ECG Guru - Instructor Resources - RVOT https://www.ecgguru.com/ecg/rvot en 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/726/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 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" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-FvsEJWpTXrPNAQMsGrySfuleZoK-4hvUKoxyw8f6DXs" /> <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_1"> <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> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); 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