ECG Guru - Instructor Resources - VT https://www.ecgguru.com/ecg/vt en VENTRICULAR TACHYCARDIA WITH SUCCESSFUL ATP https://www.ecgguru.com/blog/ventricular-tachycardia-successful-atp <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-successful-atp"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/VT%20P.jpg" width="2716" height="1705" 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 ventricular tachycardia occurs in an Implantable Cardioverter Defibrillator (ICD) wearer, the ICD can combat this with 2 different forms of therapy, provided these are activated (which can be done using a programming device). First, the ICD attempts to override the tachycardia. The fastest pacemaker gets control of the heart. If this is not successful, the defibrillator function is used. Here you can see the limb leads. Initially there is a relatively slow ventricular tachycardia.<br /> This is followed by ATP, which is successful and ends the VT by overstimulation. Then 2 beats with ventricular pacing, followed by a PVC.</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/33/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 VENTRICULAR TACHYCARDIA WITH SUCCESSFUL ATP 1/5</option><option value="40">Give VENTRICULAR TACHYCARDIA WITH SUCCESSFUL ATP 2/5</option><option value="60">Give VENTRICULAR TACHYCARDIA WITH SUCCESSFUL ATP 3/5</option><option value="80" selected="selected">Give VENTRICULAR TACHYCARDIA WITH SUCCESSFUL ATP 4/5</option><option value="100">Give VENTRICULAR TACHYCARDIA WITH SUCCESSFUL ATP 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.5</span></span> <span class="total-votes">(<span >4</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-74cH_ZQpQYgBkcC4AS2eByYqcRFivwYiTgGek4GRGdc" /> <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%2Fventricular-tachycardia-successful-atp&amp;title=VENTRICULAR%20TACHYCARDIA%20%20WITH%20SUCCESSFUL%20ATP"><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> Thu, 21 Dec 2023 17:15:41 +0000 Dr A Röschl 891 at https://www.ecgguru.com https://www.ecgguru.com/blog/ventricular-tachycardia-successful-atp#comments SUSTAINED VENTRICULAR TACHYCARDIA https://www.ecgguru.com/blog/sustained-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/sustained-ventricular-tachycardia"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/incessant%20VT.jpg" width="1926" height="1904" alt="" /></a></div><div class="field-item odd"><a href="/blog/sustained-ventricular-tachycardia"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/incessant%20VT%20773232.jpg" width="3577" height="1409" 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>A sustained VT is a ventricular rhythm with a frequency of more than 100 beats per minute that usually lasts at least 30 seconds or must be terminated earlier due to hemodynamic instability.<br /> We see here a wide complex tachycardia with a frequency of approx. 105-110 beats per minute that lasts for a good minute. It begins with a premature QRS complex without a premature P wave. The short VT after the end of the sustained ventricular tachycardia with the same QRS morphology also indicates a ventricular origin of this arrhythmia.</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/33/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 SUSTAINED VENTRICULAR TACHYCARDIA 1/5</option><option value="40">Give SUSTAINED VENTRICULAR TACHYCARDIA 2/5</option><option value="60">Give SUSTAINED VENTRICULAR TACHYCARDIA 3/5</option><option value="80">Give SUSTAINED VENTRICULAR TACHYCARDIA 4/5</option><option value="100" selected="selected">Give SUSTAINED 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-6M0Xs2enjvzHOGcM7yhsbcBjTbj3lbqmWSmcdPGXVO4" /> <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%2Fsustained-ventricular-tachycardia&amp;title=SUSTAINED%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 2023 16:11:23 +0000 Dr A Röschl 890 at https://www.ecgguru.com https://www.ecgguru.com/blog/sustained-ventricular-tachycardia#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/33/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 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--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-5T4wzN-mN7jJ4hQ14gpezftiSIgV4nYZyZdMyTVo7nk" /> <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%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 Ventricular Tachycardia After Inferior Myocardial Infarction https://www.ecgguru.com/blog/ventricular-tachycardia-after-inferior-myocardial-infarction <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-after-inferior-myocardial-infarction"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/VT%20Wein.jpg" width="3035" height="1908" 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>76-year-old man, with a history of inferior wall myocardial infarction. He experiences recurrent episodes of brief palpitations, often lasting only 5-15 seconds. In this ECG, at the beginning, the last part of a wide-complex tachycardia is visible. After 2 sinus beats, another wide-complex tachycardia begins (with the same QRS configuration). Approximately 80% of wide-complex tachycardias are ventricular tachycardias, with the rest being distributed among sinus tachycardias or supraventricular tachycardias with preexisting or functional bundle branch block, and very rarely, antidromic WPW tachycardia. In the present case, there is a history of inferior wall myocardial infarction, which can be verified by the Q waves in the inferior leads II, III, and aVF. Consequently, the probability of ventricular tachycardia (VT) is over 90%. Furthermore, the tachycardia begins with a premature broad QRS complex without a preceding premature p-wave. The 4th beat of the second tachycardia is likely a fusion beat. There is no doubt about the presence of VT in this case.</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/33/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 Ventricular Tachycardia After Inferior Myocardial Infarction 1/5</option><option value="40">Give Ventricular Tachycardia After Inferior Myocardial Infarction 2/5</option><option value="60">Give Ventricular Tachycardia After Inferior Myocardial Infarction 3/5</option><option value="80">Give Ventricular Tachycardia After Inferior Myocardial Infarction 4/5</option><option value="100" selected="selected">Give Ventricular Tachycardia After Inferior Myocardial Infarction 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--4" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-GsylKcHQTdhu7qIU9wYAxbtTxqeUWRwSw1TOknLY5x4" /> <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%2Fventricular-tachycardia-after-inferior-myocardial-infarction&amp;title=Ventricular%20Tachycardia%20After%20Inferior%20Myocardial%20Infarction"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 26 Jul 2023 12:20:19 +0000 Dr A Röschl 852 at https://www.ecgguru.com https://www.ecgguru.com/blog/ventricular-tachycardia-after-inferior-myocardial-infarction#comments Wide Complex Tachycardia https://www.ecgguru.com/ecg/wide-complex-tachycardia-3 <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-3"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/WCT121%20JL_0.jpg" width="1808" height="1012" 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"><strong><span style="color: #00b050;">The Patient:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">&nbsp;&nbsp; </span></span>The details of this patient’s complaints and presentation are lost, but we know he was a 66-year-old man who was being treated in the Emergency Department. His rhythm went from sinus tachycardia with non-respiratory sinus arrhythmia to multi-focal atrial tachycardia (MAT) to wide-complex tachycardia. The WCT lasted a few minutes and spontaneously converted to an irregular sinus rhythm.</p><p class="MsoNormal"><strong><span style="color: #00b050;">Wide-complex tachycardia:<span style="mso-spacerun: yes;">&nbsp; </span>Ventricular tachycardia or aberrantly-conducted supraventricular tachycardia?<span style="mso-spacerun: yes;">&nbsp; </span></span></strong>When confronted with a wide-complex tachycardia, it can be very difficult to determine whether the rhythm is ventricular or supraventricular with aberrant conduction, such as bundle branch block. The patient’s history and presentation may offer clues.<span style="mso-spacerun: yes;">&nbsp; </span>It is very important, if the patient’s hemodynamic status is at all compromised (they are “symptomatic”), the WCT should be treated as VENTRICULAR TACHYCARDIA until proven otherwise. <span style="mso-spacerun: yes;">&nbsp;</span></p><p class="MsoNormal">There have been many lists made of the ECG features that favor a diagnosis of ventricular tachycardia. Here are two such lists:<span style="mso-spacerun: yes;">&nbsp; </span><a href="https://litfl.coom/vt-versus-svt-ecg-library/">Life In The Fast Lane</a>, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040878/">National Institute of Health</a>.</p><p class="MsoNormal"><strong><span style="color: #00b050;">The ECG:<span style="mso-spacerun: yes;">&nbsp; </span></span></strong>This ECG shows a regular, fast, wide-QRS rhythm.<span style="mso-spacerun: yes;">&nbsp; </span>The rate is 233 bpm.<span style="mso-spacerun: yes;">&nbsp; </span>It had a sudden onset and sudden offset (not shown on this ECG), and the rhythm lasted about 3-5 minutes. The patient felt the change in rate, but did not become hypotensive or unstable.<span style="mso-spacerun: yes;">&nbsp; </span>Some features that relate directly to the most commonly-referenced VT vs. SVT charts are:</p><p class="MsoListParagraphCxSpFirst" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]-->The morphology of the QRS complexes in this ECG is indicative of <a href="https://www.ecgguru.com/ecg/left-bundle-branch-block-and-artifact">left bundle branch block</a>. V1 has a wide, negative, monomorphic QRS. Leads I and V6 have wide, positive QRSs. Aberrant conduction often takes a LBBB or RBBB pattern.</p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]-->The QRS is difficult to measure due to unclear start and stop points in all leads, but the overall width appears to be about 120 ms (.12 sec).<span style="mso-spacerun: yes;">&nbsp; </span>VT tends to have very wide QRS complexes, greater than 160 ms.</p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]-->This ECG’s axis is about -30 degrees, and aVR is negative. This indicates an axis just a little to the left, within normal range.<span style="mso-spacerun: yes;">&nbsp; </span>An extremely abnormal axis, between <span style="text-decoration: underline;">+</span>180 degrees and -90 degrees (called Northwest axis) almost always indicates VT. Both SVT and VT can have normal axes.</p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">4)<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]-->The precordial leads V2 through V6 have RS patterns. <span style="mso-spacerun: yes;">&nbsp;</span>Any precordial lead havig an RS pattern favors the diagnosis of SVT. <span style="mso-spacerun: yes;">&nbsp;</span></p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">5)<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]-->The precordial leads transition from negative in V1 to positive in V6, with a somewhat late transition in V5.<span style="mso-spacerun: yes;">&nbsp; </span>Precordial concordance (all precordial QRS complexes in the same direction) favors the diagnosis of VT.<span style="mso-spacerun: yes;">&nbsp; </span>A negative QRS in V6 also favors the diagnosis of VT.</p><p class="MsoListParagraphCxSpLast" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">6)<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]-->I see no AV dissociation (P waves that are not associated with the QRS complexes).<span style="mso-spacerun: yes;">&nbsp; </span>If present, AV dissociation guarantees a diagnosis of VT.</p><p class="MsoNormal">While the actual differentiation between SVT and VT can be much more complicated than this, I feel that this patient has a very good chance of having SVT with LBBB that is probably rate-related.<span style="mso-spacerun: yes;">&nbsp; </span>His rhythm spontaneously converted to an irregular sinus rhythm.<span style="mso-spacerun: yes;">&nbsp; </span>If this tachycardia recurs or persists, an electrophysiological study could be needed to find the cause and confirm the diagnosis.</p><p class="MsoNormal">I would love to know what you think about this rhythm.<span style="mso-spacerun: yes;">&nbsp; </span>In the Basic Rhythms section, I will post a strip of his multifocal atrial tachycardia.</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/33/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 Wide Complex Tachycardia 1/5</option><option value="40">Give Wide Complex Tachycardia 2/5</option><option value="60" selected="selected">Give Wide Complex Tachycardia 3/5</option><option value="80">Give Wide Complex Tachycardia 4/5</option><option value="100">Give Wide Complex Tachycardia 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3</span></span> <span class="total-votes">(<span >21</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-gVfnqmkOZl5CeYdyiAXWvror3UevkixHqM5VqSO0MTg" /> <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" 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/left-bundle-branch-block-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left bundle branch block</a></div><div class="field-item odd"><a href="/ecg/lbbb" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">LBBB</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></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%2Fwide-complex-tachycardia-3&amp;title=Wide%20Complex%20Tachycardia"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Fri, 01 May 2020 22:19:23 +0000 Dawn 783 at https://www.ecgguru.com https://www.ecgguru.com/ecg/wide-complex-tachycardia-3#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/33/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 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--6" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-0XiptQeQ1Li5aCWkMCUi6QBnQ1wpwTQ3xILlKNHBCx0" /> <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_6"> <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 Ventricular Tachycardia In A Patient With Myopathy https://www.ecgguru.com/ecg/ventricular-tachycardia-patient-myopathy <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-patient-myopathy"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/VT.png" width="1800" height="734" alt="" /></a></div><div class="field-item odd"><a href="/ecg/ventricular-tachycardia-patient-myopathy"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/RVOT.jpg" width="1800" height="605" 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">These two ECGs are from a 77-year-old woman who was complaining of palpitations and mild shortness of breath.&nbsp; She stated a history of atrial fibrillation.&nbsp; She was alert, with a systolic BP over 120.&nbsp; At the hospital, she was found to have cardiomyopathy, resulting in global hypokinesis. She also had significant coronary artery narrowing in her left main, left anterior descending, and circumflex, which were treated with coronary artery bypass graft surgery.</p><p class="MsoNormal"><strong><span style="font-size: 12.0pt; line-height: 107%;">The first ECG </span></strong>was taken on arrival of the EMS crew at the patient’s home.&nbsp; It shows ventricular tachycardia, rate 226 bpm,&nbsp;<strong>All WCTs should be considered to be ventricular tachycardia until proven otherwise.&nbsp;&nbsp;</strong><span style="font-size: 13.008px;">While WCT can sometimes be difficult to definitively diagnose in the field, this ECG has many features which favor the diagnosis of VT, including:</span></p><p class="MsoListParagraphCxSpFirst" style="text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-variant-numeric: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><!--[endif]-->An extremely wide QRS (I measure .24 sec., the machine measures .368 sec.).</p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-variant-numeric: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><!--[endif]-->An extreme left axis deviation (aVF is all negative).</p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-variant-numeric: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><!--[endif]-->Absence of either RBBB or LBBB pattern, with a&nbsp; completely negative QRS in V6.&nbsp; This all negative V6 places the liklihood of the rhythm being VT to about 100%.</p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-variant-numeric: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><!--[endif]-->No obvious P waves (although the machine gives a P wave axis and a PR interval).</p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-variant-numeric: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><!--[endif]-->No RS complexes seen in the precordial leads (V1-V6).</p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l1 level1 lfo1;"><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-variant-numeric: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp; &nbsp;</span></span><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="font-variant-numeric: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp; &nbsp;</span></span></p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l1 level1 lfo1;"><strong style="text-indent: -0.25in; font-size: 13.008px;"><span style="font-size: 12.0pt; line-height: 107%;">The second ECG </span></strong><span style="text-indent: -0.25in; font-size: 13.008px;">was taken three minutes later, with no change in the patient’s symptoms.&nbsp; (The age is different because a different crew took the tracing, but it was confirmed to be from the same patient.) The heart rate is now 239 bpm, and she still has a wide-complex tachycardia.&nbsp; The morphology of the QRS complexes has changed.&nbsp; This now has the pattern of r</span><span style="text-indent: -0.25in; font-size: 13.008px;">ight ventricular outflow tract ventricular tachycardia (RVOT).</span><strong style="text-indent: -0.25in; font-size: 13.008px;"> &nbsp;</strong><span style="text-indent: -0.25in; font-size: 13.008px;">RVOT</span><strong style="text-indent: -0.25in; font-size: 13.008px;"> </strong><span style="text-indent: -0.25in; font-size: 13.008px;">originates from the area around the outflow tract of the RV, or from the tricuspid annulus.&nbsp;</span><span style="font-size: 13.008px;">&nbsp;</span></p><p class="MsoNormal">Characteristics of RVOT include:</p><p class="MsoListParagraphCxSpFirst" style="text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-variant-numeric: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><!--[endif]-->Heart rate &gt; 100 bpm</p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-variant-numeric: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><!--[endif]-->Atrioventricular dissociation</p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-variant-numeric: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><!--[endif]-->QRS width &gt; .12 seconds.</p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-variant-numeric: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><!--[endif]-->Left bundle branch block morphology</p><p class="MsoListParagraphCxSpLast" style="text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-variant-numeric: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><!--[endif]-->Inferior / rightward axis (around +90 degrees)</p><p class="MsoListParagraphCxSpLast" style="text-indent: -.25in; mso-list: l0 level1 lfo2;"><span style="text-indent: -0.25in; font-size: 13.008px;">RVOT often responds to adenosine.</span></p><p class="MsoNormal">RVOT usually occurs in the absence of structural heart disease, or occasionally in the setting of arrhythmogenic right ventricular dysplasia/cardiomyopathy.&nbsp; This patient certainly was found to have serious heart disease, making the diagnosis of idiopathic RVOT unlikely, and adenosine not recommended.&nbsp;</p><p class="MsoNormal">Myopathy as severe as this patient’s frequently causes ventricular ectopy and ventricular tachycardia, which can add to the severe cardiac output issues the patient faces.<span style="font-size: 13.008px;">&nbsp;</span></p><p class="MsoNormal">References: <a href="http://ecg-interpretation.blogspot.com/2012/01/ecg-interpretation-review-35-sct-vt.html/">http://ecg-interpretation.blogspot.com/2012/01/ecg-interpretation-review-35-sct-vt.html/</a> ; <a href="https://lifeinthefastlane.com/collections/">https://lifeinthefastlane.com/collections/</a> ;&nbsp; <a href="https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/ventricular-tachycardia/types/right-ventricular-outflow-tract-tachycardia.html">https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/ventricular-tachycardia/types/right-ventricular-outflow-tract-tachycardia.html</a></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/33/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 In A Patient With Myopathy 1/5</option><option value="40">Give Ventricular Tachycardia In A Patient With Myopathy 2/5</option><option value="60">Give Ventricular Tachycardia In A Patient With Myopathy 3/5</option><option value="80" selected="selected">Give Ventricular Tachycardia In A Patient With Myopathy 4/5</option><option value="100">Give Ventricular Tachycardia In A Patient With Myopathy 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.2</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--YtAWJftztW6iGAP6uv5bSCx40l-teSoZTadG5efdaI" /> <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/vt" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">VT</a></div><div class="field-item even"><a href="/ecg/rvot" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">RVOT</a></div><div class="field-item odd"><a href="/ecg/right-ventricular-outflow-tract-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right ventricular outflow tract tachycardia</a></div><div class="field-item even"><a href="/ecg/wide-complex-tachycardia" 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></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-patient-myopathy&amp;title=Ventricular%20Tachycardia%20In%20A%20Patient%20With%20Myopathy"><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 05:15:44 +0000 Dawn 748 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ventricular-tachycardia-patient-myopathy#comments ECG Basics: Torsades Cardioverted https://www.ecgguru.com/ecg/ecg-basics-torsades-cardioverted <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-torsades-cardioverted"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/124%20Cardioversion%20of%20Torsades.jpg" width="1800" height="648" 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>These two strips are from one patient who was electrically cardioverted twice in a few minutes. &nbsp;The original reason for the cardioversion was Torsades de Pointes, a type of polymorphic ventricular tachycardia associated with a long QT interval. &nbsp;For more information about TDP, go to this<a title="Torsades" href="http://ecgguru.com/ecg/ecg-basics-torsades-de-pointes"> LINK.</a>&nbsp; It is a bit difficult to comment on the patient's post-cardioversion rhythm, because so little of it is shown. &nbsp;It appears to be sinus, with a wide QRS. &nbsp;The QT interval appears slightly prolonged at .44 sec, but it is not known what the QT interval is corrected to a rate of 60/min. &nbsp;TDP is often seen with QT intervals greater than 600 ms (.6 seconds). &nbsp;Also THESE STRIPS ARE NOT SIMULTANEOUS, they were taken two minutes apart. &nbsp;In the first one, the P waves and T waves look so much alike, they could all be P waves. &nbsp;They do not "march out". &nbsp;It is necessary to get a long strip, preferably in multiple leads, and a 12-Lead ECG, to properly evaluate the rhythm post-cardioversion.&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/33/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 ECG Basics: Torsades Cardioverted 1/5</option><option value="40">Give ECG Basics: Torsades Cardioverted 2/5</option><option value="60">Give ECG Basics: Torsades Cardioverted 3/5</option><option value="80" selected="selected">Give ECG Basics: Torsades Cardioverted 4/5</option><option value="100">Give ECG Basics: Torsades Cardioverted 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--8" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-vEbMyqryXge-UgCLckmBym6BWUV55mIVx5DGhxmUWDM" /> <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/ecg-basics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Basics</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/v-tach" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">V Tach</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/cardioversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Cardioversion</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%2Fecg-basics-torsades-cardioverted&amp;title=ECG%20Basics%3A%20%20Torsades%20Cardioverted"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Fri, 20 Dec 2013 19:08:13 +0000 Dawn 534 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-torsades-cardioverted#comments ECG Basics: Ventricular Tachycardia https://www.ecgguru.com/ecg/ecg-basics-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/ecg-basics-ventricular-tachycardia"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/114%20V%20Tach.jpg" width="1800" height="321" 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>An example of ventricular tachycardia in Lead II. &nbsp;This patient's rate is about 190/min. &nbsp;V Tach will have the following criteria: &nbsp;Rate greater than 100/min, QRS duration greater than .12 sec. (120 ms), and no P wave associated with the QRS.</p><p>It can be difficult to distinguish V Tach from other wide-complex tachycardias without a 12-lead ECG, but all wide-complex tachycardias should be treated as V Tach until proven otherwise, as V Tach is a potentially lethal dysrhythmia. &nbsp;V Tach can cause a severe reduction in cardiac output which can lead to V Fib and death.</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/33/feed" method="post" id="fivestar-custom-widget--9" 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--18" 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" selected="selected">Give ECG Basics: Ventricular Tachycardia 3/5</option><option value="80">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 >2.5</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--9" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-OIhf-08sKOLFvIlYvZJtS9EOeHYIPjLrYt6s5C_yywU" /> <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/v-tach" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">V Tach</a></div><div class="field-item even"><a href="/ecg/vt" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">VT</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/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item odd"><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_9"> <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&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> Mon, 16 Sep 2013 02:30:51 +0000 Dawn 495 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-ventricular-tachycardia#comments Wide Complex Tachycardia https://www.ecgguru.com/ecg/wide-complex-tachycardia-1 <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-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/WCT102_1.jpg" width="1400" height="1047" 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 shows a wide-complex tachycardia with a rate of 137/minute. &nbsp;No patient information is available other than what is on the ECG. &nbsp;Here, we will comment for the BASIC LEVEL learner, and allow the ECG Gurus out there to add INTERMEDIATE and ADVANCED level comments.</p><p>Beginners and emergency workers should ALWAYS be cautioned to treat all wide-complex tachycardias as VENTRICULAR TACHYCARDIA until proven to be something else. &nbsp;V Tach is a life-threatening dysrhythmia, and there should be no delay in treatment. &nbsp;That being said, not all WCTs are V Tach. &nbsp;The most common "mimic" of V Tach is left bundle branch block. &nbsp;LBBB can appear along with any supraventricular rhythm, including sinus rhythms, atrial tachycardias, atrial fibrillation, and junctional rhythms. &nbsp;The diagnostic criteria for LBBB are: &nbsp;wide QRS (.12 seconds or more), supraventricular rhythm, negative QRS in V1 and positive QRS in V6 and Lead I. &nbsp;This ECG meets the criteria for LBBB, except that the supraventricular rhythm is hard to prove. &nbsp;On one hand, P waves are not seen - or at least not easily. &nbsp;On the other hand, the ECG machine has recorded a PR interval and a P wave axis. &nbsp;What do you think?</p><p>Some of the criteria that would favor the diagnosis of V Tach are not present here: precordial concordance (all QRS complexes in V1 through V6 pointing in same direction), V6 with a negative QRS, AV dissociation. &nbsp;An extreme axis, especially extreme right, would favor V Tach. &nbsp;This ECG has an abnormal left axis, which is possible in V Tach AND in LBBB. &nbsp; For a more thorough discussion by ECG Guru Jason Roediger of the criteria for differentiating V Tach from LBBB and other aberrancy, go to this<a title="WCT by Jason Roediger" href="http://ecgguru.com/expert-review/what-are-criteria-determining-wide-complex-tachycardia-v-tach"> LINK</a>.</p><p>In an emergency setting, WTCs are most often V Tach. &nbsp;However, should the rhythm turn out to be SVT with aberrant conduction, the usual V Tach treatment protocols would do no harm. &nbsp;For instance, if the patient is deemed to be "unstable", electric cardioversion is recommended for both V Tach and SVT. &nbsp;If the patient is stable, the emergency drugs usually recommended are generally safe for both rhythms.</p><p>Care should be taken to differentiate SINUS tachycardia from SVT or V Tach. &nbsp;Sinus tachycardia usually has an obvious physiologic cause (hypoxia, hypovolemia, fear, pain, fever, etc.). &nbsp;Sinus tachycardia also will be variable in rate, slowing as the cause is alleviated, or speeding if the problem causing the tachycardia becomes worse. &nbsp;It may require &nbsp;a long period of observation to determine that the rate is gradually slowing or speeding up. &nbsp;One would hope to find P waves at some point in sinus tachycardia, and a 12-lead ECG is a great help.</p><p>WE LOOK FORWARD TO COMMENTS FROM OUR MEMBERS.</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/33/feed" method="post" id="fivestar-custom-widget--10" 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--20" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Wide Complex Tachycardia 1/5</option><option value="40">Give Wide Complex Tachycardia 2/5</option><option value="60">Give Wide Complex Tachycardia 3/5</option><option value="80">Give Wide Complex Tachycardia 4/5</option><option value="100" selected="selected">Give Wide Complex 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 >4</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--10" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-KvKbDzmRZDczTog_1hm3b3WXb9oYZ3KTFrmojL7V1mM" /> <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" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wide complex tachycardia</a></div><div class="field-item odd"><a href="/ecg/v-tach" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">V Tach</a></div><div class="field-item even"><a href="/ecg/vt" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">VT</a></div><div class="field-item odd"><a href="/ecg/left-bundle-branch-block-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left bundle branch block</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_10"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fwide-complex-tachycardia-1&amp;title=Wide%20Complex%20Tachycardia"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 15 Sep 2013 03:40:41 +0000 Dawn 494 at https://www.ecgguru.com https://www.ecgguru.com/ecg/wide-complex-tachycardia-1#comments