Wide complex tachycardia physical examination

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Differentiating VT from SVT with aberrant conduction

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Initial assessment of the ABCs (airway, breathing, and circulation) is critical in the management of the patient with wide complex tachycardia. Patients who are hemodynamically unstable should undergo immediate cardioversion. Hemodynamic stability does not reliably differentiate VT from SVT. Patients with ventricular tachycardia can often be hemodynamically stable, and stable vital signs do not rule out ventricular tachycardia. This is often a major mistake on the part of clinicians and can lead to inappropriate treatment of VT as SVT with poor outcomes. [1]

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References

  1. Morady F, Baerman JM, DiCarlo LA, DeBuitleir M, Krol RB, Wahr DW (1985). "A prevalent misconception regarding wide-complex tachycardias". JAMA : the Journal of the American Medical Association. 254 (19): 2790–2. PMID 4057488. Retrieved 2013-08-04. Unknown parameter |month= ignored (help)
  2. 2.0 2.1 2.2 Garratt CJ, Griffith MJ, Young G, Curzen N, Brecker S, Rickards AF, Camm AJ (1994). "Value of physical signs in the diagnosis of ventricular tachycardia". Circulation. 90 (6): 3103–7. PMID 7994860. Retrieved 2013-08-04. Unknown parameter |month= ignored (help)
  3. Waxman MB, Wald RW, Finley JP, Bonet JF, Downar E, Sharma AD (1980). "Valsalva termination of ventricular tachycardia". Circulation. 62 (4): 843–51. PMID 6773699. Retrieved 2013-08-04. Unknown parameter |month= ignored (help)
  4. Grubb BP (1989). "Termination of ventricular tachycardia by carotid sinus stimulation". International Journal of Cardiology. 23 (3): 397–9. PMID 2737783. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  5. Rankin AC, Oldroyd KG, Chong E. Value and limitations of adenosine in the diagnosis and treatment of narrow and board complex tachycardia. Br Heart J. 1981;46:679–682.



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