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One. Um I am have a cardiology registrar in the Southwest, um and also a regional women and cardiology rep. And I have Bethan, one of our student reps with us and doctor Honey Thomas, um who's giving the lecture today. We um this is part of a great lecture series um that's been organized by the women in cardiology branch of B CS. Um And we really hope that it will prepare you for working as a doctor and managing acute medical patients um on the front line. Um I hope you also stay for the last part of the session um where we're gonna talk a bit about cardiology careers and training. And um first of all, Honey's experience, that may be my experience of, of going through this. Um and why we love cardiology so much and really why we think everyone else should do it as well cos we think it's great. Um I want to encourage you also to have a chat uh to, to talk to wick if you have any questions about any of this. Um There's an email address that I think Bethan can pass on. Um And they're a great source um of advice for any um particularly women considering a career in cardiology. Um I'll pass over to, to Bethan now to do a little bit of housekeeping and then I'll introduce honey. Yeah. So feel free as we go through to part your questions in the chart. Um Heather is gonna be monitoring that as well. Um And honey's welcome to be taking questions throughout. Um, the session will be recorded. So everyone who's attended will be able to have access to it and you'll also get certificates for attendance. If you fill out the feedback form afterwards, I'll put the link into at the end. I know someone's already asked about previous recordings. Um They will be available um in due course on the B CS Digital Knowledge Hub. Um And also if you've attended the previous talks, you'll be able to access them through medal, but if not, you'll be able to access them eventually through er the B CS er knowledge hub. So, yeah, I'll do, I'll pass back over to Heather. Ok. So for now, I'm going to welcome doctor Honey Thomas, who's a consultant cardiologist, training in the northeast of England and now working at North UMA Healthcare NHS Foundation Trust. She subspecializes in heart failure and advanced rhythm management that's devices. Um And she is also a secretary um of the British Heart Rhythm Society and also a chair of regional uh cardiac Rhythm Management subgroup of the Cardiac Network. Um She's also gonna chat at the end a bit about her career. Um, but, um, I think it's, um, I just want to highlight that she, she works less than full time doing all and she's still achieving all of this. Um, and she has done since she had her first child in 2002. So I'll pass over now to, honey, to, er, deliver the lecture. Thank you. It's a rare experience to be more than one cardiologist who's a female in the room. So, er, er, nice to be here. Er, so I'm gonna talk a bit about um a title I've been given is to what to do if my patient is tachycardic. So, um what I'm gonna include, um, I'm gonna do a bit of a recap of the electrics. I'm gonna talk a bit about classification of tachycardia, um A bit about ecg diagnosis of common causes of tachycardia management principles and then I've got some clinical scenarios with some, er, polls to run to get a bit of audience um participation. Um I am giving this talk to a blank screen in an empty room. I can't see any of you. So please participate in the poll. So I feel less lonely and also because actually having to commit to a decision is quite a good way of ce, oh, cementing your learning. So, recap of the electrics, everybody knows this and then instantly forgets it. Um The cardiac electrics have got specialized conduction tissue, we've got the sinoatrial node, the pacemaker cells of the heart, er, they depolarize, it spreads through the atria. Uh that gives you the P wave on your CG. You then um get all of the electrical activity being channeled through the ATRIO ventricular node into the left and right bundle branches and the purkinje fibers that gives you the QR S complex, it's rapid conduction. So typically you get a nor in normal hearts, you get a narrow QR S as that electrical activity passes quickly through the heart. When we talk about a tachycardia. Uh what, what does it mean? Well, literally, it means fast heart. Um A tachycardia is defined as being over 100 BPM. And it's important to be clear that a tachycardia is not always an arrhythmia. So a tachycardia can be physiological, it can be normal, it can be normal to have a rapid heart rate and I'll talk a bit about that as well. Cos it's important to know which box you're putting this tachycardia patient into so broadly, the principles of assessment and management. Um I mean, the first bit is, is your standard exam answer, but also your standard um clinical answer about what you do when you presented with the patient is your, you know, ABC assessment, airway, breathing circulation, an assessment of how unwell they are. Do you need urgent help? Because we all need help. Uh sometimes when a patient is sick, the level of training that you're at will affect uh how often you need that. But, you know, even I need help sometimes from an anesthetist or someone else. It's important then to think about what the rhythm is and the ECG is crucial to that and then to think about whatever this rhythm is, what could be driving it because whatever it is, there's almost certainly something you can find that's driving it so that it could be electrolytes, thyroid, it could be that they're septic, could be that they're hypoxic or unwell for another reason. And then importantly, what am I gonna do about it? So we've always got the fallback um of the A LS, the advanced life support guidance um for patients with an adult's tachycardia and they're a pretty good place to start for your kind of worst case scenario. And actually often the worst case scenario is the easiest case scenario. It's the most frightening, but it's got the least number of options about what you can do because if we've got an adult tachycardia and we assess their airway breathing circulation, add on the D and E as well, which I can never remember what they are. Uh We wanna get ECG S, we wanna get um sats, we want to get a 12 lead as well. If possible, we wanna think about some test for reversible causes and then we want to think about if there's life threatening features, if that patient's got shock syncope, um myocardial ischemia, severe heart failure and they are falling in a heap in front of you. Ultimately, if you think they have an arrhythmia, you need to get them out of it. And the brilliant thing is electricity fixes all arrhythmias. So if they're sick enough, it's actually really easy because you just need to electrocute them to cardiovert them out of it. If that doesn't work, you can try some amiodarone. Amiodarone is like domes os to uh arrhythmias. And it is always uh it, it can be used to treat any arrhythmia. So again, if someone's really, really sick with a tachy arrhythmia, it's DC shocks and amiodarone. So actually, in some ways, they're the easiest group to look after. But when we're thinking about slightly more refined treatment of the patient who isn't just about to conk out in front of us who needs cardioverting. It does all rest on the ecg interpretation of what the rhythm is. And this I think is the bit that terrifies people. Um It's quite interesting. So cardiologists tend to love ECG S but lots of people are frightened of them, they're intimidated by them. They're, they're, they're something that I think people do struggle with. Sometimes when they're training, I'm gonna try and convince you that it's pretty simple. So when we're talking about tachyarrhythmias, we divide it first of all into whether we've got a narrow or a broad QR S complex on the E CG, the cut off for that is 100 and 20 milliseconds, which is three small squares um on your CG. So I'm gonna kind of just work through the different groups um of arrhythmias you can get and broadly kind of t show you some examples of the kind of things that fall into those categories to help you work out which rhythm your patient's got and therefore know what to do about it. So, in a narrow cures, regular tachycardia, the things that could be causing that are a sinus tachycardia, a supraventricular tachycardia or atrial flutter. And I'll show you a bit about that. So a physiological sinus tachycardia is normal, it can be normal, it usually is normal. Um effectively, some sort of brain related or body related factors are telling your sinus. No, that it needs to go quicker. The rhythm itself is normal. It's regular. Every P wave has a QR S and every QR S has ap wave, but it's just running faster than 100 BPM. And there's a million reasons why that might happen. Uh You might have a fever. Uh You might be exercising. I have had several patients this year come to clinic referred because their smartwatches have shown that they have a tachycardia and when you talk to them, they go, when I go to the gym and exercise, my heart rate sometimes goes up to 100 and 40 BPM. And I have to explain to them. That is a completely normal response to exercise and your heart is meant to do that. That's my own one from my cycle ride earlier on today. Um, drugs will do it. Uh, pain will do it, bleeding, will do it, alcohol will do it. I've got a great slide of heart rates when people have been out on the booze the night before, er, versus heart rates when you haven't been on the booze the night before it makes your heart rate much twitchier. Um caffeine. Uh uh my personal favorite, the Jaeger bomb, which is the perfect combination of alcohol and high caffeine, which will guarantee give you Calpis, which my daughter will confirm having rung me by the, er, the morning after a particularly big night out um and anxiety and stress. So this is quite a nice slide at the, one at the middle of the top is an individual doing a presentation at a conference and the stress and anxiety of doing that presentation and what that's doing to their heart rate um at various stages in the presentation. That is all a normal phenomenon and it shouldn't be stopped if you're bothered about a sinus tachycardia. The really important thing is to treat the cause I get a lot of people coming saying, oh, but they're really tachycardic and it's