• Key management points
  • HR 200+ should make you think of a pre-excitation syndrome
  • Narrow complex SVT is treated identically to non-WPW SVT
  • Don't try to be clever with drugs in broad complex tachycardias and WPW
  • Using AVN blockers in WPW and AF can result in 1:1 conduction through AP to ventricles = VF

• Rate + regularity
• Axis
• P wave
• QRS
• ST

• 1: is this an emergency? (is there a pulse??)
• 2: fast / slow
• 3: narrow / wide
  • narrow = implies normal ventricular depolarisation
    • usually consistent with CO
  • wide = implies abnormal ventricular depolarisation
    • sometimes consistent with CO
• 4: regular / irregular

Bradycardias

• narrow and slow

  • will atropine work?
  • sinus bradyC = yes
  • junctional bradyC = yes
  • 1D-AVB / 1HB = yes
  • 2D-I-AVB / 2HB = yes
  • 2D-II-AVB / 2HB = NO *** = paradoxical bradyC
  • SSS
    • diagnostic criteria = failure to respond to atropine

• wide and slow

  • types
    • 3HB
    • sinus arrest + ventricular escape
    • bradyC + aberrant conduction
    • drugs
    • pacing

Tachycardias

• fast and wide

  • regular
    • monomorphic VT
    • SVT + aberrant conduction
    • WPW (antidromic)
  • irregular
    • AF + aberrant conduction (BBB)
    • AF + WPW (orthodromic)
    • polymorphic VT and Torsades

• WPW + wide tachycardia

  • rare
  • don't use
    • adenosine
    • CCB
    • digoxin
    • all can accelerate NORMAL pathway

• Acute axis deviation
• New BBB
• Acute STE
• Acute STD
• Type 2 HB / CHB
  • if urgent, temporary pacing
• Tall peaked T waves
• Prolonged QTc
• Narrow complex tachycardia
• Wide complex tachycardia

• LVH
• Sinus bradycardia HR 45+