Sunday, October 2, 2022. Cardiology: Tachyarrhythmias (Abnormal Fast Heart Rate or Greater than 100 Beats Per Minute). Pathology is Abnormal Conduction System. SSx: 1)Palpitations, 2) Lightheadedness, 3) Dizziness, and 4) Syncope is Possible, and 5) Dyspnea/Shortness of Breath (SOB). Dx: Electrocardiography/Electrocardiogram with Clinicopathological Correlation. Tachyarrhythmias: 1) Supraventricular Tachycardia (SVT), 2) Paroxysmal Supraventricular Tachycardia (PSVT) and Tx involves IV Adenosine; 3) Multifocal Atrial Tachycardia (MAT) has Multiple P Wave Morphology (EKG Diagnosis); Tx: 1) Stabilization of Patient, 2) Face Mask 100% Oxygen (or Intubation if Necessary for COPD Cases); 4) Wolff-Parkinson-White Syndrome (WPWS). Aetiology is Congenital Developmental Disease (Therefore Pediatric, Infant and Young Adult Patients) creating an Accessory Conduction Site (Multiple Conduction Sites Possible) Between Atria And Ventricles; SSx: 1) Asymptomatic (Incidental Finding Usually), 2) Palpitations, 3) Lightheadedness, or 4) Episodic Syncope; Px: 1) EKG will show 1) Tachycardia (Abnormal Elevated Heart Rate), 2) Wide QRS Complexes with Sloping "Delta Wave" (Pathognomonic Morphology) Between Q and R Wave; Dx: Electrocardiography (EKG); Tx: 1) If Symptomatic with Carotid Maneuvers (Carotid Massage), or First Line Medial Treatment is IV Adenosine ( Adenosine Receptor Agnoist Antiarrythmic) or if Refractory IV Procainamide (Antiarrhythmic Class 1A with a Mechanism of Action [MOA] by Sodium Channel Antagonism of Cardiomyocytes); Long-term Treatment involves Radiofrequency Ablation can be Curative of WPWS (Oral Therapy is Possible); 5) Ventricular Tachycardia (VT) is a Medical Emergency; Cx: Ventricular Fibrillation (VF); VT has bizarre QRS Complexes with no discernible P or T Waves. SSx: 1) Palpitations, 2) Lightheadedness, 3) Syncope, and 4) Chest Pain; Pathology (Sinoatrial or Atrioventricular Nodal Paresis) is the Rapid Depolarization of the Ventricles without Atrial Depolarizations causing a Drastic Reduction of Cardiac Output (CO) and thereby Cardiac Shock; Dx: Electrocardiography/Electrocardiogram; and Tx will involve Cardioversion (IV Antiarrhythmics will usually be Ineffective); Standard Of Care follows: 1) Oxygen Supplementation; 2) If Stable IV Amiodarone (In Critical Care Guidelines known as ACLS Protocol [Advanced Cardiovascular (or Cardiac) Life Support]) and if Refractory (IV Lidocaine or IV Procainamide); 3) When Patient is Unstable (Unconscious or Pulseless) Cardioversion is Indicated STAT (Sedation with a Sedative-Hypnotic Agent (Propofol) is possible or Without); 6) Torsade De Pointes (TdP) is a Medical Emergency which can Complicate to Ventricular Fibrillation (Death). The Pathology is Ventricular Tachycardia (Accessory Ventricular Conduction Site[s]) with Oscillating Amplitudes; SSx: 1)Palpitations, 2) Lightheadedness, 3) Dizziness, and 4) Syncope is Possible, and 5) Dyspnea/Shortness of Breath (SOB). Aetiology: 1) Hypomagnesemia (Most Common Cause), 2) Congenital Long QT Syndrome, 3) Drug (Multiple Number of Medications are known to Prolong the QT Interval: 1) Methadone (Heroin Withdrawal), 2) Lithium for Bipolar, 3) TCA Antidepressants 4) Antipsychotics (Psychosis), 5) Macrolide Antibiotics, 6) Cisapride (Gastroparesis), Odansatron (Anti-emetic) and others; Dx is via EKG and Tx may be via Cardioversion. Tx: 1) Acute TdP and Stable: IV Magnesium Sulfate and 2) If Unstable Cardioversion; Long-term Treatment is with Beta Blockers (BBs) and Implantable Cardiac Defibrillator (ICD); BBs are Contraindicated in Congenital Long QT Syndrome. By MD Paul Bolin.
Excellent presentation. On Congenital long QT don’t give B1 selective B Blocker like Metoprolol or Atenolol. You can give non selective B blocker like Propranolol, Carvedolol, or Nadolol. Thank you for your efforts
You can give Non selective B Blockers like Propranolol or Carvidolol for Long QT syndrome. You can’t give selective B blockers like Metoprolol or Atenolol
