babli
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An 80-year-old man has a preoperative ECG (see Image 1) performed before elective surgery. The patient denied having any chest pain, palpitations, or a history of arrhythmias, but he did report experiencing some shortness of breath when he walked or performed chores around the house. The patient felt that the shortness of breath was due to his "lung problems" from his many years of smoking cigarettes. He also volunteered that he had experienced brief episodes of lightheadedness but again denied having any other associated symptoms, such as chest pain, nausea, presyncope, and loss of consciousness. There is no history of myocardial infarction or established history of coronary artery disease. As a result of the reported symptoms and ECG findings, the patient was admitted to the hospital for further evaluation.
Upon admission, the patient was found to be afebrile with a blood pressure of 125/67 mm Hg, a heart rate of 84 bpm, a respiratory rate of 20 breaths per minute, and an oxygen saturation of 91% breathing room air. He had a regular heart rhythm with frequent skipped beats and a slightly accentuated second heart sound. No murmurs, rubs, or gallops were appreciated. He had no jugular venous distention, and no carotid bruits were noted. Auscultation of his chest revealed distant breaths sounds without wheezes, crackles, or rhonchi. No peripheral edema was present. The remainder of the examination was unremarkable.
What does the ECG demonstrate?
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| Isther
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I'm lost  ... what is it?
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| guayoman
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Trigeminism? And if so, then what?
or
Ashman phenomenon? But I donīt think so because it doesnīt look like A fib.
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| an
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looks like ventricular tachycardia...runs of 3/more beats of ventricular origin at a rate of more than 120 bpm.
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| babli
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Good job an.
Nonsustained ventricular tachycardia (NSVT): Wide-complex tachycardias (WCTs) are, by definition, cardiac dysrhythmias with a ventricular rate greater than 100 bpm and a QRS duration of 120 milliseconds (0.12 seconds) or longer. A WCT can originate from either a ventricular or supraventricular focus with a conduction abnormality. WCTs arising in the ventricle almost invariably widen the QRS complex.
Ventricular tachycardia (VT) is the most common cause of WCT in patients, accounting for as many as 80% of cases. The frequency is higher in patients with structural or ischemic heart disease. However, in a minority of cases, the widening of the QRS complex can occur in association with a supraventricular tachycardia (SVT) with abnormal conduction. Finally, one should also keep in mind that an electronic pacemaker or an implantable cardioverter-defibrillator (ICD) with pacemaker capability typically widens the QRS complex and can be present as a WCT in certain settings.
Accurate diagnosis of the focus of a WCT is critical in determining treatment and management, both emergently, if the patient is hemodynamically unstable, and for long-term management. A specific note of interest is with medications routinely used to treat SVT. When these drugs are given to patients with a WCT with a ventricular focus (ie, VT), they can cause severe hemodynamic deterioration by potentially inducing the relatively stable rhythm of VT to degenerate into ventricular fibrillation with subsequent cardiac arrest. Misdiagnosis of VT as SVT with abnormal conduction in patients presenting with a WCT is not uncommon, especially if the abnormal rhythm is hemodynamically tolerated. (VT typically results in hemodynamic compromise, but not necessarily, and thus the patient's blood pressure and mental status must not be used to distinguish VT from SVT.)
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| Isther
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Didn't knew that... thanks!
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| jmn
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So we just diff them based on the Width of QRS?
For treatment, can we use Amiodarone , it 's safe for both dx?
Thanks for good q
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| p53
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an is just great - for her difficult questions simply do not exist!
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| AAAAA
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80% of wide-QRS complex are VT.
This goes up to more than 90% with structural
heart disease and elderly.
Never give adenosine in wide-QRS complex tachycardia !!!!
Based on wide-QRS complex is only 80-90%
accurate !!!
But the wider the QRS complex, the more accurate is VT !
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| guayoman
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an you are so smart! and if that is a view from your summer house ...I'll marry you!!!!!
But seriously now, admirable that you remembered such a tiny technical thing as 3 WC beats comprise a VT. In this case not-sustained VT.
Admirable!!!
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| an
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and if it's u in the pic ...tousled hair, and all...must say, i am bowled over...
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