CARDIOLOGY
WPW
They only seem to give you AF with WPW. Irregular ECG with HR>200 is probably AF with WPW
PromptECG interpretation (AF with WPW)
ResponseRate >200
Irregular rhythm with extremely high rates in some places (up to 300 – too rapid to be conducted via the AV node)
Wide QRS complexes due to abnormal ventricular depolarisation action potential
Subtle beat to beat variation in QRS morphology
Axis remains stable, unlike polymorphic VT
- LITFL
Irregularly irregular – AF
Vent rate 200-250 (up to 300) – VERY fast
Leftward axis of broad complexes
2 QRS morphologies – Narrow (through AV nodes) and broad (accessory pathway)
Delta wave
- Answers
Irregular rhythm with extremely high rates in some places (up to 300 – too rapid to be conducted via the AV node)
Wide QRS complexes due to abnormal ventricular depolarisation action potential
Subtle beat to beat variation in QRS morphology
Axis remains stable, unlike polymorphic VT
- LITFL
Irregularly irregular – AF
Vent rate 200-250 (up to 300) – VERY fast
Leftward axis of broad complexes
2 QRS morphologies – Narrow (through AV nodes) and broad (accessory pathway)
Delta wave
- Answers
PromptMgmt - electrical/chemical
ResponseChemical cardioversion
Cardiology referral for followup/input/admission
- AVOID drugs acting on AV node (AV node actions slow this runaway effect. Blocking AV node releases the handbrake >> Death)
- IV amiodarone 300 mg (Procainamide 15 mg/kg but not really in Australia)
- Apply defib pads, monitor for deterioration into VF
- Consent for DC cardioversion
- Small aliquots of sedation – Propofol 0.5mg/kg or midazolam 1mg boluses titrated to light sedation, Analgesia: fentanyl 0.5-1 mic/kg
- Synchronised DC cardioversion 100-200J
Cardiology referral for followup/input/admission