Narrow-complex tachycardia

Differential A. Rhythm A.rate A. morphology Vagal/adenosine A Fib Irregular >350 Fibrillatory (V1) Incr. AV block A Flutter Regular >250, <350 Sawtooth (II, III, AVF) Incr. AV block A Tach Regular >100 Neg in II, III, AVF Nothing AVNRT Regular >160 No p's --> NSR Junctional Regular >100, <150 No p's or retrograde p's Nothing MAT Irregular >100 >3 p shapes Transient slowing Sinus Regular >100 <180

Normal Transient slowing

Flutter vs coarse AFib: determine atrial regularity by taking big bites

TREATMENT:

Digoxin usually only helpful when already c a block (i.e. AF c 2:1 block) NOT c an SVT c 1:1 conduction.

AFib: IV Beta-block> IV digoxin > CCB (diltiazem) > Type IA to covert to SR

• CARDIOVERSION if UNSTABLE* start c 80joules

AFlutter: same as AFib

AT: same as AFib

AVNRT: CSM > adenosine > then Beta blockers > CCB > Digoxin PO. Consider eCV (not if low LVEF), ?procanamide , amio, sotalol.

Junctional: remove the cause, Amiodarone(, Beta-blocker, CCB).

ST: B blocker > CCB > Digoxin

MAT: Verapamil/ Diltiazem. CAREFUL of Beta-blockers b/c usually in pts with pulmonary dz. Amiodarone