Rhythm diagnosis in regular wide complex tachycardia: Difference between revisions
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== VTach vs. SVT == | == VTach vs. SVT == | ||
{| | {| cellspacing="1" cellpadding="1" border="1" style="width: 500px;" | ||
|- | |- | ||
| <br | | '''Factor'''<br> | ||
| V Tach | | '''V Tach''' | ||
| SVT w/ Aberrancy | | '''SVT w/ Aberrancy''' | ||
|- | |- | ||
| Age | | Age | ||
| | | >50 | ||
| | | <35 | ||
|- | |- | ||
| History | | History | ||
| MI, CHF, CABG, MVR | | MI, CHF, CABG, MVR | ||
| MVR, WPW | | MVR, WPW | ||
|- | |- | ||
| Cannon A Waves | | Cannon A Waves | ||
| Present | | Present | ||
| Absent | | Absent | ||
|- | |- | ||
| Arterial Pulse | | Arterial Pulse | ||
| Variation | | Variation | ||
| No variation | | No variation | ||
|- | |- | ||
| First heart sound | | First heart sound | ||
| Variable | | Variable | ||
| Not variable | | Not variable | ||
|- | |- | ||
| Fusion Beats | | Fusion Beats | ||
| Present | | Present | ||
| Absent | | Absent | ||
|- | |- | ||
| AV dissociation | | AV dissociation | ||
| Present | | Present | ||
| Absent | | Absent | ||
|- | |- | ||
| QRS | | QRS | ||
| | | >0.14sec | ||
| | | <0.14sec | ||
|- | |- | ||
| Axis | | Axis | ||
| Extreme LAD ( | | Extreme LAD (< -30) | ||
| Normal or slightly abnl | | Normal or slightly abnl | ||
|- | |- | ||
| Vagal Maneuvers | | Vagal Maneuvers | ||
| No response | | No response | ||
| Slows or terminates | | Slows or terminates | ||
|- | |- | ||
| | | | ||
QRS morphology | QRS morphology | ||
V1 positive pattern | V1 positive pattern | ||
| | | | ||
V1 - R or qR | V1 - R or qR | ||
V6 - rS | V6 - rS | ||
| | | | ||
V1 - RSR' | V1 - RSR' | ||
V6 - Rs | V6 - Rs | ||
|- | |- | ||
| | | | ||
QRS morphology | QRS morphology | ||
V1 negative pattern | V1 negative pattern | ||
| | | | ||
V1/V2 - Broad R wave ( | V1/V2 - Broad R wave (>40msec) | ||
V6 - Any Q or QS | V6 - Any Q or QS | ||
| | | | ||
V1/V2 - Small R | V1/V2 - Small R | ||
V6 - no Q | V6 - no Q | ||
|} | |} | ||
== Algorithm (Brugada Criteria) == | |||
*Only for regular rhythms | == Algorithm (Brugada Criteria) == | ||
*Only for treatment decision if pt is stable | *Only for regular rhythms | ||
*Only for treatment decision if pt is stable | |||
*Assume V-tach until proven otherwise | *Assume V-tach until proven otherwise | ||
#Absence of an RS complex in all precordial leads? | #Absence of an RS complex in all precordial leads? | ||
##If yes then VT | ##If yes then VT | ||
##If no then continue | ##If no then continue | ||
#R to S interval | #R to S interval >100ms in one precordial lead? | ||
##If yes then VT | ##If yes then VT | ||
##If no then continue | ##If no then continue | ||
#AV dissociation | #AV dissociation | ||
##If yes then VT | ##If yes then VT | ||
##If no then continue | ##If no then continue | ||
#Morphology criteria for VT present both in V1-2 and V6? | #Morphology criteria for VT present both in V1-2 and V6? | ||
##If yes then VT | ##If yes then VT | ||
##If no then possibly SVT | ##If no then possibly SVT | ||
== See Also == | |||
[[Tachycardia (Wide)]] | |||
== Source == | |||
7/2/09 Pani 4/2/10 Niemann | |||
== Source == | |||
7/2/09 Pani 4/2/10 Niemann | |||
[[Category:Cards]] | [[Category:Cards]] | ||
Revision as of 21:52, 22 July 2011
VTach vs. SVT
| Factor |
V Tach | SVT w/ Aberrancy |
| Age | >50 | <35 |
| History | MI, CHF, CABG, MVR | MVR, WPW |
| Cannon A Waves | Present | Absent |
| Arterial Pulse | Variation | No variation |
| First heart sound | Variable | Not variable |
| Fusion Beats | Present | Absent |
| AV dissociation | Present | Absent |
| QRS | >0.14sec | <0.14sec |
| Axis | Extreme LAD (< -30) | Normal or slightly abnl |
| Vagal Maneuvers | No response | Slows or terminates |
|
QRS morphology V1 positive pattern |
V1 - R or qR V6 - rS |
V1 - RSR' V6 - Rs |
|
QRS morphology V1 negative pattern |
V1/V2 - Broad R wave (>40msec) V6 - Any Q or QS |
V1/V2 - Small R V6 - no Q |
Algorithm (Brugada Criteria)
- Only for regular rhythms
- Only for treatment decision if pt is stable
- Assume V-tach until proven otherwise
- Absence of an RS complex in all precordial leads?
- If yes then VT
- If no then continue
- R to S interval >100ms in one precordial lead?
- If yes then VT
- If no then continue
- AV dissociation
- If yes then VT
- If no then continue
- Morphology criteria for VT present both in V1-2 and V6?
- If yes then VT
- If no then possibly SVT
See Also
Source
7/2/09 Pani 4/2/10 Niemann