Management of symptomatic sinus bradycardia

Management of sinus tachycardia

Management of supraventricular tachycardia

• Includes atrial fibrillation, AV re-entry tachycardia and AV nodal re-entry tachycardia

Management of SVT with adverse features

• Adverse features: heart failure, ischaemia, shock, syncope
• Patients with adverse features should be given synchronised DC shock

Management of SVT in stable patients

• If the rhythm is regular:
  • Vagal manoeuvres such as carotid sinus massage or Valsalva manoeuvre first
  • If this fails, administer IV adenosine 6mg
    • Prior to administering adenosine, patients must be warned that they might experience difficulty breathing, chest tightness and flushing
• If the rhythm is irregular manage as AF according to algorithm

Management of ventricular tachycardia with pulse

• Unstable with pulse - DCCV
• Stable monomorphic VT - anti-arrhythmic drugs first line (amiodarone or lignocaine), DCCV if medical therapy fails
• Stable TdP - IV magnesium sulphate, stop QT prolonging drugs, correct electrolyte abnormalities
• See ventricular tachycardia notes for more detail