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Runs of Wide-Complex Tachycardia on Telemetry - Dr. Littmann

11/12/2015

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Picture
Differential Diagnosis
  1. SVT with aberrancy (SVT with RBBB or SVT with LBBB)
  2. Nonsustained VT
  3. Artifact
  4. Uncertain (“I don’t know”) – this is a better choice than incorrect guessing!
 
When the intrinsic rhythm is sinus:
I. What was the first beat of the tachycardia?
  1. If the first early beat was a PAC (premature P wave in front of the QRS) -> SVT
  2. If the first early beat was a PVC (no premature P wave in front of the QRS) -> VT
II. What is the P-QRS relationship?
  1. A-V dissociation present -> VT
  2. More QRS complexes than P waves -> VT
III. Fusion complexes present? -> VT
  1. Combination QRS morphology (QRS wider than during sinus but narrower than the widest QRS)
  2. P waves must be present in front of the combination morphology QRS complexes
 
When the intrinsic rhythm is atrial fibrillation:
  1. If the WCT is regular -> VT
 
Artifact
Always consider artifact if:
  1. It is uncertain which was the first or the last beat of the WCT
  2. The rate of the tachycardia was excessive
  3. The patient remained asymptomatic during a long run of a very fast tachycardia
Prove artifact by demonstrating that the
  1. Intrinsic QRS complexes march through
  2. “Notches” march through
  3. Simultaneous hemodynamic tracing indicates regularity

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  • RESIDENCY
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  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
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    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
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      • PGY - 2
      • PGY - 3
      • Simulation Reading
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    • Individualized Interactive Instruction