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WIDE COMPLEX TACHYCARDIA

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WIDE COMPLEX TACHYCARDIA Puja Chopra, PGY-1 Emergency Medicine May 19, 2011 Vereckei et al. They aimed to devise another simplified algorithm for the diagnosis of WCT ... – PowerPoint PPT presentation

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Title: WIDE COMPLEX TACHYCARDIA


1
WIDE COMPLEX TACHYCARDIA
  • Puja Chopra, PGY-1
  • Emergency Medicine
  • May 19, 2011

2
Objectives
  • Differential Diagnosis of wide complex
    tachycardia
  • Approach to wide complex tachcardia
  • Examples of wide complex tachycardia
  • Adenosine/ACLS

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DDx
  • Ventricular tachycardia
  • SVT with a preexisting bundle branch block or a
    functional rate related bundle branch block
  • SVT with antegrade conduction via an accessory
    pathway
  • Drug induced TCA, Class one antiarryhtmic
  • Electrolyte - hyperkalemia

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Wellens Criteria
RBBB Pattern
LBBB Pattern
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Sensitivity 98.7 Specificity 96.5
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  • Brugada Criteria
  • Sensitivity 79 to 91
  • Specificity 43 to 70

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Approach to WCT
  • 1. History
  • 2. Physical Exam
  • 3. ECG
  • Regular VT, SVT with aberrancy, SVT with
    accessory pathway, Electrolyte abnormalities,
    Medications
  • Irregular a fib pre-excitation, a fib BBB, a
    flutter BBB, MAT BBB, polymorphic Vtach
    (torsades)
  • ?AV dissociation, Fusion beats, capture beats
  • 4. Adenosine (?Diagnostic, ?therapeutic)

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70 yo male with palpitations and history of angina
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61 yo male with productive cough and fever
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65 yo male with syncope, PMHx DM
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30 yo female with palpations
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30 yo female with palpations
25
28 yo male, altered and agitated after an unknown
overdose
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45 yo male, previously healthy, with palpitations
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44 year old chronic alcoholic male with
persistent vomiting and becomes unresponsive
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65 yo female with palpations
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48 yo male with palpitations
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Adenosine in the Diagnosis of Broad Complex
Tachycardia- Griffith et al. The Lancet March
1988
89 Sensitivity, 95 specificity, 92 predictive
accuracy for SVT origin
33
Intravenous Adenosine Triphosphate During Wide
QRS Complex Tachycardia Safety, Therapeutic
Efficacy and Diagnostic utility- Sharma et al.
The American Journal of Medicine, April 1990
Sensitivity 70, Specificity 92, PPV 85
34
Adenosine for the Management of Patients with
Tachycardias A new Protocol- Domanovits et al.
European Heart Journal, 1994
35
Adenosine For Wide Complex Tachycardia Efficacy
and Safety- Marill et al. Critical Care
Medicine, 2009
  • The odds of SVT increase by a factor of 36 after
    a positive response to adenosine
  • - Odds of VT increase by factor of 9 after a
    negative response to adenosine

Primary outcome termination of tachycardia with
adenosine, AV block allowing rhythm identification
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Thanks!
  • Questions?
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