Remove Atrial Fibrillation Remove Dysrhythmia Remove Tachycardia
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Wide complex tachycardia, resistant to cardioversion. Some fascinating features here.

Dr. Smith's ECG Blog

Here is her ECG: Regular Wide Complex Tachycardia. Regular means it can't be atrial fibrillation --Most regular wide complex tachcardia are VT, especially if the patient has poor LV function, as in this case. Could it be atrial tachycardia with RBBB and LPFB aberrancy? What do you think? What do you want to do?

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A young man with another episode of tachycardia. What is it? And why give adenosine in sinus rhythm?

Dr. Smith's ECG Blog

The ECGs show a wide complex, irregularly irregular tachycardia. The differential of wide complex irregularly irregular includes: polymorphic VT, atrial fibrillation with WPW, atrial fibrillation with other aberrancy. Thus, the patients rhythm is atrial fibrillation with WPW.

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Atrial fibrillation? Multifocal Atrial Tachycardia? Don't look at computer read until AFTER you interpret!

Dr. Smith's ECG Blog

Here is the computer interpretation: ATRIAL FIBRILLATION WITH RAPID VENTRICULAR RESPONSE WITH ABERRANT CONDUCTION OR VENTRICULAR PREMATURE COMPLEXES LEFT AXIS DEVIATION [QRS AXIS beyone -30] NONSPECIFIC ST and T-WAVE ABNORMALITY The over-reading physician confirmed this diagnosis, which is incorrect. It is not atrial fibrillation.

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A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Atrial fibrillation is also a predictor of worse outcomes in this case (Alborzi). Between 81-95% of life-threatening ventricular dysrhythmias and acute cardiac failure occur within 24-48 hours of hospitalization.

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60-something with wide complex tachycardia: from where does the rhythm originate?

Dr. Smith's ECG Blog

Here is her ED ECG: Here is the ED physician's interpretation: IMPRESSION UNCERTAIN REGULAR RHYTHM, wide complex tachycardia, likely p-waves. LEFT BUNDLE BRANCH BLOCK [120+ ms QRS DURATION, 80+ ms Q/S IN V1/V2, 85+ ms R IN I/aVL/V5/V6] Comparison Summary: LBBB and tachycardia are new. This is clearly ventricular tachycardia.

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Back to basics: what is this rhythm? What are your options for treating this patient?

Dr. Smith's ECG Blog

We see a regular tachycardia with a narrow QRS complex and no evidence of OMI or subendocardial ischemia. The differential of a regular narrow QRS tachycardia is sinus tachycardia, SVT, and atrial flutter with regular conduction. Now the patient is in sinus tachycardia. Her initial EKG is below. Adenosine worked.

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A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

The rhythm is atrial fibrillation. Then there is loss of pulses with continued narrow complex on the monitor ("PEA arrest") Learning Points: Sudden witnessed Cardiac Arrest due to ACS is almost always due to dysrhythmia. Tachycardia is of course, quite common in patients following cardiac arrest.