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Tachycardia due to Medications

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1. Tachycardia due to Medications

Tachycardia due to Medications Tachycardia due to Medications Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Tachycardia due (...) to Medications Tachycardia due to Medications Aka: Tachycardia due to Medications , Drug Induced Tachycardia , Toxin Induced Tachycardia From Related Chapters II. Causes: Mnemonic=FAST Free Base ( ) s, s or s s or Solvent abuse Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Tachycardia due to Medications." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related

2018 FP Notebook

2. Sympathectomy for Stabilization of Heart Failure Due to Drug-Refractory Ventricular Tachycardia. (PubMed)

Sympathectomy for Stabilization of Heart Failure Due to Drug-Refractory Ventricular Tachycardia. We describe the novel use of bilateral cardiac sympathectomy in a woman with end-stage heart failure caused by ventricular tachycardia refractory to standard medical therapy who was under consideration for heart transplantation. Postoperatively, our patient has not experienced any symptoms of ventricular tachycardia, has returned to normal physical activity, and is no longer under consideration (...) for transplantation as a result of the improvement in her cardiac function. Bilateral sympathectomy can be more effective than unilateral sympathectomy or percutaneous stellate ganglion blockade in patients with refractory ventricular tachycardia. Careful patient selection is necessary to identify patients who will benefit most from the procedure.Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

2018 Annals of Thoracic Surgery

3. Assessment of tachycardia

narrow-complex arrhythmias include: atrial fibrillation, atrial flutter with variable conduction, and multifocal atrial tachycardia. An irregular wide-complex tachycardia may be due to pre-excited atrial fibrillation (due to a rapidly anterograde-conducting bypass tract), polymorphic ventricular tachycardia and atrial fibrillation, or multifocal atrial tachycardia conducting with aberrancy. Site of origin: Tachyarrhythmias can be classified according to the site of origin: atrial, junctional (...) person-years and a prevalence of 2.29 cases per 1000 people. Orejarena L, Vidaillet HJ, DeStefano F, et al. Paroxysmal supraventricular tachycardia in the general population. J Am Coll Cardiol. 1998 Jan;31(1):150-7. http://www.ncbi.nlm.nih.gov/pubmed/9426034?tool=bestpractice.com Females are twice as likely to develop PSVT, and the incidence is five times greater in people older than 65 years compared with younger people. Most cases of supraventricular tachycardia are due to AV nodal re-entrant

2018 BMJ Best Practice

4. Sustained ventricular tachycardias

Sustained ventricular tachycardias Sustained ventricular tachycardias - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Sustained ventricular tachycardias Last reviewed: February 2019 Last updated: March 2018 Summary A ventricular rhythm faster than 100 bpm lasting at least 30 seconds or requiring termination due to haemodynamic instability. ECG findings include wide QRS complex (duration >120 milliseconds) at a rate (...) without structural heart disease. Among patients with prior MI or non-ischaemic cardiomyopathy, VT is usually due to re-entry involving regions of slowed conduction adjacent to scar. Due to the unpredictable and life-threatening nature of most aetiologies of sustained VT, prophylactic implantable cardioverter defibrillator implantation is recommended in high-risk patients. Definition Sustained ventricular tachycardia (VT) is a ventricular rhythm faster than 100 bpm lasting at least 30 seconds

2018 BMJ Best Practice

5. Modified Valsalva manoeuvre for supraventricular tachycardia

Releases 2017 Media Releases 2016 Media Releases 2015 Media Releases 2014 Media Releases 2013 Media Releases 2012 Media Releases Search Modified Valsalva manoeuvre for supraventricular tachycardia Modified Valsalva manoeuvre for supraventricular tachycardia Introduction Triggers that may predispose to episodes of SVT include medications (asthma inhalers, cold remedies), drinking large amounts of caffeine or alcohol, stress or emotional upset and smoking. Intervention Modified Valsalva manoeuvre (...) Modified Valsalva manoeuvre for supraventricular tachycardia RACGP - Modified Valsalva manoeuvre for supraventricular tachycardia Search Become a student member today for free and be part of the RACGP community A career in general practice Starting the GP journey Enrolments for the 2019.1 OSCE FRACGP exams closing 29 March 2019 Fellowship FRACGP exams Research Practice Experience Program is a self-directed education program designed to support non vocationally registered doctors

2016 Handbook of Non-Drug interventions (HANDI)

6. Right sided heart failure and tachycardia.

L-to-R (and the RV depolarizes with delay due to the rbbb) — and HOW do you determine the “average direction” of electrical activity when depolarization vectors do a “zig-zag”? (ie, L-to-R, then R-to-L, then L-to-R)? Therefore, I’d say in ECG #1 that there is RBBB/LAHB. This raises the question as to WHY there is less left axis deviation in ECG #2? Could it be that the tachycardia was not present? Could it be that development of the hemiblock (LAHB) is new? Could it be new marked left axis (...) deviation due to increase in RV forces (from exacerbation of right heart failure — and YES, you CAN get marked LAD on occasion as a response to severe pulmonary disease!)? — or could it be some combination of each of these? BOTTOM LINE: Yes, there an increase in LAD during tachycardia, though the specific reason for this in my opinion is not clear cut. Hope that helps to answer your question — :) Thanks again. great discussion. H Munoz, MD Caracas-Venezuela Anonymous Awesome case dr. Smith. . Well i

2019 Dr Smith's ECG Blog

7. Ventricular Tachycardia? Or SVT with Aberrancy?

Ventricular Tachycardia? Or SVT with Aberrancy? Dr. Smith's ECG Blog: Ventricular Tachycardia? Or SVT with Aberrancy? Thursday, January 24, 2019 This was texted to me, by a recent residency graduate, with the following information: "70-something w hx of TAVR (aortic valve replacement) and Stroke. SVT w/aberrancy or VT?" What do you think? Here is what I texted back: "SVT. Give adenosine." Response: "How did you tell?" My answer: "Very rapid initial part of the QRS. Look at the right precordial (...) there was pre-existing BBB; aberrancy implies that the LBBB or RBBB is a result of the tachycardia, not a baseline finding. But of course until you find that old ECG, you will not know. So that is of academic significance. Management: Of course either VT or SVT with aberrancy can be treated with electrical cardioversion, but unless the patient is in severe shock or pulmonary edema, you have time to give adenosine. If it is VT, adenosine is safe. Adenosine is NOT safe if the rhythm is irregular

2019 Dr Smith's ECG Blog

8. Wide-complex tachycardia: VT, aberrant, or "other?"

be diagnostic for VT under Brugada criteria. However, the widening is coincident with the rate increase, typical for the use-dependent character of flecainide toxicity. This ECG supports that the wide-complex tachycardia seen in the ED was 2:1 atrial flutter with QRS widening due to use-dependent toxicity, and not due to VT. Note of Caution! While a number of EPs have agreed that the initial rhythm was most likely atrial flutter, at least one strongly believed it was VT. Management of similar rhythms must (...) due to her decreasing flecainide level. Flecainide and the ECG: Key Takeaways A wide-complex tachycardia in a patient taking flecainide will often be VT, of course! However, if the ventricular rate is 150, consider new atrial flutter with 2:1 AV conduction, and QRS widening due to toxicity. Atrial flutter can present with in flecainide toxicity, owing to slower atrial conduction. (The flutter/ventricular rate will be around 200 bpm.) Lastly, the WCT associated with flecainide toxicity

2019 Dr Smith's ECG Blog

9. Prospective Randomized Clinical Trial for Effect of Stellate Ganglion Block in Medically Refractory Ventricular Tachycardia

Prospective Randomized Clinical Trial for Effect of Stellate Ganglion Block in Medically Refractory Ventricular Tachycardia Prospective Randomized Clinical Trial for Effect of Stellate Ganglion Block in Medically Refractory Ventricular Tachycardia - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached (...) the maximum number of saved studies (100). Please remove one or more studies before adding more. Prospective Randomized Clinical Trial for Effect of Stellate Ganglion Block in Medically Refractory Ventricular Tachycardia The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our

2016 Clinical Trials

10. Chest pain, sinus tachycardia, and ST Elevation

Chest pain, sinus tachycardia, and ST Elevation Dr. Smith's ECG Blog: Chest pain, sinus tachycardia, and ST Elevation Monday, January 22, 2018 I was reading through ECGs on the system when I saw this one: Sinus tachycardia, rate 120 Computerized QTc = 380 ms What do you think? I was immediately worried about a proximal LAD occlusion. Although sinus tachycardia generally argues against ACS, a large anterior MI may result in such poor stroke volume that there is compensatory tachycardia (...) , with an unusual onset of crushing chest pain, presumably due to sepsis from pyelonephritis. Could this have been diagnosed by the ECG? In retrospect, from the ECG alone, takotsubo may have been strongly suspected based on ST depression in aVR, absence of ST elevation in V1, and STE in lead II. However, all these findings may be present with a wraparound LAD to the inferior wall. Pathophysiology of Takotsubo Diffuse small vessel ischemia, with resulting ischemic pain, wall motion abnormalities, and ECG

2018 Dr Smith's ECG Blog

11. Tachycardia, hyperthyroid, and ST elevation. What is it?

Tachycardia, hyperthyroid, and ST elevation. What is it? Dr. Smith's ECG Blog: Tachycardia, hyperthyroid, and ST elevation. What is it? Monday, April 9, 2018 This ECG was texted to me on my phone, with the words "Asymptomatic with hyperthyroidism:" What do you think? I replied that precordial leads are misplaced and to record it again. How did I know this? There are well formed R-waves in V1, but none in V2 and V3, then they return in V4. It is possible that there is focal infarction over V3 (...) worried about STEMI, and had appropriately performed a bedside echo. Here is the parasternal short axis: There is hyperdynamic function without any wall motion abnormality. Here is the parasternal long axis: Again, hyperdynamic without any wall motion abnormality. The first troponin returned below the level of detection. Remember that an undetectable troponin does NOT rule out STEMI or OMI (Our new terminology: OMI = Occlusion Myocardial Infarction -- ). The low probability of OMI is due to: 1

2018 Dr Smith's ECG Blog

12. Sudden Chest pain and SOB with a Wide Complex Tachycardia

Sudden Chest pain and SOB with a Wide Complex Tachycardia Dr. Smith's ECG Blog: Sudden Chest pain and SOB with a Wide Complex Tachycardia Sunday, August 5, 2018 This case was contributed by a medic who wishes to remain anonymous (his comments are in red ). This was a 60 something male who called for sudden onset of severe chest pain and dyspnea. No medical history or medications. Upon arrival he was in extremis with altered mentation, cyanosis and diaphoresis . We were unable to get an initial (...) ECG due to diaphoresis but the pulse ox showed a sat of 53 and a rate of 170 without palpable radial pulse. Initial ECG: There is a wide complex tachycardia at a rate of 148. What is it? Smith Interpretation : It is fast and the patient is in extremis, so electricity is the appropriate treatment. If the patient were only moderately ill, you could try adenosine. Do you think adenosine would work? I think it would. This has a fairly convincing LBBB pattern, with rapid depolarization of the first

2018 Dr Smith's ECG Blog

13. Tachycardia and ST Elevation.

Tachycardia and ST Elevation. Dr. Smith's ECG Blog: Tachycardia and ST Elevation. Monday, September 24, 2018 This Case was sent from Anonymous. A middle-aged patient was sent to the ED with tachycardia. He denied any sensation of palpitations, but his heart rate was consistently 150 bpm. The other vitals were normal. He had JVD and swollen legs, but clear lungs and a normal room air oxygen saturation. He denied all typical and atypical ischemic symptoms. He noted, however, that he had had (...) marked fatigue starting about 5 days ago, but that he was actually feeling much better today. The initial ECG: The rhythm appeared to be atrial flutter, but also concerning were the ST segment elevations in I, aVL, V2, and V3, as well as ST depression in the reciprocal inferior leads. But atrial flutter can alter the baseline such that there is only apparent STE or STD (see example cases below) Is this: 1) true STEMI (acute or subacute)? 2) P seudoSTEMI due to the underlying atrial flutter wave ? 3

2018 Dr Smith's ECG Blog

14. Idiopathic Ventricular Tachycardias for the EM Physician

VT, how could I protect myself when none of the guidelines’ tachycardia algorithms deal with idiopathic VT?” “Cardioversion is safe, effective, and fun.” Option #2: Fancy Pants In this option you adopt a practice in which you act on your experienced suspicion of IVT, but in a way that has been prospectively thought out to avoid the pitfalls and complications in the event that you’re wrong. You’ve thought out exactly when and why you’re going to use each medication. The reasoning includes (...) Idiopathic Ventricular Tachycardias for the EM Physician Dr. Smith's ECG Blog: Idiopathic Ventricular Tachycardias for the EM Physician Friday, September 14, 2018 Written by Pendell Meyers, reviewed by Steve Smith and Scott Weingart “Idiopathic ventricular tachycardias” refer to a group of tachydysrhythmias originating below the AV node and bundle of His but differing in etiology, prognosis, and treatment compared to classic ventricular tachycardia (VT). The name “idiopathic” is becoming more

2018 Dr Smith's ECG Blog

15. Found comatose with prehospital ECG showing "bigeminal PVCs" and "Tachycardia at a rate of 156"

Found comatose with prehospital ECG showing "bigeminal PVCs" and "Tachycardia at a rate of 156" Dr. Smith's ECG Blog: Found comatose with prehospital ECG showing "bigeminal PVCs" and "Tachycardia at a rate of 156" Tuesday, December 11, 2018 This patient with a history diabetes was found with a GCS of 4. Prehospital EKG and strips (not shown) had "heart rate 156" (according to the computer interpretation) and "Bigeminal PVCs" The prehospital 12-lead looked just like the first ED ECG: What do you (...) gluconate before even drawing blood for lab values. When we did get a chem back (drawn after 6 g Ca gluconate), the K was 9.0 mEq/L and the ionized calcium was not reported because it was too low. The patient had a glucose of 1400, was severely dehydrated, and after receiving 4 liters of fluid, albuterol, and insulin, the K had dropped precipitously to 5.8 and the ECG improved: The Calcium AFTER 6 g of treatment was 8.2 mg/dL. Cr was 8.0 (previous was normal). The patient had hyperK due to acute renal

2018 Dr Smith's ECG Blog

16. Treatment of Secondary Hypertension Due to Endocrine Causes

Treatment of Secondary Hypertension Due to Endocrine Causes XIV. Treatment of Secondary Hypertension Due to Endocrine Causes | Hypertension Canada Guidelines Subgroup Members: Ally P.H. Prebtani, MD; Gregory Kline, MD, Ernesto L. Schiffrin, MD PhD; Andrew Don-Wauchope, MD Central Review Committee: Stella S. Daskalopoulou, MD MSc DIC PhD (Chair); Kaberi Dasgupta, MD MSc; Kelly B. Zarnke, MD MSc; Kara Nerenberg, MD, MSc; Alexander A. Leung, MD MPH; Kevin C. Harris, MD MHSc; Kerry McBrien, MD MPH (...) be controlled with medications less likely to affect testing (slow-release verapamil, hydralazine, prazosin, doxazosin, and terazosin), repeat testing 2 weeks after withdrawing the following medications that can interfere with test accuracy: β-blockers, centrally acting α-2 agonists, angiotensin receptor blockers, angiotensin converting enzyme inhibitors, directly acting renin inhibitors, dihydropyridine calcium channel blockers. False positive results may occur with direct renin mass/concentration

2018 Hypertension Canada

17. Wide Complex Tachycardia and Cyanosis

-waves. There is a monomorphic Right Bundle Branch block pattern with QRS duration of between 140 - 160 ms (is it difficult to ascertain the exact beginning and end of the QRS) Is it Ventricular Tachycardia (VT) or SVT with aberrancy? What else can be said about it? What should be done? Full interpretation is at the far bottom of the post Comment: If the patient is unstable, just cardiovert with electricity. Her altered mental status may be due to hypoperfusion (shock), in spite of the normal blood (...) . Thus , it is very likely that the patient has uncorrectable hypoxemia due to shunt physiology. If the patient had been stable (conscious), then there would have been a few minutes to think: First , if one can easily find old ECGs that are in sinus rhythm, then one can compare the QRS morphology at baseline with this one in tachycardia. If identical, then this is supraventricular (which includes sinus tachycardia). To diagnose sinus tachycardia, . This takes about 30 seconds. Second , in most young

2017 Dr Smith's ECG Blog

18. Cardiogenic shock with wide complex tachycardia and poor LV function in a young woman

remained in cardiogenic shock due to severely decreased LV systolic function. The remainder of the management is beyond the scope of this blog. Later in the day, this ECG was recorded: Sinus with LBBB. So the LBBB is definitely baseline. This is the same morphology that she had while in tachycardia, proving that the rhythm was supraventricular. The patient recovered neurologically, but with a persistently very low ejection fraction (20%, due to new cardiomyopathy). She also had very frequent (...) Cardiogenic shock with wide complex tachycardia and poor LV function in a young woman Dr. Smith's ECG Blog: Cardiogenic shock with wide complex tachycardia and poor LV function in a young woman Saturday, October 14, 2017 A 30-something woman presented with CP and SOB. She was hypoxic and intubated. She had very poor LV systolic function on bedside echo. There were no B-lines and the RV was normal. The following ECG was recorded: Wide complex regular tachycardia at a rate of 140, no P-waves What

2017 Dr Smith's ECG Blog

19. Tachycardia, Dehydration, and New ST Elevation in a 20-something, then a Surprise.

Tachycardia, Dehydration, and New ST Elevation in a 20-something, then a Surprise. Dr. Smith's ECG Blog: Tachycardia, Dehydration, and New ST Elevation in a 20-something, then a Surprise. Sunday, March 19, 2017 A male in his early 20s presented intoxicated, with no CP or SOB. An ECG was obtained for tachycardia. First ECG: Sinus tachycardia at 150. There is inferior ST Elevation and Q-waves that appear to be Inferior STEMI. There is reciprocal ST depression in aVL. Is this STEMI? The patient (...) tachycardia unless they are in cardiogenic shock. If such is the case, the patient should have high filling pressures and high right sided pressures and NOT have a collapsed IVC. They should also not be hyperdynamic. It is possible to be dehydrated AND have a STEMI, but in that case the best initial treatment is supportive: rehydration. Then re-evaluation. So it was perfectly appropriate to do a bedside ultrasound and, finding a hyperdynamic heart, to defer diagnosis of ACS and give fluids. Even

2017 Dr Smith's ECG Blog

20. An unstable wide complex tachycardia resistant to electrical cardioversion

An unstable wide complex tachycardia resistant to electrical cardioversion Dr. Smith's ECG Blog: An unstable wide complex tachycardia resistant to electrical cardioversion Thursday, February 23, 2017 Thanks to our electrophysiologist, Rehan Karim, for his help with this post. Case A very elderly inpatient suddenly had a rapid pulse by oximetry. The nurse put him on the monitor and noticed a wide complex tachycardia. The patient was alert with a normal blood pressure. He had a history (...) of myocardial infarction, with a known lateral wall motion abnormality and a chronic total occlusion of the circumflex. A 12-lead ECG was recorded. Click on image to enlarge Regular, Monomorphic, Wide complex Tachycardia (WCT) at a rate of 190. What do you think? Interpretation : This is clearly Sustained Monomorphic Ventricular Tachycardia . You may say that interpretation does not matter because electrical cardioversion works for any regular WCT, but you'll see in this case that electricity did NOT work

2017 Dr Smith's ECG Blog

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