Tachycardia and its ACLS Algorithm

Tachycardia/tachyarrhythmia is defined as a rhythm with a heart rate greater than 100

bpm.
An unstable tachycardia exists when cardiac output is reduced to the point of causing
serious signs and symptoms.
Serious signs and symptoms commonly seen with unstable tachycardia are: chest pain,
signs of shock, SOA, altered mental status, weakness, fatigue, and syncope

One important question you may want to ask is: Are the symptoms being caused by the
tachycardia? If the symptoms are being caused by the tachycardia treat the tachycardia.

There are many causes of both stable and unstable tachycardia and appropriate
treatment within the ACLS framework requires identification of causative factors. Before
initiating invasive interventions, reversible causes should be identified and treated.
Causes
The most common causes of tachycardia that should be treated outside of the ACLS
tachycardia algorithm are dehydration, hypoxia, fever, and sepsis. There may be other
contributing causes and review of the Hs and Ts of ACLS should take place as needed.

Administration of OXYGEN and NORMAL SALINE are of primary importance for the
treatment of causative factors of sinus tachycardia and should be considered prior to
ACLS intervention.

Once these causative factors have been ruled out or treated, invasive treatment using
the ACLS tachycardia algorithm should be implemented.
Associated Rhythms
There are several rhythms that are frequently associated with stable and unstable
tachycardia these rhythms include:
Atrial fibrillation
Atrial flutter
Supraventricular tachycardia (SVT)
Monomorphic VT
Polymorphic VT
Wide-complex tachycardia of uncertain type
Visit the links above to learn about each specific rhythm.
ACLS Treatment for Tachycardia
Click below to view the tachycardia algorithm diagram. When done click again to close
the diagram.Tachycardia Algorithm Diagram. or Members Download the Hi-Resolution
PDF Here
The fist question that should be asked when initiating the ACLS tachycardia algorithm is:
Is the patient stable or unstable? The answer to this question will determine which path
of the tachycardia algorithm is executed.

Patients with unstable tachycardia should be treated immediately with synchronized

cardioversion. If a pulseless tachycardia is present patients should be treated using the
pulseless arrest algorithm.

Patients with stable tachycardia are treated based upon whether they have a narrow or
wide QRS complex. The following flow diagram shows the treatment regimen for stable
tachycardia with narrow and wide QRS complex.
Stable (narrow QRS complex) vagal maneuvers adenosine (if regular)
beta-blocker/calcium channel blocker get an expert
Stable (wide/regular/monomorphic) adenosine consider antiarrhythmic
infusion get an expert