wide complex tachycardia

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interesting ecg- dept .cardiology,mgm medical college,indore

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wide complex tachycardia

  1. 1. ECG OF THE MONTHCANDIDATE : DR.SARATH MENON.RDEPT. OF CARDIOLOGYM G M MEDICAL COLLEGE,INDORE
  2. 2.  55 yr old male, labourer,c/c smoker from Jabua admitted in ICCU on 8.01.2011 with c/o of palpitation, gabrahaat for duration of 4-6 hrs. no h/o chest pain,dyspnoea,syncope o/e- conscious,oriented no pallor,cyanosis,clubbing,edema JVP raised. pulse- rapid ~ 170/mt regular BP- systole 80/60
  3. 3.  S1- variable. S2- normal Chest – b/l clear ,no added sounds P/A- soft,non-tender liver,spleen –non palpable Past history - h/o similar episodes before - h/o MI – 5 yr back
  4. 4. ECG AT TIME OF ADMISSION (BEFORE DC)
  5. 5. ECG AT TIME OF ADMISSION
  6. 6. ECG -AFTER DC CARDIOVERSION (200J)
  7. 7. DIFFERENTIAL DIAGNOSIS Ventricular tachycardia Supra ventricular tachycardia with abberancy
  8. 8. DISCUSSION –WIDE COMPLEX TACHYCARDIAS Definition Ecg features Diagnostic criteria - Brugada criteria - Lead aVR algorithm
  9. 9. DEFINITION Wide QRS complex tachycardia is a rhythm with a rate of more than 100 b/m and QRS duration of more than 120 ms SVT (20%) VT (80%) Stewart RB. Ann Intern Med 1986
  10. 10.  VT- 3 or more consecutive ventricular premature beats with a rate of 100/mt or more SVT- a tachycardia dependent on participation of structure at or above bundle of His LBBB morphology- QRS > 12 msec. with prominent negative deflection in V1 RBBB morphology- QRS > 12 msec. with prominent positive deflection in V1.
  11. 11. DIFFERENTIAL DIAGNOSIS Ventricular tachycardia ( 80 %) SVT with abberant conduction (20%) - SVT with BBB abberancy (fixed or functional) - pre-excited SVT (anomalous AV connection)
  12. 12. SVT VS VTCLINICAL HISTORY Age - ≥ 35 ys → VT Underlying heart disease Previous MI → 98% VT Pacemakers Increased risk of ventricular tachyarrhythmia
  13. 13. PHYSICAL EXAMINATION Signs of AV dissociation favours VT - cannon waves - varying intensity of S1 - variation of systolic BP - hypotension Termination of WCT with maneuvers ~ carotid,vasalva,adenosine favours SVT
  14. 14. ECG Rate Regularity
  15. 15. BRUGADA CRITERIA
  16. 16. STEP 1- RS COMPLEX IN PRECORDIAL LEADS
  17. 17. STEP 2- R TO NADIR OF S (BRUGADA SIGN)
  18. 18. STEP 3- A-V DISSOCIATION
  19. 19. STEP.4- QRS MORPHOLOGY
  20. 20. VT WITH LBBB MORPHOLOGY
  21. 21. SVT WITH LBBB MORPHOLOGY
  22. 22. STEP 4- VT WITH RBBB MORPHOLOGY
  23. 23. SVT WITH RBBB MORPHOLOGY
  24. 24. OTHER ECG FINDINGS FAVOUR VT North - west QRS axis deviation Negative or positive concordance Fusion beats, capture beats Ventriculoatrial conduction with block Axis shift of > 40° from SR RBBB morphology with LAD > - 30° LBBB morphology with RAD > + 90 ° In LBBB, QRS duration >160 ms In RBBB,QRS duration > 140 ms Previous ECG show MI or previous ECG show that during sinus rhythm, bundle branch block is present, which changes in configuration during tachycardia
  25. 25. RABBIT EAR
  26. 26. CONCORDANCE & NORTH WEST AXIS
  27. 27. POSITIVE CONCORDANCE
  28. 28. FUSION & CAPTURE BEATS
  29. 29. VT VERSUS AVRT
  30. 30. LEAD AVR
  31. 31. AVR ALGORITHM
  32. 32. OUR ECGFavours VT •Against VT h/o MI  Axis is normal v4 RS complex  Not typical vt LBB duration RS >100 ms morphology A-v dissociation  Qrs duration .14 s with Avr s/o vt lbbb Initial axis shift > 40°  Non concordance  Presence of RS complex
  33. 33. CONCLUSION-DIAGNOSIS VENTRICULAR TACHYCARDIA WITH LBBB MORPHOLOGY CAD- OLD ANT.SEPTAL MI QT PROLONGED
  34. 34. SUMMARY
  35. 35. THANK U….

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