Click here to load reader

Managing supraventricular tachyarrythmias

  • View
    210

  • Download
    0

Embed Size (px)

Text of Managing supraventricular tachyarrythmias

MANAGING SUPRAVENTRICULAR TACHYARRYTHMIAS..

MANAGING SUPRAVENTRICULAR TACHYARRYTHMIAS..Dr. Abhishek DasChairperson- Dr. B. P. Chatterjee, DM

To define..Tachyarrythmia- sustained or non sustained forms of tachycardia arising from myocardial foci or reentrant circuits.

Tachycardia- rhythm producing ventricular rate >100 bpm

Supraventricular tachyarrythmia- tachycardia in which the driving circuit or focus arises, at least in part, in tisuues above the level of ventricles.

PSVT??? Non specific term ; encompass tachycardias with supraventricular QRS, regular R-R interval and no evidence of ventricular preexcitation.2

SA node:S.T.S.N.R.TAtrium:APCAtrial TachyMATAfibAFlutterAV Node:AVNRTAVRTSVT encompasses..Approach to management..

ECG approach..

Clinical evaluation in SVT Symptoms- Palpitations , Exertional fatigue/dyspnea ,Chest discomfort, Near-syncope (rarely syncope)

HISTORY : MODE OF ONSET AND TERMINATION Triggers Abruptness of onset and termination - Common in AVRT and AVNRT Frequency of episodes-- Incessant is often ATAbility to stop symptoms- Common in AVRT and AVNRT

Major SVT types

Mechanism of AVNRT

Mechanism of AVRT..

CASE 1 : 32 yrs F with palpitations , vitals stable

AV Nodal Reentrant Tachycardia(AVNRT)

CASE 1: how to treat??ACUTE ATTACKRest, Reassurance,Sedation

VAGAL Manoeuvre ( Valsalva,CSM, Mullers, ice water over face)

ADENOSINE- terminates 90% casesDose: 6-12 mg rapid intravenous

VERAPAMIL or DILTIAZEM rapid iv (if above manuevers fail)

Beta Blockers

CARDIOVERSION ?? DC shock synchronised, 10-50 Jules, in presence of hemodynamic instability, rarely neededCan precipitate Vfib in case of Digitalis toxicityAssess the need

DRUGS long acting CCBs or long acting Beta Blockers

ABLATION

95% long term cure

Complete heart block