Understanding Tachycardia with Pulse Algorithm

Tachycardia with a Pulse Algorithm. Download yours at www.medicalprocerts.com

What is Tachycardia with a Pulse?

Tachycardia has a heart rate of more than 100 beats per minute. A rapid heart rate creates a shortened relaxation phase which prevents complete ventricle filling that causes decreased cardiac output. Also, decreased blood flow to the coronary arteries causes a reduced blood supply to the heart. Tachycardias include sinus tachycardia, atrial flutter, atrial fibrillation, SVT, VT (with a pulse), and wide-complex tachycardias of uncertain types. Tachycardias are further classified as either stable or unstable. Unstable tachycardia requires immediate attention, and keep in mind, stable tachycardia can become unstable.

RELATED: ACLS Algorithm for Supraventricular Tachycardia (SVT)

Exploring the Different Types of Tachycardia & Their Symptoms

Sinus Tachycardia

Sinus tachycardia results in an ECG rhythm that has normal P waves and QRS complexes, but the heart rate is over 100 BPM. Exercise, anxiety, stress, fever, or certain drugs can cause sinus tachycardia. Sinus tachycardia is usually a stable tachycardia.

Supraventricular Tachycardia

SVT is another narrow-complex tachycardia that is faster than sinus tachycardia. SVT is almost always more symptomatic than sinus tachycardia. Patients may have chest pain, palpitations, fatigue, sweating, or light-headedness. On an SVT ECG, the P waves are buried in the QRS complexes and usually cannot be seen, and the heart rate is 151–250 BPM. SVT is an unstable tachycardia.

Atrial Flutter

Atrial flutter is an unstable tachycardia caused by a disorder in the atrial conduction system. In atrial flutter, the atria contract too quickly, which causes the heart to beat in a fast, but regular, rhythm. This can lead to symptoms of palpitations, shortness of breath, fatigue, and/or dizziness. The ECG has a “saw toothed” pattern.

Atrial Fibrillation

Atrial fibrillation is another unstable tachycardia in which atrial activity is completely chaotic without any regularity, and thus, the AV node can be bombarded with more than 500 pulses per minute because there are multiple reentrant circuits occurring in an unpredictable pattern. A-fib is more common than atrial flutter. Patients can have no symptoms, or they may have palpitations, shortness of breath, dizziness, and/or fatigue (just like in atrial flutter).

RELATED: Atrial Fibrillation and ACLS Protocols

Ventricular Tachycardia (with a pulse)

Ventricular tachycardia occurs when there are irregular electrical signals in the ventricles. VT may be episodic or sustained. If it becomes a sustained rhythm, it becomes life-threatening since the heart may not be able to pump an adequate amount to the body. Patients may have chest pain, shortness of breath, palpitations, light-headedness, syncope, and/or it may lead to cardiac arrest. VT can be monomorphic or polymorphic.

RELATED: Download an ACLS Algorithm Pack

Chest discomfort may signal an oncoming heart attack.

Symptomatic Tachycardia

Any tachycardia with a heart rate greater than 150 beats per minute will usually produce symptoms. These symptoms could include any of the following in isolation or together:

  • Hypotension
  • Chest discomfort or pain
  • Sweating
  • Shortness of breath
  • Pulmonary edema and congestion
  • Weakness
  • Dizziness or light-headedness
  • Jugular venous distention
  • Altered mental status

How the Tachycardia With a Pulse Algorithm Detects Arrhythmias

The Tachycardia with a Pulse Algorithm (TWP) is an algorithm to detect arrhythmias in patients. It has been proven to be accurate and reliable in detecting arrhythmias, making it an invaluable tool for medical professionals.

RELATED: Understanding Advanced Algorithms for the Treatment of Ventricular Fibrillation

Adult Tachycardia with Pulse Algorithm

  1. Assess for signs and symptoms of tachycardia. The heart rate is typically greater than 150 beats per minute.
  1. Identify and treat any underlying cause.
  • Maintain a patent airway and assist breathing as necessary.
  • Administer oxygen if hypoxemic.
  • Identify the rhythm with a cardiac monitor. Monitor blood pressure and oxygen saturation with a pulse oximeter.
  • Obtain IV access.
  • Assess 12-lead ECG without delay.
  1. Consider if persistent tachyarrhythmia is causing any of the following:
  • Hypotension
  • Acutely altered mental status
  • Signs of shock
  • Chest pain
  • Acute heart failure
  1. If YES, tachycardia is causing severe symptoms, perform synchronized cardioversion. (If there are no severe symptoms, go to Step 6.) Cardioversion is generally not needed if the heart rate ≤150/min.
  • Consider sedation.
  • Have pulse ox, suction device, IV line, and intubation equipment at bedside.
  • If regular narrow-complex tachycardia, consider administration of adenosine.
  1. If refractory, consider any underlying causes, increasing the cardioversion energy level, adding an antiarrhythmic, and consulting an expert. 
  1. If NO, the tachycardia is not causing severe symptoms, and the patient is stable, determine if the wide QRS complex is greater than or equal to 0.12 seconds.
  • If YES, QRS ≥0.12 seconds, then move to Step 7.
  1. If QRS is ≥0.12 seconds and regular and monomorphic, only then consider administration of adenosine. Consider an antiarrhythmic infusion, and get expert consultation. If refractory, move to Step 5.
  1. If NO, QRS is NOT ≥0.12 seconds:
  • Perform vagal maneuvers, if rate is regular.
  • Administer adenosine, if rate is regular.
  • Administer a beta-blocker or a calcium channel blocker.
  • Consider expert consultation.

RELATED: The Complete American Heart Association Acute Coronary Syndrome Algorithm

Correct dopamine dose

Cardioversion and Pharmacology Doses and Details

Synchronized Cardioversion
  • To maximize first shock success, refer to the specific devices recommended energy level.
Adenosine IV Dose
  • Initial dose: 6 mg rapid IVP followed by NS flush.
  • Second dose: 12 mg if required.
Antiarrhythmic Infusions for Stable Wide-QRS Tachycardia
  1. Procainamide IV Dose
  • 20–50 mg/min until the arrhythmia becomes suppressed, hypotension ensues, or the QRS duration increases more than 50%. 
  • The maximum dose is 17 mg/kg.
  • Maintenance dose: 1–4 mg/min. 
  • Avoid in patients with prolonged QT or CHF.
  1. Amiodarone IV Dose
  • Initial dose: 150 mg over 10 minutes. Repeat as needed if VT recurs.
  • Maintenance dose: 1 mg/min for the first 6 hours.
  1. Sotalol IV Dose
  • 100 mg (1.5 mg/kg) over 5 minutes.
  • Avoid in patients with prolonged QT.

RELATED: The Complete ACLS Drug Dosages Chart for 2022

Where Can I Get the Latest Tachycardia With a Pulse Algorithm?

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