tachydysrhythmias.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Tachydysrhythmias ID - 307402 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307402/all/Tachydysrhythmias PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -