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Annotation 6936107814156

#Cardiologie #Cardiology #Tachyarrythmia #Tachyarrythmie #Tachycardie
The most important clinical determination in a patient presenting with a tachyarrhythmia is whether or not the patient is experiencing signs and symptoms related to the rapid heart rate. These can include hypotension, shortness of breath, chest pain suggestive of coronary ischemia, shock, and/or decreased level of consciousness
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t wait for a 12-lead ECG. The information acquired from these initial assessments is crucial for subsequent management of the patient. Is the patient clinically (or hemodynamically) unstable? — <span>The most important clinical determination in a patient presenting with a tachyarrhythmia is whether or not the patient is experiencing signs and symptoms related to the rapid heart rate. These can include hypotension, shortness of breath, chest pain suggestive of coronary ischemia, shock, and/or decreased level of consciousness. Determining whether a patient's symptoms are related to the tachycardia depends upon several factors, including age and the presence of underlying cardiac disease. ●Hemodynamically uns



Annotation 6936108862732

#Cardiologie #Cardiology #Tachyarrythmia #Tachyarrythmie #Tachycardie
If a patient has clinically significant hemodynamic instability potentially due to the tachyarrhythmia, an attempt should be made as quickly as possible to determine whether the rhythm is sinus tachycardia (algorithm 1). If the rhythm is not sinus tachycardia, or if there is any doubt that the rhythm is sinus tachycardia, urgent conversion to sinus rhythm is recommended.
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a patient's symptoms are related to the tachycardia depends upon several factors, including age and the presence of underlying cardiac disease. ●Hemodynamically unstable and not sinus rhythm – <span>If a patient has clinically significant hemodynamic instability potentially due to the tachyarrhythmia, an attempt should be made as quickly as possible to determine whether the rhythm is sinus tachycardia (algorithm 1). If the rhythm is not sinus tachycardia, or if there is any doubt that the rhythm is sinus tachycardia, urgent conversion to sinus rhythm is recommended. (See "Narrow QRS complex tachycardias: Clinical manifestations, diagnosis, and evaluation", section on 'Similar to sinus rhythm' and "Basic principles and technique of external electric



Annotation 6936109911308

#Cardiologie #Cardiology #Tachyarrythmia #Tachyarrythmie #Tachycardie
If the patient is not experiencing hemodynamic instability, a nonemergent approach to the diagnosis of the patient's rhythm can be undertaken [1-3]. A close examination of the 12-lead ECG should permit the correct identification of the arrhythmia in 80 percent of cases [4].
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xternal electrical cardioversion and defibrillation" and "Wide QRS complex tachycardias: Approach to the diagnosis", section on 'Assessment of hemodynamic stability'.) ●Hemodynamically stable – <span>If the patient is not experiencing hemodynamic instability, a nonemergent approach to the diagnosis of the patient's rhythm can be undertaken [1-3]. A close examination of the 12-lead ECG should permit the correct identification of the arrhythmia in 80 percent of cases [4]. (See 'Is the QRS complex narrow or wide? Regular or irregular?' below and "Narrow QRS complex tachycardias: Clinical manifestations, diagnosis, and evaluation", section on 'Evaluation'



Annotation 6936110959884

#Cardiologie #Cardiology #Tachyarrythmia #Tachyarrythmie #Tachycardie

● Narrow QRS complex tachyarrhythmias have a QRS complex <120 milliseconds in duration

● Wide QRS complex tachyarrhythmias have a QRS complex ≥120 milliseconds in duration
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n the width, morphology, and regularity of the QRS complex (algorithm 2). In most patients, the differentiation between narrow and wide QRS complex tachyarrhythmias requires only a surface ECG. <span>●Narrow QRS complex tachyarrhythmias have a QRS complex <120 milliseconds in duration ●Wide QRS complex tachyarrhythmias have a QRS complex ≥120 milliseconds in duration The various types of narrow and wide QRS complex tachyarrhythmias are discussed below. (See 'Narrow QRS complex tachyarrhythmias' below and 'Wide QRS complex tachyarrhythmias' below.) N



Annotation 6936112008460

#Cardiologie #Cardiology #Tachyarrythmia #Tachyarrythmie #Tachycardie

The regular narrow QRS complex tachycardias include (algorithm 2) [3]:

● Sinus tachycardia (see "Sinus tachycardia: Evaluation and management")

● Inappropriate sinus tachycardia (see "Sinus tachycardia: Evaluation and management", section on 'Inappropriate sinus tachycardia')

● Sinoatrial nodal reentrant tachycardia (SANRT) (see "Sinoatrial nodal reentrant tachycardia (SANRT)")

● Atrioventricular nodal reentrant tachycardia (AVNRT) (see "Atrioventricular nodal reentrant tachycardia")

● Atrioventricular reentrant (or reciprocating) tachycardia (AVRT) (see "Atrioventricular reentrant tachycardia (AVRT) associated with an accessory pathway")

● Atrial tachycardia (AT) (see "Focal atrial tachycardia")

● Atrial flutter (see "Overview of atrial flutter")

● Intraatrial reentrant tachycardia (IART) (see "Intraatrial reentrant tachycardia")

● Junctional ectopic tachycardia

● Nonparoxysmal junctional tachycardia

● Idiopathic ventricular tachycardia (see "Ventricular tachycardia in the absence of apparent structural heart disease")
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dias will be divided into those with a regular ventricular response and those with an irregular ventricular response (algorithm 3 and algorithm 1). Regular narrow QRS complex tachyarrhythmias — <span>The regular narrow QRS complex tachycardias include (algorithm 2) [3]: ●Sinus tachycardia (see "Sinus tachycardia: Evaluation and management") ●Inappropriate sinus tachycardia (see "Sinus tachycardia: Evaluation and management", section on 'Inappropriate sinus tachycardia') ●Sinoatrial nodal reentrant tachycardia (SANRT) (see "Sinoatrial nodal reentrant tachycardia (SANRT)") ●Atrioventricular nodal reentrant tachycardia (AVNRT) (see "Atrioventricular nodal reentrant tachycardia") ●Atrioventricular reentrant (or reciprocating) tachycardia (AVRT) (see "Atrioventricular reentrant tachycardia (AVRT) associated with an accessory pathway") ●Atrial tachycardia (AT) (see "Focal atrial tachycardia") ●Atrial flutter (see "Overview of atrial flutter") ●Intraatrial reentrant tachycardia (IART) (see "Intraatrial reentrant tachycardia") ●Junctional ectopic tachycardia ●Nonparoxysmal junctional tachycardia ●Idiopathic ventricular tachycardia (see "Ventricular tachycardia in the absence of apparent structural heart disease") Because the vast majority of regular narrow QRS complex tachycardias are due to sinus tachycardia, AVNRT, AVRT, AT, and atrial flutter, these conditions will be presented here. Discussi



Annotation 6936113057036

#Cardiologie #Cardiology #Tachyarrythmia #Tachyarrythmie #Tachycardie
In patients with sinus tachycardia and certain forms of heart disease, such as coronary disease or aortic stenosis, treatment may need to be directed at the heart rate itself. In such cases, cautious use of an intravenous beta blocker is appropriate.
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olemia, anemia, hyperthyroidism, fever, pain, or anxiety). This may include volume replacement or diuresis, antibiotics, anti-pyretics, oxygen, pain control, or other treatments as appropriate. <span>In patients with sinus tachycardia and certain forms of heart disease, such as coronary disease or aortic stenosis, treatment may need to be directed at the heart rate itself. In such cases, cautious use of an intravenous beta blocker is appropriate. (See "Sinus tachycardia: Evaluation and management" and "Acute myocardial infarction: Role of beta blocker therapy" and "Medical management of symptomatic aortic stenosis".) Atrioventri



Annotation 6936114105612

#Cardiologie #Cardiology #Tachyarrythmia #Tachyarrythmie #Tachycardie
For patients with AVNRT who are hemodynamically unstable related to their arrhythmia, we recommend immediate DC cardioversion
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the tachycardia (eg, angina, hypotension, or heart failure) require rapid termination of the arrhythmia. (See "Atrioventricular nodal reentrant tachycardia", section on 'Initial management'.) ●<span>For patients with AVNRT who are hemodynamically unstable related to their arrhythmia, we recommend immediate DC cardioversion. Consideration for using vagal maneuvers (Valsalva maneuver or carotid sinus massage) is also reasonable if it does not delay cardioversion. (See "Vagal maneuvers".) ●For patients with



Annotation 6936115154188

#Cardiologie #Cardiology #Tachyarrythmia #Tachyarrythmie #Tachycardie
For patients with AVNRT associated with severe symptoms due to the tachycardia (eg, angina, hypotension, heart failure, or mental status changes) in whom intravenous access is available, we suggest an initial attempt at termination with adenosine rather than cardioversion. If adenosine cannot be administered or is ineffective, patients should undergo immediate DC cardioversion
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immediate DC cardioversion. Consideration for using vagal maneuvers (Valsalva maneuver or carotid sinus massage) is also reasonable if it does not delay cardioversion. (See "Vagal maneuvers".) ●<span>For patients with AVNRT associated with severe symptoms due to the tachycardia (eg, angina, hypotension, heart failure, or mental status changes) in whom intravenous access is available, we suggest an initial attempt at termination with adenosine rather than cardioversion. If adenosine cannot be administered or is ineffective, patients should undergo immediate DC cardioversion. ●For patients with AVNRT that is not associated with severe symptoms or hemodynamic collapse, including patients without symptoms, we suggest the following sequential approach to acute



Annotation 6936116202764

#Cardiologie #Cardiology #Tachyarrythmia #Tachyarrythmie #Tachycardie

For patients with AVNRT that is not associated with severe symptoms or hemodynamic collapse, including patients without symptoms, we suggest the following sequential approach to acute termination:

• Vagal maneuvers (see "Vagal maneuvers")

• IV adenosine

• IV non-dihydropyridine calcium channel blocker or an IV beta blocker
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e suggest an initial attempt at termination with adenosine rather than cardioversion. If adenosine cannot be administered or is ineffective, patients should undergo immediate DC cardioversion. ●<span>For patients with AVNRT that is not associated with severe symptoms or hemodynamic collapse, including patients without symptoms, we suggest the following sequential approach to acute termination: •Vagal maneuvers (see "Vagal maneuvers") •IV adenosine •IV non-dihydropyridine calcium channel blocker or an IV beta blocker Atrioventricular reentrant tachycardia (AVRT) — Patients with any arrhythmia (ie, orthodromic AVRT, antidromic AVRT, atrial fibrillation/flutter) involving an accessory pathway should h