When is tachycardia an emergency

If it's bothersome, a cardiologist can do an oblation where they find the spot that's causing that premature beat and get rid of it. But usually, it's not a serious thing where you need to rush right into the ER and get that diagnosed.

Madsen: For some people, it happens more frequently. Others, may never even notice it when it's happening, you know. In some cases, people do feel it.

They may notice it more when they exercise or they're walking, so it varies from person to person. And in the case of where you would go to the ER if it was continual and it lasted for a while, what could that be an indication of? Madsen: Yes. So that could sometimes be an indication of more serious things. The most serious thing being ventricular tachycardia where your heart is just racing.

And that can be a life-threatening thing. Keep an eye out for these telling symptoms:. If you experience unusual heart rate, please visit one of our emergency rooms.

Our ERs are open 24 hours a day, 7 days a week for your emergency room needs and health concerns, and we have all of the equipment necessary to diagnose and treat most medical conditions.

Our board-certified physicians will get you taken care of within the comforts of our fully-stocked facility. Electrical cardioversion also can be used for rhythm control in stable patients. There is an association between ED electrocardioversion and perceived ED effectiveness by patients receiving this modality; however, no association was found between this mode of treatment and a day quality of life score.

Pharmacologic rhythm control especially has adverse effects in acutely ill patients. The goal with ablation is to eliminate the arrhythmogenic foci. Ablation generally is indicated in patients who are anticoagulated and continue to have symptomatic occurrences despite appropriate pharmacotherapy.

It can be considered first-line in patients who have symptomatic, paroxysmal AF. This risk of progression is thought to be related to the time spent in AF. It seems that younger patients benefit more from ablation overall, but it can be effective in select older individuals.

SVT is a general term that describes any tachycardia originating from above the bundle of His. See Figure 4. The anatomical difference is that with AVRT there is a myocardial strand that creates an electrical bridge between the atrium and the ventricle.

This circuit generally involves two pathways: a fast pathway usually anterograde and a slow pathway usually retrograde. It is important to differentiate between the two terms because knowing if the AV node is the primary culprit will predict whether an AV-blocking agent is going to be effective. Women are affected more than men at a ratio of approximately Commonly, P waves are not visible.

AVRT can lead to wide QRS complexes if there is antidromic conduction if the ventricles are depolarized by the accessory pathway , resulting in a wide-complex tachyarrhythmia that can be confused with VT. While these two entities can be difficult to differentiate on an ECG, the safest approach is to treat any unstable, wide-complex tachyarrhythmia as ventricular tachycardia.

In the stable patient, use vagal maneuvers first. There are many techniques for this, such as asking the patient to bear down as if having a bowel movement or having the patient blow into a 5-cc syringe. These techniques work by increasing the intrathoracic pressure, causing stimulation of the baroreceptors in the carotid bodies and aortic arch, in turn causing vagal stimulation and activation of the parasympathetic vagal nervous system.

In this study, the researchers compared the standard Valsalva to a modified Valsalva: starting patients in the semi-recumbent position, then having them bear down and then laying them flat and performing a passive leg raise. If vagal maneuvers prove ineffective, second-line treatments include adenosine and diltiazem. Currently, adenosine is the preferred drug for SVTs that present to the ED and do not resolve with vagal maneuvers. Adenosine has a short half-life and rare adverse effects.

By causing a temporary AV block and slowing the rhythm, the true dysrhythmia such as AF or AVRT can be seen more clearly and diagnosed more accurately.

In ACLS, the standard algorithm is to first give a 6 mg dose, followed by a 12 mg push if needed , which can be repeated one additional time. In patients who fail vagal maneuvers and adenosine and remain hemodynamically stable, it is reasonable to try a calcium channel blocker or beta-blocker. Calcium channel blockers are considered more efficacious. The potential side effects of calcium channel blockers include hypotension and bradycardia.

Adenosine still is preferred since these drugs last much longer in the system than adenosine. In , Dogan et al retrospectively investigated the effectiveness of adenosine vs. In patients with paroxysmal symptoms, outpatient beta-blockers, diltiazem, or verapamil may be appropriate if there is no evidence of pre-excitation on ECG.

If all of the pharmacologic methods have failed, synchronized cardioversion then can be performed even in the hemodynamically stable patient to prevent further strain on the heart. VT can be classified as monomorphic or polymorphic. Monomorphic VT has long been thought to be more common; however, more recently, this was found to be true only in certain settings, such as in the CCU and the catheterization lab, and did not necessarily hold true in the ED.

Monomorphic and polymorphic VT can be caused by myocardial ischemia as well as dilated cardiomyopathy or hypertrophy and their subsequent changes to the myocardial architecture. These complexes are all uniform and are more likely to have signs of AV dissociation such as capture beats and fusion complexes.

Lead II, monomorphic ventricular tachycardia at rate of Patients may present with chest pain, palpitations, shortness of breath, syncope, seizures, or in cardiac arrest.

Remember to obtain an ECG in the seizure patient, as seizure-like activity can be due to cerebral hypoxia from an arrhythmia and would not be cured by antiepileptic medications. Women also were more likely to benefit from an ICD but, interestingly, were referred less frequently than men for ICD placement.

Monomorphic VT usually is seen when a circuit around a region of scar tissue is present, except in one rare subtype found in structurally normal hearts.

This rare subtype originates from the right ventricular outflow tract. It can be identified by a left bundle branch block pattern with tall R waves in the inferior leads on ECG. Generally, this type of VT does not result in hemodynamic decompensation as does traditional VT, thus its ECG characteristics can be reassuring. Polymorphic VT encompasses torsades de pointes TdP and a bidirectional subtype.

Polymorphic VTs are driven by ischemia and are associated with frequent ectopic ventricular beats and an R on T phenomenon. However, TdP can be thought of as a distinct entity that is highly affected by electrolyte concentrations. The best treatment for this arrhythmia is to re-perfuse the heart. In the case of TdP, electrolyte abnormalities also should be corrected immediately. Following successful percutaneous coronary intervention, the arrhythmia usually will resolve.

This determination is essential for safe treatment, as an AV-nodal blocking agent will terminate many SVTs but has the potential to cause serious harm if given in the setting of VT. In stable patients, many algorithms have been employed to attempt differentiation of these entities.

Examples include the Brugada 51 and Vereckei 52 algorithms. Although both of these show very good specificity for VT and thus may be helpful if they are able to confirm SVT with aberrancy, neither demonstrates good sensitivity. Several newer algorithms also have been proposed; however, in a study comparing many of these head to head, none were found to have significant sensitivity to be used confidently in clinical practice.

Since it is not completely possible to rule out SVT with aberrancy in a wide-complex tachycardia, and assuming this incorrectly could result in serious consequences, when in doubt, all wide-complex tachycardias should be treated as VT. In an unstable patient who still has a pulse, the treatment is very straightforward: Treat with DC cardioversion. Following successful cardioversion, an amiodarone drip should be considered to maintain sinus rhythm, and the patient should be admitted to the hospital.

The treatment of stable monomorphic VT is controversial. The most effective treatment is certainly DC cardioversion; however, in stable patients, there are several antiarrhythmic medications that can be tried. These include procainamide, amiodarone, lidocaine, ajmaline, sotalol, propafenone, and flecainide. Lidocaine, once a mainstay antiarrhythmic, has fallen out of favor in the treatment of VT with preserved ejection fraction.

Corresponding author. Duane S Pinto: ude. Received Apr 24; Accepted Aug 5. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL. Abstract Background The emergency department diagnosis of sinus versus nonsinus tachycardia is an important clinical challenge.

Results As age and heart rate increased, nonsinus tachycardias became more frequent. Conclusion Nonsinus tachycardia is significantly more common than sinus tachycardia in elderly patients in the emergency department. Background Tachycardia is a very common clinical finding in the emergency department ED , and the differential diagnosis is often challenging. Statistical Analysis To develop a simple screening system to estimate the likelihood of ST versus NST, we used the following procedure.

Open in a separate window. Conclusions Based on our ED findings, physicians caring for subjects in the ED should have a very high suspicion for a primary NST, rather than a secondary ST, particularly in the elderly, tachycardic subject. KH and AP performed the statistical analysis and assisted in manuscript preparation.

All authors have read and approved the final manuscript. Competing Interests None declared. Acknowledgements This work was supported by a grant from the G. References Applied Logistic Regression. McComb JM. Tachycardias in the elderly. J R Soc Med. Electrocardiographic abnormalities in the sick elderly.

Age Ageing. Prevalence, age distribution, and gender of patients with atrial fibrillation.