Wide complex tachycardia differential diagnosis: Difference between revisions
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{{familytree | | | | | | E01 |-|-| E02 |-|-| E03 | | |E01=AV dissociation?|E02='''yes'''|E03='''VT''' SN=0.82 SP=0.98}} | {{familytree | | | | | | E01 |-|-| E02 |-|-| E03 | | |E01=AV dissociation?|E02='''yes'''|E03='''VT''' SN=0.82 SP=0.98}} | ||
{{familytree | | | | | | |!| | | | | | | | | | | | | | }} | {{familytree | | | | | | |!| | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | {{familytree | | | | | | F01 | | | | | | | | | | | | |F01='''no'''}} | ||
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{{familytree | | | | | | G01 |-|-| G02 |-|-| G03 | | |G01=Morphology criteria for VT present both in precordial leads V1-2 and V6?|G02='''yes'''|G03='''VT''' SN=0.987 SP=0.965}} | {{familytree | | | | | | G01 |-|-| G02 |-|-| G03 | | |G01=Morphology criteria for VT present both in precordial leads V1-2 and V6?|G02='''yes'''|G03='''VT''' SN=0.987 SP=0.965}} | ||
{{familytree | | | | | | |!| | | | | | | | | | | | | | }} | {{familytree | | | | | | |!| | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | {{familytree | | | | | | H01 | | | | | | | | | | | | |H01='''no'''}} | ||
{{familytree | | | | | | |!| | | | | | | | | | | | | | }} | {{familytree | | | | | | |!| | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | I01 | | | | | | | | | | | | |I01='''SVT''' SN=0.965 SP=0.987}} | {{familytree | | | | | | I01 | | | | | | | | | | | | |I01='''SVT''' SN=0.965 SP=0.987}} | ||
Revision as of 22:11, 2 August 2013
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Wide complex tachycardia Microchapters |
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Wide complex tachycardia differential diagnosis On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Differential Diagnosis
Algorithms to Distinguish VT from SVT
Brugada Criteria
| Absence of an RS complex in all precordial leads? | yes | VT SN=0.21 SP=1.0 | |||||||||||||||||||||||||||||||||||||||
| no | |||||||||||||||||||||||||||||||||||||||||
| R to S interval>100ms in one precordial lead? | yes | VT SN=0.21 SP=1.0 | |||||||||||||||||||||||||||||||||||||||
| no | |||||||||||||||||||||||||||||||||||||||||
| AV dissociation? | yes | VT SN=0.82 SP=0.98 | |||||||||||||||||||||||||||||||||||||||
| no | |||||||||||||||||||||||||||||||||||||||||
| Morphology criteria for VT present both in precordial leads V1-2 and V6? | yes | VT SN=0.987 SP=0.965 | |||||||||||||||||||||||||||||||||||||||
| no | |||||||||||||||||||||||||||||||||||||||||
| SVT SN=0.965 SP=0.987 | |||||||||||||||||||||||||||||||||||||||||
Vereckei Criteria
An algorithm has been proposed by Vereckei and colleagues. In addition to to do the traditional criteria, the voltage change on the EKG is used as a final discriminatory criteria. In this method, the voltage change during the initial 40 ms (v(i)) and the terminal 40 ms (v(t)) of the same QRS complex is used to estimate the (v(i)) and terminal (v(t)) ventricular activation velocity ratio (v(i)/v(t)). A v(i)/v(t) > 1 suggests SVT and a v(i)/v(t) ≤ 1 suggests VT.[1]
The method calculating Vi/Vt is shown below. Because the Vi/Vt is < 1, a diagnosis of VT is suggested by the tracing:
ACC Algorithm for Distinguishing SVT from VT
The above figure is adapted from the American College of Cardiology algorithm.
References
- ↑ Vereckei A, Duray G, Szénási G, Altemose GT, Miller JM (2007). "Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia". European Heart Journal. 28 (5): 589–600. doi:10.1093/eurheartj/ehl473. PMID 17272358. Retrieved 2012-10-13. Unknown parameter
|month=ignored (help)