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narrow complex tachycardia
Narrow complex tachycardias are almost always supraventricular tachycardia.
Prognosis is generally good.
Etiology: (excluding atrial fibrillation, atrial flutter)
1) junctional tachycardia
2) ectopic or multifocal atrial tachycardia
3) paroxysmal supraventricular tachycardia
4) sinus tachycardia
5) re-entry
Clinical manifestations:
- heart rate-related signs & symptoms seldon occur at rates < 150/min
Laboratory:
1) thyroid function testing
2) urine drug screen for amphetamines
3) 24 hour urine metanephrines if suspect pheochromocytoma
Special laboratory:
1) electrocardiogram
a) establish the rhythm
b) r/o WPW (re-entry)
2) saO2 monitor
Management:
1) attempt therapeutic/diagnostic maneuver
a) vagal stimulation (carotid sinus massage)
b) adenosine
2) unstable patient, with instability related to heart rate
- prepare for immediate synchronized DC cardioversion
3) consider sedative (benzodiazpeine, barbiturate) with or without analgesic (opiate)
5) at bedside:
a) suction device
b) IV line
c) setup for endotracheal intubation
Specific
AV junctional tachycardia
AV nodal re-entrant tachycardia (AVNRT)
orthodromic AV reciprocating tachycardia
sinus node re-entrant tachycardia
supraventricular tachycardia (SVT)
General
tachyarrhythmia (tachycardia)
References
- Manual of Medical Therapeutics, 28th ed, Ewald &
McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 141
- Shah RL, Badhwar N.
Approach to narrow complex tachycardia: non-invasive guide to interpretation
and management.
Heart. 2020;106:772-83.
PMID: 32303628
- American Heart Association