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Tachycardia Algorithm

 

Tachycardia and its ACLS Algorithm

Tachycardia/tachyarrhythmia is defined as a rhythm with a heart rate greater than 100 bpm.
An unstable tachycardia exists when cardiac output is reduced to the point of causing serious signs and symptoms.
Serious signs and symptoms commonly seen with unstable tachycardia are: chest pain, signs of shock, SOA, altered mental status, weakness, fatigue, and syncope

One important question you may want to ask is: “Are the symptoms being caused by the tachycardia?” If the symptoms are being caused by the tachycardia treat the tachycardia.

There are many causes of both stable and unstable tachycardia and appropriate treatment within the ACLS framework requires identification of causative factors. Before initiating invasive interventions, reversible causes should be identified and treated.

Causes

The most common causes of tachycardia that should be treated outside of the ACLS tachycardia algorithm are dehydration, hypoxia, fever, and sepsis. There may be other contributing causes and review of the H’s and T’s of ACLS should take place as needed.

Administration of OXYGEN and NORMAL SALINE are of primary importance for the treatment of causative factors of sinus tachycardia and should be considered prior to ACLS intervention.

Once these causative factors have been ruled out or treated, invasive treatment using the ACLS tachycardia algorithm should be implemented.

Associated Rhythms

There are several rhythms that are frequently associated with stable and unstable tachycardia these rhythms include:

Visit the links above to learn about each specific rhythm.

ACLS Treatment for Tachycardia

Click below to view the tachycardia algorithm diagram. When done click again to close the diagram. Tachycardia Algorithm Diagram. or Members Download the Hi-Resolution PDF Here

The fist question that should be asked when initiating the ACLS tachycardia algorithm is: “Is the patient stable or unstable?” The answer to this question will determine which path of the tachycardia algorithm is executed.

Patients with unstable tachycardia should be treated immediately with synchronized cardioversion. If a pulseless tachycardia is present patients should be treated using the pulseless arrest algorithm.

Patients with stable tachycardia are treated based upon whether they have a narrow or wide QRS complex. The following flow diagram shows the treatment regimen for stable tachycardia with narrow and wide QRS complex.

  • Stable (narrow QRS complex) → vagal maneuvers → adenosine (if regular) → beta-blocker/calcium channel blocker → get an expert
  • Stable (wide/regular/monomorphic) → adenosine → consider antiarrhythmic infusion → get an expert



  124 Responses to “Tachycardia Algorithm”

  1. I have a patient with RDH presenting with AF in rapid ventricular response (HR 180), no detectable BP, diaphoretic, non compliance to medication. The patient did not consent for Cardioversion, what is the best antiarrhythmic agent that i could give?

    • I’m not sure what RDH stands for. Afib with RVR can be treated in a variety of ways. Here is a link to the AHA recommendations for the treatment of Atrial Fibrillation. (It is a PDF file)
      AHA Recommendations for the treatment of atrial fibrillation
      It sounds like the patient’s perfusion was significantly compromised. I hope he was ready for some serious chest compressions and an ET tube. I would have chosen the less invasive cardioversion if I were him.

      Kind regards,
      Jeff

      • Sorry it was RHD (Rheumatic Heart Disease) not RDH.
        But is it warranted to cardiovert if the AF is already permanent? The patient was previously admitted 4 months ago with noted AF already. Thanks

      • If the patient has a history of chronic A-fib then they would most likely be being managed by a cardiologist. Unless the patient is unstable and the unstable condition is related to the Atrial fibrillation, it probably would not be advisted to perform cardioversion. If the patient is unstable and cardioversion is necessary, you would need to rule out any thrombus which can occur in the patient with chronic Afib.
        Kind regards,
        Jeff

  2. Regarding Torsade, why is MgSo4 given slowly when the patient is already arrested and is on CPR? Also, is it true that Amiodarone losses some of its effect if given after MgSO4, or vise versa? Thanks

    • When magnesium is given during cardiac arrest for the treatment of Torsades, it should be started as soon as possible, AHA recommendations are over 5-20 minutes but it can be rapid pushed. It can be pushed rapidly over 60 seconds, but may cause hypotension due to a direct vasodilating effect.
      I am not aware of amiodarone losing or gaining effectiveness from the administration of MgSO4. Kind regards, Jeff

  3. For aha purposes for acls what criteria is used to determine weather patient is considered stable/unstable other than the obvious unresponsive

  4. Why use adenosine for monomorphic VT? Wouldn’t I be better to use amiodarone or synchronized cardioversion?! I’ve never seen adenosine used for VT ever, nor have I seen a doctor order it… Is this new to ACLS algorithm?

  5. this algorithm has always been difficult for me …I’m not sure why …

  6. Jeff,

    This is probably a dumb question, but what is SOA? As in “Serious signs and symptoms commonly seen with unstable tachycardia are: chest pain, signs of shock, SOA, altered mental status, weakness, fatigue, and syncope”

    Thanks!
    Bonnie

    • Nevermind, Jeff, I figured it out — SOA = Shortness Of Air. I’ve always used SOB = Shortness Of Breath.

      Thanks again!
      Bonnie

      • SOA-Sons of Anarchy- things get confusing when people start to substitute new words for old nomenclature and abbreviations- screw being PC- it’s SOB-SHORTNESS OF AIR would mean less air in your surrounding environment. Keep using SOB, it’s what we all know!!!!!!!!!!!!!!!!!!!

      • Different regions use different abbreviations. SOA means “short of air.” Kind regards, Jeff

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