Supravetricular Tachyarrhythmias Part 2

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SupravetricularTachyarrhythmiasPart 2

• Rey Vivo, MD
• Assistant Professor of Medicine
• Texas Tech University Health Sciences Center

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Objectives

• Describe the AVNRT
• Recognize and differentiate the Supraventricular
  Tachyarrhythmias
• PRACTICE, PRACTICE, PRACTICE!!!

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Review of last week

• The two mechanisms that
• produce arrhythmias are
• Automaticity
• (problems of impulse
• formation)
• 2. Block or Reentry
• (problems of impulse
• conduction)

• Two most important aspects of arrhythmias
• 1. Their mechanism
• 2. Their site of origin

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SVTs

• Accelerated Automaticity
• Sinus Tachycardia
• Atrial Tachyarrhythmias
• e.g. PAT with Block, MAT
• 3. Accelerated Junctional Rhythm
• Reentrant Atrial Tachyarrhythmias
• Atrial Flutter
• Atrial Fibrillation
• Reentrant Junctional Tachyarrhythmias
• - The Atrioventricular Nodal and Bypass
  Tachycardias

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RJT

• Reentrant Junctional Tachyarrhythmias
• AVNRT Atrioventricular Nodal Reentrant
  Tachycardia
• Atrioventricular Bypass Tachycardia

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AVNRT
Rate 140 220 beats/minute Usually 11
atrial-ventricular association Every QRS has a
P (concealed, fused or retrograde)
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AVNRT
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AVNRT
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SVT Differentials
SVT Rate Rhythm P wave Adenosine effect
Sinus tach 100 - (220-age) Regular Discrete anterograde P waves Gradual slowing, then reaccelerates
AAR 140 - 250 Regular Not sinus antegrade P Gradual slowing to reveal atrial activity
MAT gt 100 Irregular gt 3 different forms in 1 lead NA
AJR 60 - 130 Regular Inverted, absent or after QRS Gradual slowing, then reaccelerates
Flutter A 220-430 V lt300 Regular or Reg. Irreg. F waves Gradual slowing to reveal atrial activity
Fibrillation A 350-650 V slow to rapid Irreg. Irreg. f waves Gradual slowing to reveal atrial activity
AVNRT 140-220 (AV 11) Regular Absent or discrete retrograde P waves Breaks abruptly, converts to sinus
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Narrow Complex Tachs

• Regular
• Normal ante Ps..ST
• Abnormal Ps
• Rate lt 140.AJR
• Rate gt 140
• Ante PAAR
• No or Retro P...AVNRT
• F waves.Flut

• Irregular
• Polymorphic Ps..MAT
• f waves.Fib
• (Reg. irreg, F...Flut)

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Lets practice!

• Bix rule
• Whenever the P of an SVT is halfway between QRS
  complexes always suspect that an extra P is
  hiding within the QRS

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EKG 1
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EKG 2
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EKG 3
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EKG 4
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EKG 5
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EKG 6
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EKG 7
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EKG 8
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EKG 9
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EKG 10
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The End