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WIDE COMPLEX TACHYCARDIA. Puja Chopra, PGY-1 Emergency Medicine May 19, 2011. Objectives. Differential Diagnosis of wide complex tachycardia Approach to wide complex tachcardia Examples of wide complex tachycardia Adenosine/ACLS. DDx:. Ventricular tachycardia - PowerPoint PPT Presentation
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WIDE COMPLEX TACHYCARDIA
Puja Chopra, PGY-1
Emergency Medicine
May 19, 2011
Objectives
Differential Diagnosis of wide complex tachycardia
Approach to wide complex tachcardia
Examples of wide complex tachycardia
Adenosine/ACLS
DDx:
Ventricular tachycardia
SVT with a preexisting bundle branch block or a functional rate related bundle branch block
SVT with antegrade conduction via an accessory pathway
Drug induced – TCA, Class one antiarryhtmic
Electrolyte - hyperkalemia
Wellen’s Criteria
RBBB Pattern LBBB Pattern
Sensitivity: 98.7%Specificity: 96.5%
Brugada Criteria: -Sensitivity: 79 to 91%-Specificity: 43 to 70%
Approach to WCT
1. History
2. Physical Exam
3. ECGRegular: VT, SVT with aberrancy, SVT with accessory pathway, Electrolyte abnormalities, Medications
Irregular: a fib + pre-excitation, a fib + BBB, a flutter + BBB, MAT + BBB, polymorphic Vtach (torsades)
?AV dissociation, Fusion beats, capture beats
4. Adenosine (?Diagnostic, ?therapeutic)
70 yo male with palpitations and history of angina
61 yo male with productive cough and fever
65 yo male with syncope, PMHx: DM
30 yo female with palpations
30 yo female with palpations
28 yo male, altered and agitated after an unknown overdose
45 yo male, previously healthy, with palpitations
44 year old chronic alcoholic male with persistent vomiting and becomes unresponsive
65 yo female with palpations
48 yo male with palpitations
Adenosine in the Diagnosis of Broad Complex Tachycardia
- Griffith et al. The Lancet March 1988
89% Sensitivity, 95% specificity, 92% predictive accuracy for SVT origin
Sensitivity: 70%, Specificity: 92%, PPV: 85%
Intravenous Adenosine Triphosphate During Wide QRS Complex Tachycardia: Safety, Therapeutic
Efficacy and Diagnostic utility- Sharma et al. The American Journal of Medicine, April
1990
Adenosine for the Management of Patients with Tachycardias – A new
Protocol- Domanovits et al. European Heart Journal,
1994
Adenosine For Wide Complex Tachycardia: Efficacy and Safety
- Marill et al. Critical Care Medicine, 2009
Primary outcome: termination of tachycardia with adenosine, AV block allowing rhythm identification
- The odds of SVT increase by a factor of 36 after a positive response to adenosine
- Odds of VT increase by factor of 9 after a negative response to adenosine
Thanks!Questions?
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