Rhythm diagnosis in regular wide complex tachycardia: Difference between revisions
Line 85: Line 85:
*Only for treatment decision if pt is stable  
*Only for treatment decision if pt is stable  
*Assume V-tach until proven otherwise
*Assume V-tach until proven otherwise
*Sn 98%, Sp 97% for V-tach


#Absence of an RS complex in all precordial leads?  
#Absence of an RS complex in all precordial leads?  
##If yes then VT  
##If yes then VT  
##If no then continue  
##If no then continue  
#RS interval >100ms in one precordial lead?  
#RS interval >100ms in one precordial lead? (onset of R wave to deepest part of S wave)
##If yes then VT  
##If yes then VT  
##If no then continue  
##If no then continue  
#AV dissociation  
#AV dissociation?
##If yes then VT  
##If yes then VT  
##If no then continue  
##If no then continue  
#Morphology criteria for VT present both in V1-2 and V6?  
#Morphology criteria for v-tach present in both V1-2 and V6?  
##If yes then VT  
##If yes then VT  
##If no then possibly SVT
##If no then possibly SVT w/ aberrant conduction


== See Also  ==
== See Also  ==

Revision as of 20:44, 4 January 2012

VTach vs. SVT

Factor
 V Tach SVT w/ Aberrancy
Age >50 <35
History MI, CHF, CABG, MVR MVR, WPW
Cannon A Waves Present Absent
Arterial Pulse Variation No variation
First heart sound Variable Not variable
Fusion Beats Present Absent
AV dissociation Present Absent
QRS >0.14sec <0.14sec
Axis Extreme LAD (< -30) Normal or slightly abnl
Vagal Maneuvers No response Slows or terminates

QRS morphology

V1 positive pattern

V1 - R or qR

V6 - rS

V1 - RSR'

V6 - Rs

QRS morphology

V1 negative pattern

V1/V2 - Broad R wave (>40msec)

V6 - Any Q or QS

V1/V2 - Small R

V6 - no Q


Algorithm (Brugada Criteria)

  • Only for regular rhythms
  • Only for treatment decision if pt is stable
  • Assume V-tach until proven otherwise
  • Sn 98%, Sp 97% for V-tach
  1. Absence of an RS complex in all precordial leads?
    1. If yes then VT
    2. If no then continue
  2. RS interval >100ms in one precordial lead? (onset of R wave to deepest part of S wave)
    1. If yes then VT
    2. If no then continue
  3. AV dissociation?
    1. If yes then VT
    2. If no then continue
  4. Morphology criteria for v-tach present in both V1-2 and V6?
    1. If yes then VT
    2. If no then possibly SVT w/ aberrant conduction

See Also

Tachycardia (Wide)

Source

7/2/09 Pani 4/2/10 Niemann

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