Arrhythmia treatment options

This is a guest post from vanumu . You can also find and follow him on twitter @vanstar7. I am a huge fan of his work.

Essential concept lies with recognizing if the patient is stable or unstable.
UNSTABLE = “Chest pain, Shortness of Breath, Hypotension, Confusion means you’re not getting enough perfusion” (Dr.Fisher) = SHOCK!

For stable patients, you can consider medical management.

Here is the mnemonic I use to remember the drugs for each type of arrhythmia. Click on the image for a larger view.

Mnemonics overview:

1. Hard calcified matted lungs = MAT (Multifocal Atrial Tachycardia) due to LUNG problems = treat with Ca-Blocker
2. SVT “goes in to A DEN” = ADENOSINE for SupraVentricular Tachycardia
3. Flutter wave in the left atrium looks like “AM” = AMIODARONE for Atrial Flutter
4. “Gates” at AV junction = Rate control in Atrial Fibrillation
5. An accessory pathway(Kent bundle) that looks like P-shaped Cane= ProCAINE for Wolff-Parkinson-White
6. Lid and cane in the ventricle (lid + cane)and wave wrapping it = drug of choice for V Tach is AMiodarone, second line is LIDoCAINE

Overview of ECGs for mnemonic:

Click on the image for a larger view.

Important points for each arrhythmia:

MAT (Multifocal Atrial Tachycardia)

Usually due to lung problems/failure (matted lung)
presence of P waves (so not Atrial Fibrillation or SVT)
multiple P-wave morphologies = multifocal = MAT

Rx =
treat underlying cause (lungs = O2 therapy)
Ca-blockers (Verapamil or Diltiazem) (hard/calcified matted lungs)

SVT (Supraventricular Tachycardia)

Regular
Narrow QRS
HR>140
loss of P wave

Rx = “goes in to A DEN” = ADENOSINE (Verapamil #2 DOC)

(try vagal maneuvers first)
1. Carotid massage (CI in carotid stenosis)
2. Valsalva
3. Rectal stimulation

ATRIAL FLUTTER (sawtooth)

absolutely regular rhythm
Atrial:Ventricular rate ratio = 2:1 or 3:1 or 4:1
(makes it look like a lighthouse in a turbulent sea)
(A = 250-300 / V = 125-150)

Rx = the flutter wave in the left atrium = AMIODARONE

ATRIAL FIBRILLATION (AF) (irregularly, irregular)

Rx = Rate Control (GATE CONTROL)

Gold-colored Gate controllers control the number of beats that pass via the AV node, these are:

1. Ca channel-Blockers

2. Beta-Blockers

3. Digoxin (CHF pts)

AF with WPW = Procaine (DOC) or Disopyramide
Lone AF = Aspirin only
AF longer than 48 hrs = Anti-coagulants

Wolff-Parkinson-White (delta wave)

delta wave = slurrrrrrrred upstroke of the QRS wave

Rx = the cane looks like an accessory pathway(kent bundle) and shaped like a P (P + cane) = PROCAINE

Ventricular Tachycardia

three or more consecutive beats of ventricular origin at 120
Widddde complex QRS (a widddde lid stuck in the left ventricle)

= the lid and cane in the ventricle (lid + cane)and wave wrapping it

1. AMIODARONE (drug of choice)
2. LIDOCAINE

V TACH –> VF –> Asystole

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