Wide complex tachycardia physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Initial assessment of the ABCs (airway, breathing, and circulation) is critical in the management of the patient with wide complex tachycardia. Patients who are hemodynamically unstable should undergo immediate cardioversion. Hemodynamic stability does not reliably differentiate VT from SVT. Patients with ventricular tachycardia can often be hemodynamically stable, and stable vital signs do not rule out ventricular tachycardia. This is often a major mistake on the part of clinicians and can lead to inappropriate treatment of VT as SVT with poor outcomes. [1]
Physical Examination
Vital Signs
Vitals should be obtained to assess hemodynamic stability and guide therapy. If the patient is hemodynamically unstable (i.e. hypotensive), they should undergo immediate cardioversion.
Neck
- Cannon "a waves" are a manifestation of AV dissociation and suggest VT.
- Carotid sinus massage (CSM) and / or Valsalva maneuvers may help in determining the underlying rhythm responsible for the wide complex tachycardia:
- Sinus tachycardia may gradually slow.
- Multifocal atrial tachycardia, atrial flutter, and even atrial fibrillation may transiently slow with carotid sinus massage or Valsalva maneuvers.
- A wide complex tachycardia that conducts via an AV nodal reentrant circuit may terminate.
- AV dissociation may become more apparent with carotid sinus massage and / or vagal maneuvers in ventricular tachycardia (VT).
- It should be noted that even ventricular tachycardia (VT) can terminate with carotid sinus massage and / or Valsalva maneuvers.
Cardiac
References
- ↑ Morady F, Baerman JM, DiCarlo LA, DeBuitleir M, Krol RB, Wahr DW (1985). "A prevalent misconception regarding wide-complex tachycardias". JAMA : the Journal of the American Medical Association. 254 (19): 2790–2. PMID 4057488. Retrieved 2013-08-04. Unknown parameter
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