11.2 MTB Step 3 - Arrhythmias (MAT, SVT, & WPW)

Question 1

MULTIFOCAL ATRIAL TACHYCARDIA (MAT)

What is the Presentation for MAT?

Answer 1

MAT presents like Atrial Arrhythmia in a patient with

COPD/Emphysema

Question 2

MULTIFOCAL ATRIAL TACHYCARDIA (MAT)

What are (3) Findings on ECG for MAT?

Answer 2

1. Polymorphic P-waves (different Atrial Foci for the QRS complexes)
2. Tachycardia (HR > 100bpm)
3. Irregular “Chaotic” Rhythm

Question 3

MULTIFOCAL ATRIAL TACHYCARDIA (MAT)

What is the 2-Step Treatment for MAT?

Answer 3

Step 1: Oxygen

Step 2: Diltiazem

Do NOT use Beta-Blockers!

Question 4

SUPRAVENTRICULAR TACHYCARDIA (SVT)

What are (3) Common Presenting Signs/Symptoms of SVT?

Answer 4

1. Palpitations
2. Tachycardia (Ventricular Rate = 160 - 180)

Question 5

SUPRAVENTRICULAR TACHYCARDIA (SVT)

What are the Best Inpatient & Outpatient Diagnostic Tests for SVT?

Answer 5

Inpatient = Telemetry

Outpatient = Holter Monitor

Question 6

SUPRAVENTRICULAR TACHYCARDIA (SVT)

What is the Best INITIAL Management for Stable patients with SVT?

Answer 6

Vagal Maneuvers

(Carotid Sinus Massage, Ice Immersion of Face, Valsalva)

Question 7

SUPRAVENTRICULAR TACHYCARDIA (SVT)

What is the Next BEST Step in Management for Stable patients with SVT who don’t respond to initial treatment?

Answer 7

Adenosine (IV)

Most Frequently asked SVT question

Question 8

SUPRAVENTRICULAR TACHYCARDIA (SVT)

What is the Best INITIAL Management for Unstable patients with SVT?

Answer 8

Synchronized Cardioversion

Question 9

SUPRAVENTRICULAR TACHYCARDIA (SVT)

What is the Best Long-Term Management for SVT?

Answer 9

Radiofrequency Catheter Ablation

Question 10

WOLFF-PARKINSON-WHITE SYNDROME (WPW)

Hows does WPW Present?

Answer 10

WPW presents like SVT that can Alternate with Ventricular Tachycardia (VT)

Question 11

WOLFF-PARKINSON-WHITE SYNDROME (WPW)

What is a Unique Clue to the Diagnosis of WPW?

Answer 11

Worsening of SVT after the use of:

Calcium-Channel Blockers

or

Digoxin

Question 12

WOLFF-PARKINSON-WHITE SYNDROME (WPW)

1. What is the Best INITIAL Test for WPW?
2. What is the Most ACCURATE Test for WPW?

Answer 12

1. ECG showing Delta-wave
2. Electrophysiologic Studies

Question 13

WOLFF-PARKINSON-WHITE SYNDROME (WPW)

1. What is the Best INITIAL Therapy if the patient is described as being in SVT or VT from WPW?
2. What is the Best Long-Term Therapy for WPW?

Answer 13

1. Procainamide
2. Radiofrequency Catheter Ablation

Question 14

WOLFF-PARKINSON-WHITE SYNDROME (WPW)

What is the Mechanism of WPW?

Answer 14

• There is an abnormal piece of neutralized cardiac muscle going around the AV node in WPW.
• This can result in either Atrial or Ventricular arrhythmia.
• The slowest conduction in the heart is the AV node.
• Conduction in the aberrant tract is faster; that is why the PR is short (< 120 msec) and there is a Delta-wave of ECG.
• Calcium Channel Blockers and Digoxin block conduction more in the normal AV and force the conduction down the abnormal conduction tract.