View source for Narrow-complex tachycardia

==Background==
*Heart rate > 100 bpm
*Originates above the ventricles

==Clinical Features==
*Heart rate > 100 bpm
*May have:
**[[Palpitations]]
**[[Syncope]] or pre-syncope
**[[Chest pain]]
**[[Dyspnea]]
**[[Altered level of consciousness]]
**Delayed capillary refill

==Differential Diagnosis==
{{Tachycardia (narrow) DDX}}
{{Tachycardia (wide) DDX}}

==Evaluation==
[[File:Narrow Complex Atrial Tachycardias.jpg|thumb|Examples of '''narrow'''-complex tachycardias.]]
===Workup===
*[[ECG]]

===Diagnosis===
*Flutter vs coarse AFib: determine atrial regularity by taking big bites

===Narrow-complex tachycardia comparison table===
{| class="wikitable" 
|-
| '''Differential''' 
| '''A.Rhythm''' 
| '''A.rate''' 
| '''A.morphology''' 
| '''Vagal/adenosine'''
|-
| [[A fib]] 
| Irregular 
| >350 
| Fibrillatory (V1) 
| Incr. AV block
|-
| [[A Flutter]]
| Regular 
| >250, <350 
| Sawtooth (II, III, AVF) 
| Incr. AV block
|-
| A Tach 
| Regular 
| >100 
| Neg in II, III, AVF 
| Nothing
|-
| [[AVNRT]] (SVT)
| Regular 
| >160 
| No p's 
| → NSR
|-
| Junctional 
| Regular 
| >100, <150 
| No p's or retrograde p's 
| Nothing
|-
| [[MAT]]
| Irregular 
| >100 
| >3 distinct p shapes  
| Transient slowing
|-
| [[Sinus tachycardia]]
| Regular 
| 
>100 <180 

| Normal 
| Transient slowing
|}

===Narrow-Complex Tachycardia Examples===
<gallery mode="packed">
File:SVT12.jpg|[[PSVT]]
File:Sinustachy.jpg|[[Sinus tachycardia]]]]
File:Aflutter.jpg|[[Atrial flutter]] (with alternating 2:1 and 3:1 block).
File:Atrial flutter.jpg|[[Atrial flutter]] (with variable block)
File:PAC.png|[[PACs]]
File:Afib.jpg|[[Atrial fibrillation]]
File:Multifocal atrial tachycardia - MAT.png|[[Multifocal atrial tachycardia]]
</gallery>

==Management==
{{ACLS Narrow Regular Tachycardia}}
{{ACLS Narrow Irregular Tachycardia}}

===[[Atrial fibrillation with RVR]]/flutter===
*Rate control: [[Diltiazem]], [[metoprolol]], [[digoxin]]
**Dig usually only helpful when already with a block (e.g. 2:1)
*Cardioversion: [[Sotalol]], [[cardioversion|electric]]

===[[Junctional tachycardia]]===
*Treat underlying cause
*Consider:
**[[Amiodarone]]
**[[Beta-blocker]]
**[[Calcium-channel blocker]]

==Disposition==
*Stable patients without serious comorbid illness who are adequately rate or rhythm controlled can be discharged home with follow-up
*Patients with acute underlying cause may require admission
*Patients who cannot achieve asymptomatic rate or rhythm control may require admission

==See Also==
*[[Tachycardia]]
*[[ACLS: Tachycardia]]
*[[V Tach vs. SVT]]
*[[SVT]]
*[[Atrial Fibrillation (RVR)]]

==External Links==

==References==
<references/>

[[Category:Cardiology]]