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==Overview==
==Overview==
A wide complex tachycardia is either of ventricular origin ([[ventricular tachycardia]] or [[VT]]), or is of supraventricular origin with aberrant conduction ([[SVT]] with aberrancy) such as occurs with conduction down a [[bypass tract]].  Approximately 80% of wide complex tachycardias are due to [[ventricular tachycardia]].<ref name="pmid16951728">{{cite journal |author=Lam P, Saba S |title=Approach to the evaluation and management of wide complex tachycardias |journal=[[Indian Pacing and Electrophysiology Journal]] |volume=2 |issue=4 |pages=120–6 |year=2002 |pmid=16951728 |pmc=1557420 |doi= |url=http://www.ipej.org/2/120 |issn= |accessdate=2013-08-04}}</ref>  Therefore a thorough review of the potential causes of ventricular tachycardia is critical in the patient with a wide complex tachycardia.
A wide complex tachycardia is either of ventricular origin ([[ventricular tachycardia]] or [[VT]]), of supraventricular origin with aberrant conduction ([[SVT]] with aberrancy), of supraventricular origin and is conducted down a [[bypass tract]] such as in [[Wolff-Parkinson-White syndrome]] ([[WPW]]), or is due to a pacemaker malfunction.  Approximately 80% of wide complex tachycardias are due to [[ventricular tachycardia]].<ref name="pmid16951728">{{cite journal |author=Lam P, Saba S |title=Approach to the evaluation and management of wide complex tachycardias |journal=[[Indian Pacing and Electrophysiology Journal]] |volume=2 |issue=4 |pages=120–6 |year=2002 |pmid=16951728 |pmc=1557420 |doi= |url=http://www.ipej.org/2/120 |issn= |accessdate=2013-08-04}}</ref>  Therefore a thorough review of the potential causes of ventricular tachycardia is critical in the patient with a wide complex tachycardia.


==Ventricular Tachycardia==
==Ventricular Tachycardia==

Revision as of 01:19, 5 August 2013



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

Overview

A wide complex tachycardia is either of ventricular origin (ventricular tachycardia or VT), of supraventricular origin with aberrant conduction (SVT with aberrancy), of supraventricular origin and is conducted down a bypass tract such as in Wolff-Parkinson-White syndrome (WPW), or is due to a pacemaker malfunction. Approximately 80% of wide complex tachycardias are due to ventricular tachycardia.[1] Therefore a thorough review of the potential causes of ventricular tachycardia is critical in the patient with a wide complex tachycardia.

Ventricular Tachycardia

Common causes of ventricular tachycardia include ischemic heart disease, illicit drugs (cocaine and methamphetamine), structural heart disease (including congenital heart diseases such as tetralogy of Fallot), inherited channelopathies, drug toxicity (digoxin, drugs that prolong the QT interval) and electrolyte disturbances (such as hypokalemia, hypomagnesemia, and hypocalcemia).

Causes

Common Causes

Across All Ages

Among Patients Under 35 Years of Age

Causes by Organ System

Cardiovascular Acute coronary syndrome, Andersen cardiodysrhythmic periodic paralysis, Arrhythmogenic right ventricular dysplasia, AV block, Cardiomyopathy, Catecholaminergic polymorphic ventricular tachycardia, Congenital Heart Disease, Congestive heart failure, Hypertrophic cardiomyopathy, Ischaemic heart disease, Jervell and Lange-Nielsen syndrome, Long QT Syndrome, Myocardial Infarction, Myocarditis, NSTEMI, Right ventricular outflow tract tachycardia, Romano-Ward syndrome, Short QT syndrome, Short QT syndrome type 1, Short QT syndrome type 2, Short QT syndrome type 3, Short QT syndrome type 4, Short QT syndrome type 5, STEMI, Timothy syndrome, Torsade de pointes, Unstable angina, Valvular heart disease, Ventricular aneurysm, Wolff-Parkinson-White syndrome
Chemical / poisoning Arsenic trioxide, Arsenicals
Dermatologic No underlying causes
Drug Side Effect Alimemazine, Almokalant, Amiodarone, Amitriptyline, Amphetamines, Antiarrhythmics, Asenapine, Astemizole, Azimilide, Azithromycin, Bepridil, Bretylium, Budipine, Chloroquine, Cibenzoline, Cisapride, Citalopram, Clomipramine, Clozapine, Cocaine, Crizotinib, Desipramine, Digitalis, Diphenhydramine, Disopyramide, Dofetilide, Dolasetron, Doxepin, Dronedarone, Droperidol, Eribulin mesylate, Fluconazole, Grepafloxacin, Halofantrine, Haloperidol, Ibutilide, Imipramine, Indapamide, Inotropes, Ketanserin, Ketoconazole, Lidoflazine, Lubeluzole, Methadone, Methadyl acetate, Methamphetamine, Midodrine, Mizolastine, Moxifloxacin, Naratriptan, Nicardipine, Nilotinib, Ondansetron, Pasireotide, Pazopanib, Pentamidine, Phenothiazines, Pimozide, Piperaquine, Prenylamine, Probucol, Procainamide, Propoxyphene, Quinidine, Quinine, Ranolazine, Retigabine, Ritodrine, Ritonavir, Saquinavir, Sertindole, Sotalol, Sparfloxacin, Sympathomimetic agents, Tedisamil, Telithromycin, Terfenadine, Terodiline, Tetrabenazine, Thioridazine, Vandetanib, Vemurafenib, Venlafaxine, Vernakalant, Voriconazole, Vorinostat, Ziprasidone, Zotepine, Zuclopenthixol
Ear Nose Throat No underlying causes
Endocrine Hyperthyroidism, Hypothyroidism, Pheochromocytoma
Environmental Hypothermia, Zero gravity
Gastroenterologic No underlying causes
Genetic Channelopathies, Myotonic dystrophy, Andersen cardiodysrhythmic periodic paralysis, Jervell and Lange-Nielsen syndrome, Romano-Ward syndrome, Short QT syndrome type 1, Short QT syndrome type 2, Short QT syndrome type 3, Short QT syndrome type 4, Short QT syndrome type 5, Timothy syndrome
Hematologic No underlying causes
Iatrogenic Cardioversion, Defibrillation, Electrophysiologic studies, Heart surgery, Pulmonary artery catheter , Right heart catheterisation
Infectious Disease No underlying causes
Musculoskeletal / Ortho Andersen cardiodysrhythmic periodic paralysis, Timothy syndrome, Myotonic dystrophy
Neurologic No underlying causes
Nutritional / Metabolic Acidosis, Acid-base disturbances, Acute starvation, Electrolyte imbalance, Hyperkalaemia, Hypocalcemia, Hypoglycaemia, Hypokalemia, Hypomagnesemia
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity Alimemazine, Almokalant, Amiodarone, Amitriptyline, Amphetamines, Antiarrhythmics, Asenapine, Astemizole, Azimilide, Azithromycin, Bepridil, Bretylium, Budipine, Caffeine,Chloroquine, Cibenzoline, Cisapride, Citalopram, Clomipramine, Clozapine, Cocaine, Crizotinib, Desipramine, Digitalis, Diphenhydramine, Disopyramide, Dofetilide, Dolasetron, Doxepin, Dronedarone, Droperidol, Eribulin mesylate, Fluconazole, Grepafloxacin, Halofantrine, Haloperidol, Ibutilide, Imipramine, Indapamide, Inotropes, Ketanserin, Ketoconazole, Lidoflazine, Lubeluzole, Methadone, Methadyl acetate, Methamphetamine, Midodrine, Mizolastine, Moxifloxacin, Naratriptan, Nicardipine, Nilotinib, Ondansetron, Pasireotide, Pazopanib, Pentamidine, Phenothiazines, Pimozide, Piperaquine, Prenylamine, Probucol, Procainamide, Propoxyphene, Quinidine, Quinine, Ranolazine, Retigabine, Ritodrine, Ritonavir, Saquinavir, Sertindole, Sotalol, Sparfloxacin, Sympathomimetic agents, Tedisamil, Telithromycin, Terfenadine, Terodiline, Tetrabenazine, Thioridazine, Vandetanib, Vemurafenib, Venlafaxine, Vernakalant, Voriconazole, Vorinostat, Ziprasidone, Zotepine, Zuclopenthixol
Psychiatric Anorexia nervosa, Starvation
Pulmonary Hypoxia, Obstructive sleep apnea, Sleep apnea
Renal / Electrolyte Acidosis, Acid-base disturbances, Acute starvation, Electrolyte imbalance, Hyperkalaemia, Hypocalcemia, Hypoglycaemia, Hypokalemia, Hypomagnesemia
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma Myocardial contusion
Urologic No underlying causes
Dental No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

Supraventricular Tachycardia

Pre-Excitation Syndrome

The diagnosis of rapid antegrade conduction down a bypass tract due to ventricular pre-excitation such as Wolff-Parkinson-White syndrome (WPW) should be considered if

Paced Rhythms

A paced rhythm as a cause of wide complex tachycardia is infrequent. This diagnosis is suggested if

  • A pacemaker is in place and there is a LBBB pattern with superior left axis deviation, however, depending on the site of pacing this pattern can vary significantly
  • A wide complex tachycardia can be due to an SVT if the pacemaker is tracking sensed atrial activity and is pacing the ventricles rapidly as result
  • Pacemaker-mediated tachycardia may be present if there is retrograde conduction which triggers atrial activity during ventricular pacing.

References

  1. Lam P, Saba S (2002). "Approach to the evaluation and management of wide complex tachycardias". Indian Pacing and Electrophysiology Journal. 2 (4): 120–6. PMC 1557420. PMID 16951728. Retrieved 2013-08-04.

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