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Wide complex tachycardia

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Wide complex tachycardia WCT Principles of Differentiation Clinical judgment: patient and his heart disease Basic ECG Conduction abnormality? – PowerPoint PPT presentation

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Title: Wide complex tachycardia


1
Wide complex tachycardia
2
WCT Principles of Differentiation
  • Clinical judgment patient and his heart disease
  • Basic ECG
  • Conduction abnormality?
  • WPW?
  • Signs of old MI or Cardiomiopathy
  • VT has to be wide complex
  • SVT could be wide complex (aberrant conduction,
    pre-excitation)
  • AV dissociation always means VT and exists in 80
    of VTs
  • AV association may be antegrade (SVT) or
    retrograde (VT)

3
ECG Diagnosis of WCT
  • Evidence of AV dissociation
  • P waves marching through tachycardia
  • Fusion beats
  • Capture beats
  • May use maneuvers to amplify P waves
  • Lewis leads
  • Esophageal ECG
  • Various morphology criteria

4
Esophageal recording for VT diagnosis
Surface
Esophageal
5
(No Transcript)
6
Case presentation
  • 63 yo gentleman
  • Palpitations, dizziness, weakness for one week
  • No previous medical history
  • After ECG was obtained - send to ER susp MI
  • In ER PS 160, BP 80/50
  • Adenosine not converted,
  • Amiodarone no response
  • Cardioversion failed ---- called EP consult

7
Esophageal ECG
  • 11 AV (VA??) conduction

8
Next diagnostic step
  • Another attempt of cardioversion
  • More amiodarone IV
  • Adenosine with esophageal recording
  • Endocardial recording/ EPS
  • Complete blood count

9
ADENOSINE IV esophageal ECG
10
  • EP consult conclusion
  • Right atrial ectopic (or sinus) tachycardia
  • CBC Hb 8 mg/dl ...
  • Diagnosis at discharge Renal cell tumor
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