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