Although procainamide, lidocaine and sotalol are proven to be effective and even preferred by some clinicians, amiodarone (Class III antiarrhythmic with potassium, calcium, and sodium channel blocking properties) remains the primary antiarrhythmic agent in the prehospital setting for wide complex tachycardia.
Which medications are used in the treatment of QRS tachycardia?
Beta-blockers and calcium channel blockers may be considered for narrow QRS tachycardia (QRS <0.12 sec) For stable, wide QRS complex tachycardia (QRS ≥0.12 sec) Strongly consider expert consultation Consider procainamide 20-50 mg/min IV, OR
What are antiarrhythmic infusions for a stable wide QRS?
Antiarrhythmic infusions for a stable wide-QRS consider Procainamide, Amiodaone or Sotalol IV. Procainamide dose is 20–50 mg/min until the arrhythmia is suppressed, the patient becomes hypotensive, the QRS duration increases more than 50% or the maximum dose of 17 mg/kg is reached.
What is the initial management of tachycardia?
For tachycardia, assess appropriateness for clinical considering and treating the underlying cause. Tachycardia is heart rate over 150 beats per minute. Maintain a patent airway and assist breathing as necessary. Administer oxygen if hypoxic. Place the patient on a cardiac monitor to identify rhythm and monitor blood pressure and oximetry.
What should nurses know about antiarrhythmic drugs?
Nurses, pharmacists, and other healthcare workers who look after patients with heart disease should be very familiar with the different antiarrhythmic agents. All antiarrhythmic drugs are also potentially pro-arrhythmic. Intravenous administration should be performed only under cardiac monitoring.
What medication is used for wide complex tachycardia?
The treatment of choice is IV procainamide, probably the only time you'll reach for this agent. Amiodarone would not be the agent to use long term given its side effects. Immediate cardioversion would not be the best choice because the patient is having this rhythm intermittently and is hemodynamically stable.
Which medication therapy is first line treatment for stable supraventricular tachycardia SVT )?
Adenosine (Adenocard) Adenosine is the first-line medical treatment for the termination of paroxysmal SVT. It is a short-acting agent that alters potassium conductance into cells and results in hyperpolarization of nodal cells.
What is the first line treatment for tachycardia?
Calcium channel blockers are typically used as the first line of treatment. However, some authors consider magnesium sulfate to be the drug of choice. Most patients with MAT require hospital admission to further manage their underlying cardiopulmonary diseases.
What is a first line treatment for a patient with unstable tachycardia?
Unstable patients with tachycardia should be treated with synchronized cardioversion as soon as possible. Stable patients with tachycardia with a palpable pulse can be treated with more conservative measures first.
Which of the following is the drug of choice for a patient with stable ventricular tachycardia?
Amiodarone is the drug of choice for acute VT refractory to cardioversion shock. After recovery, oral medications are used for long-term suppression of recurrent VT. Current evidence favors class III antiarrhythmic drugs over class I drugs.
How do you treat stable SVT?
If you have recurring episodes of SVT, you may need to take medicines, either on an as-needed basis or daily. Medicine treatment may include beta-blockers, calcium channel blockers, or other antiarrhythmic medicines. In people who have frequent episodes, treatment with medicines can decrease how often these occur.
What is the most common treatment for tachycardia?
Drugs to control the heart rate and restore a normal heart rhythm are typically prescribed for most people with tachycardia. Catheter ablation. In this procedure, a health care provider threads one or more thin, flexible tubes (catheters) through an artery, usually in the groin, and guides them to the heart.
Is metoprolol used for tachycardia?
Metoprolol appears to be an effective and safe drug in the treatment of supraventricular tachycardia.
Is metoprolol used for atrial tachycardia?
We conclude that metoprolol is effective in the management of multifocal atrial tachycardia.
How do you treat a wide QRS complex?
Treatment / ManagementSVT will typically be managed with adenosine, Afib with WPWS will be treated with amiodarone, and Afib with aberrancy with either diltiazem or a beta-blocker.Typically, amiodarone will be the first-line drug of choice for all ventricular arrhythmias (VT, polymorphic VT, Vfib, etc.)More items...•
What is the first step in the treatment of persistent tachycardia causing hypotension?
Assess the individual's hemodynamic status and begin treatment by establishing IV, giving supplementary oxygen, and monitoring the heart. Heart rate of 100 to 130 bpm is usually the result of an underlying process and often represents sinus tachycardia.
Can amiodarone be used for SVT?
Background— Intravenous amiodarone and procainamide are both used as therapies for refractory supraventricular tachycardia (SVT).
What does a QRS complex of 120 mean?
A QRS complex wider than 120 milliseconds is usually associated with ventricular tachycardia (VT)—meaning the impulse originates in the ventricles, below the atrioventricular node. That's not always the case, however. If it's narrow, it has to be SVT.
What is tachycardia in 2021?
Updated on May 16, 2021. Tachycardia (rapid heart rate ) is one of the more complicated dysrhythmias to treat because it has so many presentations and so many causes. This article focuses on the treatment of cardiac-related unstable tachycardia in the emergency setting by prehospital professionals.
Why is the QRS narrow?
This is the normal conduction pathway, and the only way the QRS can be narrow is if the impulse travels through it properly. Because the impulse has to start above the ventricles in a narrow-complex tachycardia, it's also known as supraventricular tachycardia (SVT).
Why isn't a 12-lead ECG available?
One reason not to treat tachycardia unless it's hemodynamically unstable is because of the possibility of treating a wide-complex tachycardia as ventricular tachycardia when it is not. Taking that chance when the patient is in significant danger of cardiac arrest is acceptable. ...
What is the primary factor to consider when considering hemodynamic stability?
Outside of a hospital, the primary factor to consider is hemodynamic stability —that is, the stability of blood flow from the heart to the brain. When there is hemodynamically unstable tachycardia, the chambers of the heart do not have enough time to fill with blood between contractions. A patient with no obvious signs of hemodynamic instability ( ...
What does it mean when the QRS is narrower than 120 milliseconds?
When the QRS is narrower than 120 milliseconds (three little boxes on the ECG strip) it indicates that the heart's electrical impulse originated in the atria and traveled down through the atrioventricular (AV) node to the bundles of HIS and the Purkinje fibers, which are located in the ventricles.
What is the best way to treat low blood pressure?
Patients that do not have low blood pressure but have other symptoms (dizziness, heart palpitations) can sometimes be treated with IV fluids or drugs, such as adenosine. 2 . Adenosine must be given via rapid IV push. Initial dose is 6 mg, but if that doesn't work, a follow-up dose of 12 mg can be tried.