Changes

* [[Tachyarrhythmias]]

* [[Tachyarrhythmias]]

**H&P: palpitations, syncope

**H&P: palpitations, syncope

**DDx: Sinus tach, Afib, Aflutter, Vtach, Vfib, Vflutter, AVNRT, AVRT, WPW

**DDx: Sinus tach, Multifocal Atrial Tachycardia, [[Afib]], Aflutter, AVNRT, AVRT, WPW, Vtach, Vfib

**Tx: Stable vs. Unstable. Synchronized cardioversion vs DCCV. Vagal maneuvers, atropine, beta blockers, amiodarone, digoxin, diltiazem. Rate control superior to rhythm control most of the time. Calculate a CHAD2S2VASc for Afib patients. Consider cardioablation vs. Watchman. Always get a TEE/cardioversion for chronic Afib. The most effective [[AC]] is warfarin. Best AC is usually DOAC because of once daily oral dosing. LMWH is an alternative if they can't have a DOAC. Aflutter can be 2:1, 3:1, or 4:1 with fixed rates of 150, 100, and 75 respectively. Do NOT shock sinus tach.

**Tx: Stable vs. Unstable. Synchronized cardioversion vs DCCV. Vagal maneuvers (blowing into a 20 ml syringe), atropine, [[beta blockers]], [[amiodarone]], digoxin, diltiazem. Rate control superior to rhythm control most of the time. Calculate a CHA2DS2-VASc for Afib patients. Consider cardioablation vs. Watchman. Always get a TEE/cardioversion for chronic Afib. The most effective [[AC]] is warfarin. Best AC is usually DOAC because of once daily oral dosing. LMWH is an alternative if they can't have a DOAC. Aflutter can be 2:1, 3:1, or 4:1 with fixed rates of 150, 100, and 75 respectively. Do NOT shock sinus tach.

=Congestive Heart Failure=

=Congestive Heart Failure=