Tachycardia and Tachyarrhythmias

Tachycardia and Tachyarrhythmias

David Ray Velez, MD

Table of Contents

Classification
EKG Patterns

See Also:

*See Sinus Tachycardia
*See Atrial Fibrillation (A-Fib)
*See Atrial Flutter (A-Flutter)
*See Multifocal Atrial Tachycardia (MAT)
*See Supraventricular Tachycardia (SVT)
*See Wolff-Parkinson-White (WPW) Syndrome
*See Torsades de Pointes (TdP)
*See Ventricular Tachycardia (VT/V-Tach)
*See Ventricular Fibrillation (VF/V-Fib)

Classification

Tachycardia: Heart Rate > 100 Beats per Minute

Narrow Complex Tachycardia

  • Regular Rhythm
    • Sinus Tachycardia
    • Atrial Flutter (A-Flutter)
    • Supraventricular Tachycardia (SVT)
  • Irregular Rhythm
    • Atrial Fibrillation (A-Fib)
    • Atrial Flutter (A-Flutter) – With a Variable Block
    • Multifocal Atrial Tachycardia (MAT)

Wide Complex Tachycardia

  • Regular Rhythm
    • Monomorphic Ventricular Tachycardia (VT/V-Tach)
  • Irregular Rhythm
    • Polymorphic Ventricular Tachycardia (VT/V-Tach)
    • Ventricular Fibrillation (VF/V-Fib)

EKG Patterns

Sinus Tachycardia

  • Heart Rate > 100 bpm
  • Normal P Waves Preceding Every QRS Complex
    • *With Significant Tachycardia, the P Waves Can Be “Hidden” in the Preceding T Wave (“Camel Hump” Appearance)
  • Compared to SVT
    • Most Likely Secondary to Underlying Cause (Pain/Stressor)
    • Progressively Increases Rate
    • Heart Rate is Usually Not Very High (< 150 bpm)
    • Typically See Separate P and T Waves
    • Generally Asymptomatic
    • May See Moderate Rate Variability

Sinus Tachycardia

Atrial Fibrillation

  • RR-Interval with No Regular Pattern (“Irregularly Irregular”)
  • No Distinct P Waves

Atrial Fibrillation

Atrial Flutter

  • Rapid Regular Atrial Depolarizations (“Saw Tooth” Pattern) – About 300 bpm
  • Not All P Waves Produce a Ventricular Contraction
  • Regular Ventricular Rate – About 150 bpm

Atrial Flutter

Multifocal Atrial Tachycardia (MAT)

  • “Chaotic” Variable P Waves with ≥ 3 Different Morphologies (Different Sites of Origin)
  • Heart Rate > 100 bpm
  • *May Appear Similar to Atrial Fibrillation/Atrial Flutter with Transition to Frequent Premature Atrial Complexes (PACs)

Multifocal Atrial Tachycardia (MAT)

Supraventricular Tachycardia (SVT)

  • Heart Rate > 100 bpm
  • Narrow QRS Complex (< 120 ms)
  • Compared to Sinus Tachycardia:
    • Often Has No Identified Underlying Cause
    • Sudden Onset
    • Rate is Usually Very High > 150 bpm
    • Typically See Combined P and T Waves
    • Generally Symptomatic (Chest Pain, Dyspnea, Anxiety)
    • Often Has Limited Rate Variability

Supraventricular Tachycardia (SVT)

Wolff-Parkinson-White (WPW) Syndrome

  • Pre-Excitation “Delta Waves” (Slurring Slow Risk of the Initial QRS Complex)
  • Short PR Interval (< 120 ms)
  • Prolonged QRS Complex

Wolff-Parkinson-White (WPW) Syndrome

Torsades de Pointes (TdP)

  • Polymorphic Ventricular Tachycardia
  • QRS Complexes Appear to Be “Twisting’ Around the Isoelectric Points

Torsades de Pointes (TdP)

Ventricular Tachycardia (VT/V-Tach)

  • Heart Rate > 100 bpm
  • Wide QRS Complex (≥ 120 ms)
  • No Fixed Relationship of P Wave and QRS Complex

Ventricular Tachycardia (VT/V-Tach)

Ventricular Fibrillation (VT/V-Fib)

  • Sudden Chaotic Irregular Deflections
  • No Identifiable P Waves, QRS Complexes or T Waves
  • Rate 150-500 bpm

Ventricular Fibrillation