ECG: Wide QRS Tachycardia

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ECG: Wide QRS Tachycardia

  1. 1. PHYSICIAN’S MEET ECG of the week Prof. S.SUNDAR’s unit, Dr. N.IDHAYACHANDRAN,PG
  2. 2. <ul><li>a 46 year old Rajeswari, a k/c of DCMP </li></ul><ul><li>Admitted with the </li></ul><ul><li>c/o palpitations </li></ul><ul><li>c/o breathlessness </li></ul><ul><li>BP- 80/? mmHg, </li></ul><ul><li>pulse - feeble </li></ul>
  3. 4. <ul><li>Ventricular rate: 300/min </li></ul><ul><li>QRS duration: 200 milliseconds </li></ul><ul><li>P-R interval: 120 milliseconds </li></ul><ul><li>QRS axis: +30 degree </li></ul><ul><li>Monophasic & polymorphic QRS complexes </li></ul>
  4. 5. WQRS TACH Irregular Regular QRS morphology Changing beat to beat QRS morphology similar Polymorphic VT Preexcited afib QTC prolonged QTC Monomorphic VT
  5. 6. Wide QRS Tachycardia <ul><li>VT AB Cond. AP Cond. </li></ul><ul><li> </li></ul><ul><li>( 81% ) ( 14% ) ( 5% ) </li></ul>
  6. 7. Regular WQRS tachycardia
  7. 8. <ul><li>If no AV dissociation for </li></ul><ul><li>Morphology criteria for VT present both in </li></ul><ul><li>Precordial leads V1-2 & V6? </li></ul><ul><li>Yes No </li></ul><ul><li>VT SVT with aberrant conduction </li></ul>
  8. 9. Wide QRS ECG Is this VT : Preexisting WQRS Sinus Tach SVT VT MMVT PMVT Not sure Tt as VT
  9. 11. PMVT <ul><li>stop the offending drug. </li></ul><ul><li>Correct Electrolyte abnormalities </li></ul><ul><li>IV Mg bolus (1 to 2 g over 10 min followed by continuous infusions) are indicated. </li></ul><ul><li>Pacing </li></ul>
  10. 12. Role of i.v.Magnesium <ul><li>Drug of choice in </li></ul><ul><ul><li>digitalis-toxicity related arrhythmias </li></ul></ul><ul><ul><li>hypokalemia-hypomagnesemia related </li></ul></ul><ul><ul><li>polymorphic VT of proarrhythmia </li></ul></ul><ul><ul><li>myocarditis </li></ul></ul><ul><li>Dose </li></ul><ul><ul><li>2-4 gm bolus infusion </li></ul></ul><ul><ul><li>4-8 gm infusion over 24 hours </li></ul></ul>
  11. 13. VT:Normal Heart <ul><li>We prefer IV beta blocker, as the drug of choice. </li></ul><ul><li>Once acute episode is treated EP consultation is warranted , as most of them can be cured by catheter ablation </li></ul>
  12. 14. Refractory VT/ VF <ul><li>( 1 ) intravenous amiodarone, and Beta blockers </li></ul><ul><li>( 3 ) overdrive pacing, </li></ul><ul><li>( 4 ) intraaortic balloon pump, and </li></ul><ul><li>( 5 ) coronary revascularization </li></ul>
  13. 15. <ul><li>THANK YOU </li></ul>

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