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Pre-hospital pharmacological management of narrow complex tachycardias - Essay Example

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Narrow complex tachycardia or a tachycardia with a QRS complex less than 120 msec, reflects a rapid activation of the ventricles by way of the normal His-Purkinje system, which means that the tachycardia originated either within or above the AV node. That could be the sinus…
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Pre-hospital pharmacological management of narrow complex tachycardias
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Download file to see previous pages There will be a general overview of the arrhythmias followed by more specific with treatment guidelines. Supporting research will be investigated in an effort to determine credible practice guidelines.
The narrow complex tachycardias include sinus tachycardia (ST), atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), atrial tachycardia (AT), inappropriate sinus tachycardia (IST), sinoatrial nodal reentrant tachycardia (SNRT), junctional ectopic tachycardia (JET), nonparoxysmal junctional tachycardia (NPJT), atrial fibrillation (AF), atrial flutter (AFI), and multifocal atrial tachycardia (MAT). Symptomology that may occur with these tachyarrhythmia’s are hypotension, heart failure, or pulmonary congestion, shortness of breath, renal failure, shock, decreased consciousness, angina or acute MI (Podrid, 2008). If these symptoms are occurring cardioversion is recommended. The state of stability of the patient who is pre-hospital is of course the focus of care. Determining the nature of narrow QRS tachyarrhythmia is necessary and an EKG is of great importance at this point.
When we consider pathogenesis, reentry is the most common cause of QRS complex tachycardia. The mechanism of reentry requires two distinct pathways or tissues in the heart that have different electrophysiological properties that are linked proximally and distally, forming a circuit that is anatomic or functional (Ansdorf & Ganz, 2009). You will note the following diagrams.
AVNRT as shown above is characterized by two pathways within the AV node. AVRT also shown above is characterized by an extranodal accessory pathway connecting the atrium and ventricle. Wolf-Parkinson White syndrome would fall into this category. SNRT and reentrant tachycardia do not involve the AV node (Arnsdorf, 2009).
There are also other mechanisms that lead to narrow QRS complex tachycardia. Those include automaticity ...Download file to see next pagesRead More
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