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)

1 Comment

  1. lisekempler

    Epic podcast! Thanks Zack – super useful

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