Cardiology Ex.4 - EKG Rhythms and Mgmt only

Ventricular Tachycardia

*Pulseless VT - CPR/ACLS, DC cardioversion

*With pulse in those with heart disease, hypotension, HF or ischemia - Immediate synchronized cardioversion, amiodarone if recurrent

*VT with pulse and more stable - IV amiodarone (DOC), IV lidocaine, +/- short acting BB or CCB

Rhythm?

Management?

Sinus bradycardia

*DC AV nodal slowing agents; r/o underlying disease; depends on associated symptoms

*Atropine

*External Pacing (starting rate for TCP is 60-80/min

*TCP contraindicated in hyopthermia and not recommended tx for asystole

Rhythm?

Management?

Sick Sinus Syndrome

Permanent pacemaker placement (usually dual chamber)

Rhythm?

Management?

Premature Atrial Complexes (PAC/PAB)

Usually no treatment necessary.

If sx's - treat underlying cause and sometimes use BB

Rhythm?

Management?

Multifocal Atrial Tachycardia (MAT)

Treat the underlying disease

Rhythm?

Management?

Atrial Fibrillation

*Replace K+ and Mg++

*Rate control - BB, CCB, digoxin (not used much)

*Rhythm control - amiodarone, ibutilide, flecainide

*Anticoagulation (CHA2DS2-VASc) - Dabigatran, rivaroxaban, apixaban, edoxaban, warfarin, heparin, aspirin?

*Cardioversion - electrical or chemical (amiodarone)

*Ablation (could include pulm vein isolation PVI)

*MAZE procedure

Rhythm?

Management?

Atrial Flutter

Electrical cardioversion or Ibutilide

May require catheteter ablation

In general - tx is same as afib

Rhythm?

Management?

Supraventricular Tachycardia (SVT)

Vagal maneuvers - valsalva

Medications - IV adenosine 6mg, IV CCB's, IV BB's

Cardioversion if unstable or refractory to meds and maneuvers - synchronized start at 100

Prevention - radiofrequency catheter ablation (recurrent symptomatic reentrant PSVT)

Rhythm?

Management?

First Degree AV Block

May not require treatment

Rhythm?

Management?

Second Degree AV Block - Mobitz Type 1 (Wenckebach)

Atropine - acutely

Permanent pacemaker insertion - long term

Rhythm?

Management?

Second Degree AV Block - Mobitz Type II

Address transient reversible causes

Atropine (acute)

Permanent pacemaker (long-term)

Rhythm?

Management?

Third Degree AV Block - AKA Complete Heart Block

Address reversible causes

Temporary pacemaker (acutely)

Permanent pacemaker (long-term)

Rhythm?

Management?

Torsades de Pointes

CPR/ACLS

IV magnesium

defibrillate

Rhythm?

Management?

Ventricular Fibrillation

ACLS (defibrillation, epinephrine, antiarrhythmics)

Therapeutic hypothermia

Rhythm?

Management?

Sinus Rhythm with Multifocal PVCs

If sx's - Beta Blockers or non-Dihydropyridine CCBs

Rhythm?

Management?

Pulseless Electrical Activity (PEA)

Determine cause - CPR/ACLS

Rhythm?

Management?

Asystole

High quality CPR, Epinephrine

Rhythm?

Management?

Brugada Syndrome

Implantable Cardioverter Defibrillator (ICD)

Rhythm?

Management?