ECG Guru - Instructor Resources - Wide-complex tachycardia https://www.ecgguru.com/ecg/wide-complex-tachycardia-0 en Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB https://www.ecgguru.com/blog/atrial-flutter-right-bundle-branch-block-and-left-anterior-fascicular-block-patient-preexisting <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/atrial-flutter-right-bundle-branch-block-and-left-anterior-fascicular-block-patient-preexisting"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/RSB%20und%20LAH.jpg" width="3297" height="1784" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>If a wide complex tachycardia occurs, the probability is very high that it is a ventricular tachycardia (approx. 80%, in patients with a previous myocardial infarction (...) approx. 90%). Here we see a broad complex tachycardia that looks like an RBBB + LAFB, which is regular. In this constellation, 3 causes must be considered:<br /> 1. fascicular tachycardia from the left posterior fascicle of the left tawara fascicle (QRS width usually only around 130 ms, but sometimes significantly longer).<br /> 2. AT/AFL with 2:1 conduction in the case of pre-existing bifascicular block<br /> 3. AT/ AFL with 2:1 conduction in the case of functional bifascicular block (i.e. first generated by the tachycardia) </p> <p>In this ECG, it is very difficult to recognize atrial activity. After electrical cardioversion of the existing atrial flutter with 2:1 conduction in this case, this patient showed a picture of SR with RBBB + LAFB.</p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/593/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 1/5</option><option value="40">Give Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 2/5</option><option value="60">Give Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 3/5</option><option value="80" selected="selected">Give Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 4/5</option><option value="100">Give Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.7</span></span> <span class="total-votes">(<span >3</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-Wg831mszBeN0LMx6uHHdX1bloMF3V0KqA_AzO6b4LK0" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Fatrial-flutter-right-bundle-branch-block-and-left-anterior-fascicular-block-patient-preexisting&amp;title=Atrial%20Flutter%20With%20Right%20Bundle%20Branch%20Block%20and%20Left%20Anterior%20Fascicular%20Block%20In%20a%20Patient%20%20With%20Preexisting%20RBBB%20%2B%20LAFB"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Mon, 18 Dec 2023 17:14:52 +0000 Dr A Röschl 888 at https://www.ecgguru.com https://www.ecgguru.com/blog/atrial-flutter-right-bundle-branch-block-and-left-anterior-fascicular-block-patient-preexisting#comments Ventricular Tachycardia https://www.ecgguru.com/blog/ventricular-tachycardia <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/ventricular-tachycardia"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/VT_0.jpg" width="3452" height="1784" alt="" /></a></div><div class="field-item odd"><a href="/blog/ventricular-tachycardia"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/erkl%C3%A4rung.jpg" width="3145" height="1669" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>There are several differential diagnoses in the presence of broad-complex tachycardia. The most common cause of wide-complex tachycardia is ventricular tachycardia. In 2nd place is sinus tachycardia/supraventricular tachycardia with aberrant conduction or preexisting bundle branch block.<br /> In this case, there are several indications that this is a ventricular tachycardia: If the patient has a history of myocardial infarction, the probability of ventricular tachycardia is about 90%. In this ECG, we can see the pathological Q- waves (circled in blue) in the inferior wall leads, which clearly indicate that a inferior wall infarction has occurred. Furthermore, the tachycardia does not start with a preceding (premature) P wave but with a premature QRS complex (circled in red). The third feature is AV dissociation (fewer P waves than QRS complexes), the only visible P wave during tachycardia is circled in green.</p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/593/feed" method="post" id="fivestar-custom-widget--2" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--4" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Ventricular Tachycardia 1/5</option><option value="40">Give Ventricular Tachycardia 2/5</option><option value="60">Give Ventricular Tachycardia 3/5</option><option value="80">Give Ventricular Tachycardia 4/5</option><option value="100" selected="selected">Give Ventricular Tachycardia 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >5</span></span> <span class="total-votes">(<span >1</span> vote)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-mz-tkRT6ag8C7MhqVoRmwP_FtW7f_2H6d3OtFAJJLo4" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Fventricular-tachycardia&amp;title=Ventricular%20Tachycardia"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 24 Oct 2023 11:34:35 +0000 Dr A Röschl 876 at https://www.ecgguru.com https://www.ecgguru.com/blog/ventricular-tachycardia#comments WHY IS THIS VT https://www.ecgguru.com/blog/why-vt <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/why-vt"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/F3PYOlYWkAApVzE.jpeg" width="2926" height="1903" alt="" /></a></div><div class="field-item odd"><a href="/blog/why-vt"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/VT.jpg" width="3167" height="1903" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>The tachycardia starts with a premature broad QRS complex. We see nonconducted sinus P waves. There are more QRS complexes than P waves, so it is AV-dissociation. There is no doubt that there is a VT present here.</p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/593/feed" method="post" id="fivestar-custom-widget--3" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--6" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give WHY IS THIS VT 1/5</option><option value="40" selected="selected">Give WHY IS THIS VT 2/5</option><option value="60">Give WHY IS THIS VT 3/5</option><option value="80">Give WHY IS THIS VT 4/5</option><option value="100">Give WHY IS THIS VT 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >2</span></span> <span class="total-votes">(<span >1</span> vote)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-wui8l1G3HJnvT3mvYDP1gyeVOdhkDk1ANPKMzCYJvhI" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_3"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Fwhy-vt&amp;title=WHY%20IS%20THIS%20VT"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 12 Aug 2023 08:21:00 +0000 Dr A Röschl 865 at https://www.ecgguru.com https://www.ecgguru.com/blog/why-vt#comments VT or SVT? Here, Both! https://www.ecgguru.com/blog/vt-or-svt-here-both <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/vt-or-svt-here-both"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/crazy.jpg" width="2751" height="1657" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>Complex ECGs like this one have to be approached systematically. Firstly, we can see a normal sinus rhythm. A is the first beat of a wide complex tachycardia. This must be a ventricular tachycardia. Although there is a P-wave before the first beat of the tachycardia, it is not premature. Therefore, there is no SVT with aberrant conduction. The first beat of the tachycardia looks different from the subsequent beats because there is a fusion beat present. The VT conducts 1:1 back to the atria (a small negative P-wave can be seen at the end of the QRS complex in V1). At C, the wide-complex tachycardia converts into a narrow-complex tachycardia, indicating that the VT has stopped and an SVT has started (due to V-A conduction). It could be an AVNRT, but this cannot be confirmed with certainty. At D, a PVC is seen within the SVT (which stops after 5 beats). A transition of VT into SVT is rare, but it is essential to know that such a phenomenon exists.</p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/593/feed" method="post" id="fivestar-custom-widget--4" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--8" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give VT or SVT? Here, Both! 1/5</option><option value="40">Give VT or SVT? Here, Both! 2/5</option><option value="60">Give VT or SVT? Here, Both! 3/5</option><option value="80" selected="selected">Give VT or SVT? Here, Both! 4/5</option><option value="100">Give VT or SVT? Here, Both! 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.3</span></span> <span class="total-votes">(<span >11</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--4" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-RrK7KRtEGsTC4K7QMxCmOtMotIv_M2MGEWn7qCg5G9w" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_4"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Fvt-or-svt-here-both&amp;title=VT%20or%20SVT%3F%20Here%2C%20Both%21"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 30 Jul 2023 08:07:33 +0000 Dr A Röschl 854 at https://www.ecgguru.com https://www.ecgguru.com/blog/vt-or-svt-here-both#comments ECG Basics: Ventricular Tachycardia https://www.ecgguru.com/ecg/ecg-basics-ventricular-tachycardia-0 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/ecg-basics-ventricular-tachycardia-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/165%20V%20Tach.jpg" width="1938" height="338" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>V tach is identified by:&nbsp; wide QRS complexes (&gt;.12 seconds), rate faster than 100 bpm.&nbsp; In MONOMORPHIC V tach, all QRS complexes look alike.&nbsp; There are other mechanisms of wide-complex tachycardia, but they can be difficult to differentiate from a single rhythm strip.&nbsp; All WCT should be treated as V tach until proven otherwise.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/593/feed" method="post" id="fivestar-custom-widget--5" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--10" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give ECG Basics: Ventricular Tachycardia 1/5</option><option value="40">Give ECG Basics: Ventricular Tachycardia 2/5</option><option value="60">Give ECG Basics: Ventricular Tachycardia 3/5</option><option value="80" selected="selected">Give ECG Basics: Ventricular Tachycardia 4/5</option><option value="100">Give ECG Basics: Ventricular Tachycardia 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4</span></span> <span class="total-votes">(<span >2</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--5" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-v6RzHO624U-TdQNa9mHgAQFmWYchuwuTq9Id6w0b1xM" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/wide-complex-tachycardia-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wide-complex tachycardia</a></div><div class="field-item odd"><a href="/ecg/wct" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">WCT</a></div><div class="field-item even"><a href="/ecg/ventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular tachycardia</a></div><div class="field-item odd"><a href="/ecg/vt" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">VT</a></div><div class="field-item even"><a href="/ecg/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item odd"><a href="/ecg/ecg-basics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Basics</a></div><div class="field-item even"><a href="/ecg/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_5"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fecg-basics-ventricular-tachycardia-0&amp;title=ECG%20Basics%3A%20%20Ventricular%20Tachycardia"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 20 Dec 2017 21:00:14 +0000 Dawn 749 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-ventricular-tachycardia-0#comments Wide-complex Tachycardia: Ventricular Tachycardia https://www.ecgguru.com/ecg/wide-complex-tachycardia-ventricular-tachycardia <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/wide-complex-tachycardia-ventricular-tachycardia"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/WCT118%20VT_0.jpg" width="1800" height="931" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">This ECG is from a man who was experiencing palpitations and light-headedness with near-syncope.&nbsp;<span style="font-size: 13.008px; line-height: 1.538em;">On first look, you will see a wide-complex tachycardia (WTC) with a rate around 240 per minute.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">It is difficult to assess for the presence of P waves because of the rate and the baseline artifact.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">&nbsp;</p><p class="MsoNormal">The differential diagnosis of WCT includes ventricular tachycardia and supraventricular tachycardia with aberrant conduction, or interventricular conduction delay (IVCD). We should ALWAYS consider VENTRICULAR TACHYCARDIA first.&nbsp; If the patient is an older adult with structural heart disease, WCT almost always proves to be VT.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><strong>ABERRANT SVT?</strong>&nbsp; &nbsp;In the setting of SVT with wide QRS, the most common aberrancy is right or left bundle branch block.&nbsp; This ECG could be said to have a “RBBB” type pattern in V1, rSR’ and in Lead I and V6 with a wide S wave.&nbsp; However, the other precordial leads do not have a RBBB pattern.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><strong>VENTRICULAR TACHYCARDIA?</strong> There are some features of this ECG that favor the diagnosis of <a href="http://ecgguru.com/ecg/ventricular-tachycardia-2">VENTRICULAR TACHYCARDIA</a> (VT).&nbsp; They include, but are not limited to:</p><p class="MsoNormal">* Regular, wide QRS complexes, about .14 seconds in this ECG, but varies because of difficulty in measuring the beginning and end of the QRS in each lead.&nbsp; The artifact obscures the exact points of beginning and ending. The QRS complexes, especially from V2 leftward, are very “ugly”, and don’t resemble patterns we would expect with bundle branch block.</p><p class="MsoNormal">* Horizontal plane axis extremely abnormal:&nbsp; Leads II, III, and aVF are negative and aVR and aVL are positive.&nbsp; The biphasic Lead I indicates a nearly vertical axis at around – 90 degrees.</p><p class="MsoNormal">* There is “almost” precordial concordance, but V1 is biphasic.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal">Unfortunately, we do not see <a href="http://lifeinthefastlane.com/ecg-library/basics/vt_vs_svt/">capture beats</a> or fusion beats, which would secure the diagnosis of VT. Disassociated P waves would also be a sure sign of VT, but the artifact in this ECG makes it impossible to say whether there are P waves.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><strong>IDIOPATHIC POSTERIOR FASCICULAR TACHYCARDIA?</strong>&nbsp; This tracing also has features of <a href="http://lifeinthefastlane.com/ecg-library/fascicular-vt/">Posterior Fascicular Tachycardia</a>, a type of <strong>ventricular tachycardia</strong> sometimes called Belhassen-type Tachycardia.&nbsp; These include:</p><p class="MsoNormal">* Borderline QRS width.&nbsp; Fascicular tachycardia usually has a QRS duration of .10 - .14 seconds. (100-140 ms), narrower than other types of VT.</p><p class="MsoNormal">* Short RS interval in the precordial leads.&nbsp; The time from onset of the r wave to the nadir of the S wave appears to be between .04 sec. and .06 sec. &nbsp;&nbsp;The RS interval is usually .10 sec. (100 ms) or more in other types of VT.</p><p class="MsoNormal">* A RBBB pattern, with additional left anterior fascicular block (LAFB or LAHB) pattern.&nbsp; While not typical for RBBB in all the precordial leads, V1, V6 and Lead I suggest a RBBB pattern.</p><p class="MsoNormal">* Left axis deviation, indicating that, if this is fascicular tachycardia, it is arising from the posterior fascicle.</p><p class="MsoNormal">Fascicular tachycardia is an idiopathic tachycardia usually occurring in young, healthy patients, most often male.&nbsp; There is a lack of structural heart disease, and the tachycardia usually occurs at rest. The mechanism is re-entry of an ectopic beat from the left ventricle. It often responds to the use of Verapamil, rather than the usual drugs used for SVT and VT.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><strong>BOTTOM LINE &nbsp;&nbsp;</strong><span style="font-size: 13.008px; line-height: 1.538em;">When faced with a patient with wide-complex tachycardia, the more information you have, the better. That includes patient history, family history, medications, signs and symptoms.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">A 12-lead ECG may prove to be invaluable, unless the patient is so severely unstable that there is no time.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">It can be very difficult to diagnose a WCT from these tools, and electrophysiology studies may prove beneficial.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><strong><span style="color: #c00000;">ALWAYS TREAT WCT AS VENTRICULAR TACHYCARDIA UNTIL IT IS PROVEN TO BE SOMETHING ELSE.</span></strong><span style="font-size: 8pt; line-height: 107%;">&nbsp;</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">Of course, we would welcome a discussion on this topic, sign in to comment below. (Sign in is necessary for our efforts to repel SPAMMERS.</span></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/593/feed" method="post" id="fivestar-custom-widget--6" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--12" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Wide-complex Tachycardia: Ventricular Tachycardia 1/5</option><option value="40">Give Wide-complex Tachycardia: Ventricular Tachycardia 2/5</option><option value="60">Give Wide-complex Tachycardia: Ventricular Tachycardia 3/5</option><option value="80" selected="selected">Give Wide-complex Tachycardia: Ventricular Tachycardia 4/5</option><option value="100">Give Wide-complex Tachycardia: Ventricular Tachycardia 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4</span></span> <span class="total-votes">(<span >5</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--6" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-hDQl1GEVPfUx6RT3o1r64gxwI0S6yjMdi-svgi1QJgM" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/wide-complex-tachycardia-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wide-complex tachycardia</a></div><div class="field-item odd"><a href="/ecg/ventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular tachycardia</a></div><div class="field-item even"><a href="/ecg/supraventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Supraventricular tachycardia</a></div><div class="field-item odd"><a href="/ecg/aberrant-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Aberrant conduction</a></div><div class="field-item even"><a href="/ecg/fascicular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Fascicular tachycardia</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_6"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fwide-complex-tachycardia-ventricular-tachycardia&amp;title=%20Wide-complex%20Tachycardia%3A%20Ventricular%20Tachycardia"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 14 Jun 2016 20:23:19 +0000 Dawn 702 at https://www.ecgguru.com https://www.ecgguru.com/ecg/wide-complex-tachycardia-ventricular-tachycardia#comments Ventricular Tachycardia https://www.ecgguru.com/ecg/ventricular-tachycardia-2 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/ventricular-tachycardia-2"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/WCT103.jpg" width="1800" height="1065" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p><span style="font-size: 13.0080003738403px; line-height: 20.0063037872314px;">This wide-complex tachycardia is ventricular tachycardia.&nbsp; Along with the wide QRS and the fast rate, features which favor a diagnosis of VT over BBB include:&nbsp; backwards (extreme right) QRS axis, negative QRS in V6, and an apparently monophasic QRS in V1, as opposed to the rSR' pattern of right bundle branch block.&nbsp;</span><br style="font-size: 13.0080003738403px; line-height: 20.0063037872314px;" /><span style="font-size: 13.0080003738403px; line-height: 20.0063037872314px;">Remember, ALL wide-QRS tachycardias should be treated as V Tach until proven otherwise, as it is a life-threatening arrhythmia. &nbsp;Factors which lower cardiac output during V Tach include: &nbsp;Fast rate, wide QRS, and lack of P wave preceding the QRS. &nbsp;The sudden severe lowering of perfusion that usually accompanies V Tach can lead to rapid deterioraton and ventricular fibrillation.</span></p><p><span style="font-size: 13.0080003738403px; line-height: 20.0063037872314px;">For discussions by Jason Roediger (ECG GURU extroidonairre) on recognizing ventricular tachycardia, go to this <a title="Jason WCT" href="http://ecgguru.com/expert-review/question-does-extreme-right-axis-backward-always-indicate-ventricular-rhythm">LINK</a>, and this<a title="Jason on VT" href="http://ecgguru.com/expert-review/what-are-criteria-determining-wide-complex-tachycardia-v-tach"> LINK</a>.</span></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/593/feed" method="post" id="fivestar-custom-widget--7" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--14" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Ventricular Tachycardia 1/5</option><option value="40">Give Ventricular Tachycardia 2/5</option><option value="60">Give Ventricular Tachycardia 3/5</option><option value="80">Give Ventricular Tachycardia 4/5</option><option value="100" selected="selected">Give Ventricular Tachycardia 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.8</span></span> <span class="total-votes">(<span >5</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--7" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-BsRgf3JZpkatgauWUR88JYxDdsBYyJjW8JEWVLwVe1g" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/ventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular tachycardia</a></div><div class="field-item odd"><a href="/ecg/tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Tachycardia</a></div><div class="field-item even"><a href="/ecg/wide-complex-tachycardia-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wide-complex tachycardia</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_7"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fventricular-tachycardia-2&amp;title=Ventricular%20Tachycardia"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Thu, 19 Mar 2015 20:42:08 +0000 Dawn 630 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ventricular-tachycardia-2#comments Anti-tachycardia Function of ICD https://www.ecgguru.com/ecg/anti-tachycardia-function-icd <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/anti-tachycardia-function-icd"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/PM%20200%20Antitachycardia%20functon%20of%20ICD%20from%20Brent%20DuBois.jpg" width="1200" height="474" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This ECG was donated to the ECG Guru by Brent Dubois, and was originally published on the FaceBook page, Paramedic Tips &amp; Tricks. &nbsp;We published it to this site three years ago, but believe it should be shown again, as it is somewhat rare to catch a good-quality 12-Lead ECG of an implanted cardioverter-defibrillator pacemaer using overdrive pacing to terminate a ventricular tachycardia. &nbsp;Most of our examples have been rhythm strips.</p><p>In this strip, we see the patient in ventricular tachycardia (V tach) at a rate of about 190 / minute. &nbsp;The ICD, in response to the fast rate, delivers a short burst of even faster paced beats. &nbsp;The physological rule in the heart is, "the fastest pacemaker controls the heart". &nbsp;Once the pacemaker has terminated the V tach, it paces at a much slower rate. &nbsp;It is pacing the atria, and the conduction system is intact, allowing the impulse to travel normally through the ventricles. &nbsp;If the sinus node is able to "outpace" the slower paced rhythm, the heart will resume a sinus rhythm.</p><p>This is called "overdrive pacing" and is done automatically by an ICD that is programmed to do so. &nbsp;Overdrive pacing can also be accomplished by a temporary transvenous pacer or transcutaneous pacemaker. &nbsp;</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/593/feed" method="post" id="fivestar-custom-widget--8" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--16" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Anti-tachycardia Function of ICD 1/5</option><option value="40">Give Anti-tachycardia Function of ICD 2/5</option><option value="60">Give Anti-tachycardia Function of ICD 3/5</option><option value="80">Give Anti-tachycardia Function of ICD 4/5</option><option value="100" selected="selected">Give Anti-tachycardia Function of ICD 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.1</span></span> <span class="total-votes">(<span >9</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--8" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-DnBxn7v8dPE7L2oxMQZ2DNadcCfEm4hupjokurGTXJM" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/icd" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ICD</a></div><div class="field-item odd"><a href="/ecg/pacemaker" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pacemaker</a></div><div class="field-item even"><a href="/ecg/anti-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Anti-tachycardia</a></div><div class="field-item odd"><a href="/ecg/overdrive-pacing" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Overdrive pacing</a></div><div class="field-item even"><a href="/ecg/ventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular tachycardia</a></div><div class="field-item odd"><a href="/ecg/wide-complex-tachycardia-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wide-complex tachycardia</a></div><div class="field-item even"><a href="/ecg/tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Tachycardia</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_8"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fanti-tachycardia-function-icd&amp;title=Anti-tachycardia%20Function%20of%20ICD"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 06 Jan 2015 08:53:57 +0000 Dawn 613 at https://www.ecgguru.com https://www.ecgguru.com/ecg/anti-tachycardia-function-icd#comments What Are The Criteria For Determining That A Wide-Complex Tachycardia Is V Tach? https://www.ecgguru.com/expert-review/what-are-criteria-determining-wide-complex-tachycardia-v-tach <div class="field field-name-field-expert-ecg-interpretation field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/WCT103_0%20copy.png" width="730" height="400" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><address>Today's&nbsp;Answer is provided by Jason E. Roediger,&nbsp;CCT, CRAT,&nbsp;who is&nbsp;a highly respected&nbsp;Cardiovascular&nbsp;Technician at the Dept. of Veterans Affairs,&nbsp;Hunter Holmes&nbsp;McGuire VA Medical Center in&nbsp;Richmond, VA.&nbsp;&nbsp;He is known for holding&nbsp;numerous&nbsp;certifications in&nbsp;all levels of ECG interpretation, and also for&nbsp;scoring 100% on the&nbsp;Level IV Advanced ECG Board Certification exam that is usually reserved for&nbsp;cardiologists.</address> <p><a class="permalink" href="http://www.ekgguru.com/members/comment/39#comment-39" rel="bookmark">Comprehensive list of criteria</a></p> <p><a class="permalink" href="http://www.ekgguru.com/members/comment/39#comment-39" rel="bookmark">Permalink</a>Submitted by <a class="username" title="View user profile." lang="" xml:lang="" href="http://www.ekgguru.com/members/user/226">jer5150</a> on Tue, 01/10/2012 - 22:17</p> <p><strong>INTERPRETATION: </strong> Ventricular tachycardia (rate about 163/min) presumably originating from the left ventricle (LV).<br> Overwhelming evidence that this is ventricular tachycardia are as follows:<br> 1.) The ventricular tachycardia is apparently dissociated from a sinus tachycardia at a somewhat slower rate of about 123/min (best seen in leads V1 and aVL; vertical arrows). While not nearly as clinically significant as those types of double tachycardia caused by digitalis intoxication, this example might technically qualify as a form of “double tachycardia” since both the upper and lower chambers of the heart are exceeding a rate of 100/min.<br> 2.) The duration of the QRS interval is so-called “wide-wide” (i.e., &gt; 0.14s) at about 0.19s to 0.20s.<br> 3.) The predominantly negative rS complex in Lead I and wholly negative QS complex in aVF indicate an axis of roughly about -120 and would place it in the right upper quadrant (i.e., “No-Man’s-Land” or “N-M-L”). This is suggestive of an apical origin of the tachycardia.<br> 4.) Brugada criterion # 1: There are <em>no</em> RS complexes in <em>any</em> of the V leads (here they’re either qR or QS complexes.) Brugada pointed out that if <em>none</em> of the V leads contained a diphasic RS complex, then there was no need for any further analysis, the tachycardia was unequivocally ventricular in origin. 2<br> 5.) The presence of a monophasic QS complex in V6 is more diagnostic of ventricular tachycardia than just a rS complex; especially if associated with a QRS complex in V1 that is predominantly positive. By Dr. Marriott’s estimation, this combination only occurs in about 20% of all left ventricular tachycardias (LVT).<br> 6.) Cogent evidence arguing against this being the result of conduction over an accessory pathway are threefold:<br> a. The wholly negative QS complexes from V4-6 are also suggestive of an apical origin of the tachycardia. Since all accessory pathways enter the ventricles at their base, accessory pathway conduction is effectively excluded; and . . . 1<br> b. . . . a qR complex in <em>any</em> of the five leads, V2-6 (here in V2-3) also excludes preexcited (W-P-W) tachycardia; and . . . 1<br> c. . . . the presence of more QRS complexes than P-waves (because in any form of preexcited tachycardia, the atria are involved in every beat). 1<br> 7.) The QRS complex in V1 is not a monophasic R-wave. Rather it is a diphasic qR complex with very subtle notching / slurring on the downstroke (oblique arrow) of the R-wave (i.e., so-called taller left “rabbit-ear” equivalent.)<br> 8.) The q-waves in V1-3 are <em>superficially mimicking</em> the negative component (i.e., nadir) of an atrial flutter wave but right-sided chest leads do not usually show the typical “saw-tooth” pattern so often seen in inferior leads II, III, and aVF. Atrial flutter waves in V1 usually take on the appearance of little positive “P-like” waves. What looks like a retrograde atrial impulse immediately following a QRS complex in V4 is actually part of the QRS complex itself.</p> <p><strong>References / Sources.</strong><br> 1.) Marriott, HJL. Emergency Electrocardiography. Naples, Fl.: Trinity Press, 1997, p. 60 - 71.<br> 2.) Nelson's EKG Site: <a href="http://nelsonsekgsite.com/">http://nelsonsekgsite.com/</a></p> </div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/ventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular tachycardia</a></div><div class="field-item odd"><a href="/ecg/wide-complex-tachycardia-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wide-complex tachycardia</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_9"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fexpert-review%2Fwhat-are-criteria-determining-wide-complex-tachycardia-v-tach&amp;title=What%20Are%20The%20Criteria%20For%20Determining%20That%20A%20Wide-Complex%20Tachycardia%20Is%20V%20Tach%3F"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 11 Jan 2012 05:13:55 +0000 Dawn 157 at https://www.ecgguru.com https://www.ecgguru.com/expert-review/what-are-criteria-determining-wide-complex-tachycardia-v-tach#comments