_QRS COMPLEX TACHYCARDIA AFRAVIETMUR宽QRS波心动过速课件.ppt

APPROACH TO WIDE QRS COMPLEX TACHYCARDIA Dr HA TUAN KHANH Dr DAVID TRAN Content Definition Causes of WCT Diagnosis criteria Clinical history Physical examination ECG criteria: Brugada criteria, other criteria, findings favoring SVT, VT vs AVRT criteria Management Unstable hemodynamic Stable hemodynamic 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 Causes of wide QRS complex tachycardia Supraventricular tachycardia - with prexsisting BBB - with BBB due to heart rate (aberrant conduction) - antidromic tachycardia in WPW syndrome Ventricular tachycardia SVT vs VT  Clinical history SVT vs VTPhysical examination Physical findings that indicate presence of AV dissociation (cannon A waves, variable-intensity S1,variation in BP unrelated to respiration) if present are useful Termination of WCT in response to maneuvers like Valsalva, carotid sinus pressure, or adenosine is strongly in-favor of SVT but there are well-documented cases of VT responsive to these SVT vs VTECG criteria: Brugada algorithm Step 4: LBBB - type wide QRS complex Step 4: RBBB - type wide QRS complex Other ECG criteria North - west QRS axis deviation Negative or positive concordance Fusion beats, capture beats Ventriculoatrial conduction with block RBBB morphology with LAD > - 300 LBBB morphology with RAD > + 900 Previous ECG show MI or previous ECG show that during sinus rhythm, bifascular block is present, which changes in configuration during tachycardia Findings favoring SVT Triphasic pattern in V1 and V6 Rabbit’s ear Previous ECG: Preexistent BBB or preexcitation Triphasic pattern Rabbit’s ear Wide complex SVT from preexisting RBBB Wide complex SVT from preexisting LBBB VT vs AVRTECG criteria Wide complex SVT from bypass tract Summary : diagnosis evaluation Management – Hemodynamic compromise Unstable patient, but still responsible with a discernible BP and/or pulse: - Emergent synchronize