Positive exercise stress test

Positive exercise stress test

Learning Objectives:

1. List specific rhythms that are wide-complex tachycardias.

2. List antiarrhythmic agents to use for monomorphic ventricular tachycardia.

3. List antiarrhythmic agents to AVOID in atrial fibrillation with preexcitation (Wolff-Parkinson-White).

Wide-Complex Tachycardias:

1. Ventricular tachycardia

a. Monomorphic

b. Polymorphic

2. Supraventricular tachycardia with aberrant conduction

a. Junctional tachycardia

b. Paroxysmal SVT

c. Ectopic or multifocal atrial tachycardia

Note:

It can be difficult to distinguish ventricular tachycardia from supraventricular tachycardia with aberrant conduction. The presence of P waves or irregularity in rate favor supraventricular tachycardia. When in doubt assume the rhythm is ventricular tachycardia

Treatment for Wide-Complex Tachycardia

1. Obtain 12 lead ECG and consult with a cardiologist if there is time.

2. Amiodarone is the safest bet for stable wide complex tachycardia. Load with 150 mg over 10 minutes

3. If unstable use synchronized cardioversion. Start at 100 Joules.

Meds to AVOID in Atrial Fibrillation with Preexcitation (Wolff-Parkinson-White)

AV Blocking medications:

1. Adenosine

2. Digoxin

3. Diltiazem

4. Verapamil