Wide complex tachycardias examples: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(9 intermediate revisions by the same user not shown)
Line 13: Line 13:


==Overview==
==Overview==
Shown below are examples of wide complex tachycardias and their diagnosis.
There are several EKG criteria that may help differentiate [[ventricular tachycardia]] ([[VT]]) from [[supraventricular tachycardia]] ([[SVT]]) with aberrancy in the patient with a wide complex tachycardia. The diagnosis of [[VT]] is more likely if the [[electrical axis]] is -90 to -180 degrees (a “northwest” or “superior” axis), if the [[QRS]] is > 140 msec, if there is [[AV dissociation]],  if there are positive or negative [[QRS]] complexes in all the precordial leads, and if the morphology of the [[QRS]] complexes resembles that of a previous [[premature ventricular contraction]] ([[PVC]]).


==EKG Examples==
==EKG Examples==
Shown below is an [[EKG]] demonstrating [[VT]] with [[right bundle branch block]].
Shown below is an [[EKG]] demonstrating [[VT]] with [[right bundle branch block]].
[[File:VT with RBBB morphology.jpg|center|800px]]
[[File:VT with RBBB morphology.jpg|center|800px]]
Copyleft images obtained courtesy of ECGpedia.
Copyleft images obtained courtesy of ECGpedia.<ref name="ecg">ecgpedia.org</ref>
 
----
----
Shown below is an EKG demonstrating [[sinus tachycardia]] and [[WPW]] which mimics [[VT]].
Shown below is an EKG demonstrating [[sinus tachycardia]] and [[WPW]] which mimics [[VT]].


[[File:WPW with sinus tachycardia mimicking VT.jpg|center|800px]]
[[File:WPW with sinus tachycardia mimicking VT.jpg|center|800px]]
Copyleft images obtained courtesy of ECGpedia.
====Interpretation of the Previous ECG====


ECG pedia suggests the 7 + 2 method to interpret the above EKG:
====Rhythm====


===Rhythm===
* This is a regular rhythm and every [[QRS complex]] is preceded by a [[P wave]]. The [[P wave]] is positive in II,III, and AVF and thus originates from the [[sinus node]]; hence, this is a [[sinus rhythm]].


* This is a regular rhythm and every QRS complex is preceded by a p wave. The p wave is positive in II,III, and AVF and thus originates from the sinus node. Conclusion: sinus rhythm.
====Rate====
 
===Rate===


* Use the 'count the squares' method (a bit less than 3 large squares ~> 300-150-100), thus about 110 bpm and thus sinustachycardia.
* Use the 'count the squares' method (a bit less than 3 large squares ~> 300-150-100), thus about 110 bpm and thus sinustachycardia.


===Conduction (PQ,QRS,QT)===
====Conduction (PQ,QRS,QT)====
 
* PQ-interval=0.10sec (2.5 small squares), QRS duration=0.10sec, QT interval=320ms


===Axis===
* PQ-interval=0.10sec (2.5 small squares), [[QRS]] duration=0.10sec, [[QT]] interval=320ms


* Positive in I, II, negative in III and AVF. Thus a horizontal (normal) heart axis.
====Axis====
* The EKG depicts a horizontal normal [[heart axis]] as there are positive deflections in leads I and II and negative deflections in leads III and AVF.


===P wave morphology===
====P wave morphology====


* The p wave is rather large in II, but does not fulfill the criteria for right atrial dilatation.
* The [[P wave]] is rather large in II, but does not fulfill the criteria for right atrial dilatation.


===QRS morphology===
====QRS morphology====


* The QRS shows a slurred upstroke or delta wave.
* The [[QRS]] shows a slurred upstroke or [[delta wave]].


===ST morphology===
====ST morphology====


* Negative T wave in I and AVF. Flat ST in V3-V5.
* There is a negative [[T wave]] in I and AVF in addition to a flat [[ST segment]] in V3-V5.<ref name="ecg">ecgpedia.org</ref>


Compare with the old ECG (not available, so skip this step)
----
----
Shown below is an EKG demonstrating wide complex tachycardia.
Shown below is an [[EKG]] demonstrating wide complex tachycardia at a rate of 160/min with a [[RBBB]], [[AV dissociation]], and extreme [[right axis deviation]] as both leads I and aVF are directed downwards.  These findings favor [[VT]].
[[File:Wide complex tachycardia 1.jpg|center|800px]]
[[File:Wide complex tachycardia 1.jpg|center|800px]]
Copyleft images obtained courtesy of ECGpedia.
A broad complex tachycardia at a rate of 160/min with a [[RBBB]] configuration is present.  The following findings favor [[VT]] as a diagnosis:
*Extreme right axis deviation. Both I and avF are downward.
*AV dissociaiton
7.5 mg [[verapamil]] was administered, which slowed the [[VT]], and [[AV dissociation]] is now more apparent:


Shown below is an [[EKG]] of the same patient after 7.5 mg [[verapamil]] was administered, which slowed the [[VT]] and caused the [[AV dissociation]] to become more apparent.
[[File:Wide complex rhythm with AV dissociation.jpg|center|800px]]
[[File:Wide complex rhythm with AV dissociation.jpg|center|800px]]
Copyleft images obtained courtesy of ECGpedia.
Ultimately converted the patient to [[sinus rhythm]]:


Shown below is an [[EKG]] of the same patient who ultimately converted to [[sinus rhythm]].
[[File:Wide complex rhythm converted to NSR.jpg|center|800px]]
[[File:Wide complex rhythm converted to NSR.jpg|center|800px]]
Copyleft images obtained courtesy of ECGpedia.
Copyleft images obtained courtesy of ECGpedia.<ref name="ecg">ecgpedia.org</ref>
----
----



Latest revision as of 19:28, 5 August 2013



Resident
Survival
Guide
File:Physician Extender Algorithms.gif

Wide complex tachycardia Microchapters

Home

Patient Information

Overview

Causes

Differentiating VT from SVT with aberrant conduction

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples

Electrophysiologic testing

Treatment

Medical Therapy

Primary Prevention

Case Studies

Case #1

Wide complex tachycardias examples On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Wide complex tachycardias examples

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Wide complex tachycardias examples

CDC on Wide complex tachycardias examples

Wide complex tachycardias examples in the news

Blogs on Wide complex tachycardias examples

Directions to Hospitals Treating Wide complex tachycardia

Risk calculators and risk factors for Wide complex tachycardias examples

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

Overview

There are several EKG criteria that may help differentiate ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with aberrancy in the patient with a wide complex tachycardia. The diagnosis of VT is more likely if the electrical axis is -90 to -180 degrees (a “northwest” or “superior” axis), if the QRS is > 140 msec, if there is AV dissociation, if there are positive or negative QRS complexes in all the precordial leads, and if the morphology of the QRS complexes resembles that of a previous premature ventricular contraction (PVC).

EKG Examples

Shown below is an EKG demonstrating VT with right bundle branch block.

Copyleft images obtained courtesy of ECGpedia.[1]


Shown below is an EKG demonstrating sinus tachycardia and WPW which mimics VT.

Interpretation of the Previous ECG

Rhythm

Rate

  • Use the 'count the squares' method (a bit less than 3 large squares ~> 300-150-100), thus about 110 bpm and thus sinustachycardia.

Conduction (PQ,QRS,QT)

  • PQ-interval=0.10sec (2.5 small squares), QRS duration=0.10sec, QT interval=320ms

Axis

  • The EKG depicts a horizontal normal heart axis as there are positive deflections in leads I and II and negative deflections in leads III and AVF.

P wave morphology

  • The P wave is rather large in II, but does not fulfill the criteria for right atrial dilatation.

QRS morphology

ST morphology


Shown below is an EKG demonstrating wide complex tachycardia at a rate of 160/min with a RBBB, AV dissociation, and extreme right axis deviation as both leads I and aVF are directed downwards. These findings favor VT.

Shown below is an EKG of the same patient after 7.5 mg verapamil was administered, which slowed the VT and caused the AV dissociation to become more apparent.

Shown below is an EKG of the same patient who ultimately converted to sinus rhythm.

Copyleft images obtained courtesy of ECGpedia.[1]


References

  1. 1.0 1.1 1.2 ecgpedia.org

Template:WH Template:WS