Phys · cardiovascular
Arrhythmias and Conduction Disease
Also known as arrhythmia · SVT · supraventricular tachycardia · AVNRT · AVRT · VT · ventricular tachycardia · Torsades de pointes · atrial flutter · heart block · AV block · Mobitz · bradycardia · sick sinus syndrome · bundle branch block · bifascicular block · pacemaker · ICD · adenosine · cardioversion
Consultant-physician-depth guide to tachy- and bradyarrhythmias — the stability rule, SVT and adenosine, AF rate/rhythm strategy and anticoagulation evidence, VT and Torsades, ICD primary prevention, heart block and pacing decisions, and conduction disease — structured for FRACP DWE and DCE preparation.
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FRACP DWEFRACP DCEMRCP Part 2MRCP PACESABIM Internal Medicine
Red flags
- Any tachyarrhythmia with shock, pulmonary oedema, ischaemic chest pain or reduced conscious level — synchronised cardioversion now, drugs later
- Wide-complex tachycardia in structural heart disease — treat as VT; verapamil can kill
- Pre-excited AF (irregular wide-complex tachycardia with varying QRS width) — AV nodal blockers contraindicated
- Polymorphic VT with a long QT — Torsades: stop the offending drug, give magnesium, do not reach for amiodarone
- Syncope with bifascicular block or documented Mobitz II/complete heart block — asystole risk, pacing decision
Arrhythmias and Conduction Disease
Meet the patient
A 72-year-old on the ward two days after a bowel resection is suddenly breathless with a regular narrow-complex tachycardia at 170. He is talking, but his systolic pressure is 86 and his chest is tight. The registrar reaches for adenosine.[1]
The move that wins is one stability rule dictates — synchronised cardioversion, not a drug. Before you name any rhythm, judge the blood pressure, the chest, the lungs and the conscious level: adverse features buy the rhythm a shock regardless of its name.[1]
References25ShowHide
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- [2]Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society J Am Coll Cardiol, 2016.PMID 26409259
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- [20]Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial N Engl J Med, 1991.PMID 1900101
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