1. As a follow up to Raashee’s expertly presented Wide Complex Tachycardia Talk, here are 2 questions:


SVT with RBBB or VT?



1. + concordance in all precordial leads (90% specific)

2. Rsr’ in V1


My notes from Raashee’s lecture:

Wide Complex Tachycardia:
Aflutter with BBB
Monomorphic VT- single focus, more likely ischemic
Polymorphic VT- multiple foci, more likely metabolic
Afib with abberancy

Things to look at:

Rate- limited, 150 or 300 think aflutter

Axis- right axis VT, look at aVR- qrs upwards likely VT
QRS- if greater than >140 ms likely VT
Bundle branch-
      RBBB-V1 rsr’ with upwards deflection, V6 promient s wave
      -V1 will be rsR’ in SVT , Rsr’ or monomorphic R In VT
       -V6 little R big S likely VT
      LBBB-V1 qrs downwards, V6 qrs upwards
       -V1 notch on downwards S wave likely VT, sleek slope Likely SVT
        -V6 any q wave present, likely VT. No q likely SVT
Concordance- all same way in pre cordial leads-90% specific for VT
AV dissociation- hard to see, but if present specific for VT