Approach to the Patient with Narrow Complex Tachycardia

Approach to the Patient with Narrow Complex Tachycardia - Flowchart Narrow Complex Tachycardia Narrow Complex Tachycardia

Flowchart

See Chapter 39 for general approach to the patient with an arrhythmia

End

Narrow complex tachycardia

Key observations (Table 1.1)
Oxygen, ECG monitor, IV access
Focused assessment (Table 39.1)

Table 1.1

Table 39.1

Stabilize airway and breathing
Call resuscitation team
DC cardioversion
Refer to cardiologist

Patient unstable?

Yes

Table 42.1

Table 42.2

Vagotonic maneuvers

Adenosine IV (Table 42.3)

Table 42.3

Likely diagnosis is AVNRT or AVRT (Fig. 42.1) Refer to cardiologist if:

ECG in sinus rhythm shows pre-excitation (Wolff-Parkinson-White syndrome)
Episodes of supraventricular tachycardia (SVT) are frequent/severe
Associated cardiac disease

Likely diagnosis is AVNRT or AVRT (Fig. 42.1) Refer to cardiologist if:

ECG in sinus rhythm shows pre-excitation (Wolff-Parkinson-White syndrome)
Episodes of supraventricular tachycardia (SVT) are frequent/severe
Associated cardiac disease

Likely diagnosis is AVNRT or AVRT (Fig. 42.1) Refer to cardiologist if:

Fig. 42.1

ECG in sinus rhythm shows pre-excitation (Wolff-Parkinson-White syndrome)
Episodes of supraventricular tachycardia (SVT) are frequent/severe
Associated cardiac disease

Sinus rhythm restored?

Yes

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Likely diagnosis is atrial flutter (Fig. 42.2) or atrial tachycardia
Control heart rate (Tables 42.4 and 43.2)
Refer to cardiologist

Fig. 42.2
42.4 43.2

Sinus rhythm restored?

Yes

12-lead ECG and rhythm strip: regular or irregular tachycardia?

Regular

Irregular