Wide complex tachycardias examples: Difference between revisions
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Shown below are examples of wide complex tachycardias and their diagnosis. | Shown below are examples of wide complex tachycardias and their diagnosis. | ||
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Shown below is an [[EKG]] demonstrating [[VT]] with [[right bundle branch block]]. | |||
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. | |||
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Shown below is an EKG demonstrating [[sinus tachycardia]] and [[WPW]] which mimics [[VT]]. | |||
Shown below is | |||
[[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. | |||
ECG pedia suggests the 7 + 2 method to interpret the above EKG: | ECG pedia suggests the 7 + 2 method to interpret the above EKG: | ||
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Compare with the old ECG (not available, so skip this step) | Compare with the old ECG (not available, so skip this step) | ||
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Shown below is an EKG demonstrating wide complex tachycardia. | |||
Shown below is | |||
[[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: | 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. | *Extreme right axis deviation. Both I and avF are downward. | ||
*AV dissociaiton | *AV dissociaiton | ||
7.5 mg verapamil was administered, which slowed the VT, and [[AV dissociation]] is now more apparent: | 7.5 mg [[verapamil]] was administered, which slowed the [[VT]], and [[AV dissociation]] is now 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: | Ultimately converted the patient 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. | |||
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Revision as of 18:24, 5 August 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Shown below are examples of wide complex tachycardias and their diagnosis.
Shown below is an EKG demonstrating VT with right bundle branch block.
Copyleft images obtained courtesy of ECGpedia.
Shown below is an EKG demonstrating sinus tachycardia and WPW which mimics VT.
Copyleft images obtained courtesy of ECGpedia.
ECG pedia suggests the 7 + 2 method to interpret the above EKG:
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
- 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
- Positive in I, II, negative in III and AVF. Thus a horizontal (normal) heart axis.
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
- Negative T wave in I and AVF. Flat ST in V3-V5.
Compare with the old ECG (not available, so skip this step)
Shown below is an EKG demonstrating wide complex tachycardia.
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:
Copyleft images obtained courtesy of ECGpedia.
Ultimately converted the patient to sinus rhythm:
Copyleft images obtained courtesy of ECGpedia.