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WIDE COMPLEX TACHYCARDIA

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

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WIDE COMPLEX TACHYCARDIA

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  1. WIDE COMPLEX TACHYCARDIA Puja Chopra, PGY-1 Emergency Medicine May 19, 2011

  2. Objectives • Differential Diagnosis of wide complex tachycardia • Approach to wide complex tachcardia • Examples of wide complex tachycardia • Adenosine/ACLS

  3. 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

  4. Wellen’s Criteria RBBB Pattern LBBB Pattern

  5. Sensitivity: 98.7% Specificity: 96.5%

  6. Brugada Criteria: • Sensitivity: 79 to 91% • Specificity: 43 to 70%

  7. Approach to WCT • 1. History • 2. Physical Exam • 3. ECG • Regular: 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)

  8. 70 yo male with palpitations and history of angina

  9. 61 yo male with productive cough and fever

  10. 65 yo male with syncope, PMHx: DM

  11. 30 yo female with palpations

  12. 30 yo female with palpations

  13. 28 yo male, altered and agitated after an unknown overdose

  14. 45 yo male, previously healthy, with palpitations

  15. 44 year old chronic alcoholic male with persistent vomiting and becomes unresponsive

  16. 65 yo female with palpations

  17. 48 yo male with palpitations

  18. 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

  19. Intravenous Adenosine Triphosphate During Wide QRS Complex Tachycardia: Safety, Therapeutic Efficacy and Diagnostic utility- Sharma et al. The American Journal of Medicine, April 1990 Sensitivity: 70%, Specificity: 92%, PPV: 85%

  20. Adenosine for the Management of Patients with Tachycardias – A new Protocol- Domanovits et al. European Heart Journal, 1994

  21. Adenosine For Wide Complex Tachycardia: Efficacy and Safety- Marill et al. Critical Care Medicine, 2009 • 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 Primary outcome: termination of tachycardia with adenosine, AV block allowing rhythm identification

  22. Thanks! Questions?

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