narrow complex tachycardia

Introduction

Narrow complex tachycardias are almost always supraventricular tachycardia.

Prognosis is generally good.

Etiology

(excluding atrial fibrillation, atrial flutter)

• junctional tachycardia
• ectopic or multifocal atrial tachycardia
• paroxysmal supraventricular tachycardia
• sinus tachycardia
• re-entry

Clinical manifestations

• heart rate-related signs & symptoms seldon occur at rates < 150/min

Laboratory

• thyroid function testing
• urine drug screen for amphetamines
• 24 hour urine metanephrines if suspect pheochromocytoma

Diagnostic procedures

• electrocardiogram
  • establish the rhythm
  • r/o WPW (re-entry)
• saO2 monitor

Management

• attempt therapeutic/diagnostic maneuver
  • vagal stimulation (carotid sinus massage)
  • adenosine
• unstable patient, with instability related to heart rate
  • prepare for immediate synchronized DC cardioversion
• consider sedative (benzodiazpeine, barbiturate) with or without analgesic (opiate)
• at bedside:
  • suction device
  • IV line
  • setup for endotracheal intubation

More general terms

• tachyarrhythmia (tachycardia)

More specific terms

• AV junctional tachycardia
• AV nodal re-entrant tachycardia (AVNRT)
• orthodromic AV reciprocating tachycardia
• sinus node re-entrant tachycardia
• supraventricular tachycardia (SVT)