Wide complex tachycardias examples: Difference between revisions
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==Overview== | ==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== | ==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]] | ||
====Interpretation of the Previous ECG==== | |||
====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]]. | |||
====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==== | ||
* 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 | * 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==== | ||
* | * 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> | ||
---- | ---- | ||
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]] | ||
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]] | ||
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
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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
- 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.
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)
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
- The QRS shows a slurred upstroke or delta wave.
ST morphology
- There is a negative T wave in I and AVF in addition to a flat ST segment in V3-V5.[1]
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]