Cardiology Question 15 Instructor

Among patients with wide-complex tachycardia, what are the clues to help distinguish between ventricular tachycardia (VT) versus supraventricular tachycardia (SVT) with aberrancy?

Clinical clues:

Presenting symptoms Not Helpful
History of CAD and previous MI VT
Physical Exam:

  • Cannon “a” waves
  • Variable S1

  • VT
  • VT
Carotid sinus massage/adenosine terminate arrhythmia SVT*
AV dissociation VT
Capture or fusion VT
QRS width>140 msec VT
Extreme axis deviation
(left or right superior axis)
Positive QRS concordance
(R wave across chest leads)
Negative QRS concordance
(S wave across chest leads)
may suggest VT
Axis shift during arrhythmia VT (polymorphic)

*if patient >65 and previous MI or structural heart disease, then chance of VT is >95%.

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