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Supraventricular Tachycardias

Supraventricular Tachycardias. Types: . SA source: Sinus tachy , SANRT Atrial source: EAT, MAT, AF, Aflut AV source: AVNRT , AVRT , JET. A-Flutter. Classical saw-tooth appearance on ECG .

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Supraventricular Tachycardias

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  1. SupraventricularTachycardias

  2. Types: • SA source: Sinus tachy, SANRT • Atrial source: EAT, MAT, AF, Aflut • AV source: AVNRT, AVRT, JET

  3. A-Flutter • Classical saw-tooth appearance on ECG. • Treatment/management essentially follows AF however flutter typically responds well to a low energy DC or to pace cardioversion • Often relatively insensitive to antiarrhythmic drugs.

  4. Aflutter.Typical saw tooth baseline

  5. Atrial Fibrillation • Most common sustained arrhythmias • Assoc. w/ ↑ CVS morbidity & mortality and preventable stroke. • CLASSIFICATIONS (3P’s) • Paroxysmal – self-ltd <24hrs • Persistant – recurrent >2days • Permanent – cardioversion unsuccessful

  6. AF - prevention • ↓ incidence: ACE inhib, ARB’s & statins • Prevent after cardiac surgery with pre-op β-blockers, sotalol, amiodarone and statins

  7. AF - causes • Cardiac: • IHD, cardiac failure, HTN, MI, PE, mitral valve Dz, CAD, ASD, cardiomyopathies, pericarditis, atrial myxoma, endocarditis. • Non- Cardiac: • Lung CA, pneumonia, hyperthyroidism, electrolyte imbalances, haemochromatosis, sarcoidosis, amyloidosis, phaeochromocytoma • Other: • Drugs, alcohol, caffeine • Lone AF • Familial

  8. AF – from Hx • Details of palpitaions • Precipitating factors • Onset/offset • Nature • Duration • Assoc. Sx • Medications/drug use/alcohol/caffeine • Past medical Hx • Family Hx

  9. AF – S&S • Can be asymptomatic • Chest pain • Palpitations • Dyspnoea • Dizziness • Irreg. irreg. pulse • Apical PR > radial PR

  10. AF - Ix • Bloods: U&E, cardiac enzymes, thyroid fxn tests • ECHO: left atrial enlargement, MV dz, ↓ LV function any other abnormalities • CXR • ECG - later

  11. AF - mangement 3 main objectives of treatment: • ID and treat causative factors (may abort arrhythmia) • Decide on rate or rhythm control (maintain sinus rhythm or control HR?) • Prevent thromboembolism – CHADS SCORE

  12. Linear relationship btw CHADS2 score and risk of stroke with AF

  13. CHADS2 scores, stroke risk, and risk levels CHADS2 scores, stroke risk, and risk levels

  14. AF – acute mgmt <48hrs • If very unwell: O2, cardioversion, IV amiodarone • Tx assoc. illnesses • Control ventricular rate (1st choices: diltiazem, verapamil, metoprolol • Fully anti-coag: LMWH (keeps options open for cardioversion) • Cardioversion or drug cardioversion • For drug: amiodarone or flecainide

  15. AF – long term mgmt • Rate or rhythm control? • RHYTHM: cardioversion (echo, pre-treat with Sotalol or amiodarone for >4wks if req.). Drug cardioversion. • RATE: Digoxin only in elderly sedentary. Others: atenolol, metroprololdiltiazem or verapamil are 1st line when there is failure to control exercise induced tachy. • Anti-coag – CHADS2. usually given atleast aspirin.

  16. AF – Paroxysmal mgmt • Pill in pocket method often tried. • Sotalol or flecainide if infrequent, BP 100mg and no past LV dysfunction. • May also anticoag.

  17. Absent P waves, erratic electrical activity instead. Irregularly irregular rate – no pattern Narrow QRS complexes ECG in AF - Absent P waves, erratic electrical activity instead. - Irregularly irregular rate – no pattern - Narrow QRS complexes

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