Cardiac arrhythmia pearls

Atrial Flutter vs. Atrial Fibrillation:

Both are tachyarrhythmia, almost with same symptoms of palpitation, dizziness or fainting, shortness of breath, and chest pain or tightness, both increase the chance of blood clots and stroke
The main difference is that atrial fibrillation is always irregular whereas atrial flutter usually regular rhythm


Multifocal Atrial Tachycardia (MAT) is more common in elderly patients with chronic lung disease (e.g COPD)


Cardioversion and digoxin are not useful in the management of Multifocal Atrial Tachycardia (MAT)



Features suggesting ventricular tachycardia (VT) rather than supra ventricular tachycardia (SVT) with aberrant conduction are:
Atrioventricular (AV) dissociation
Fusion or capture beats
Positive QRS concordance in chest leads
Marked left axis deviation
History of ischemic heart disease (IHD)
Lack of response to adenosine or carotid sinus massage
QRS > 160 ms


Verapamil is contraindication in wide complex tachycardia as it may causes ventricular fibrillation in patients with ventricular tachycardia


In case of V Tach in case of digoxin toxicity:
Treat with lidocaine and phenytoin; avoid Amiodarone and Procainamide because they increase digoxin toxicity
Use DC shock when medical treatment failed


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