1. As a follow up to Raashee’s expertly presented Wide Complex Tachycardia Talk, here are 2 questions:
SVT with RBBB or VT?
VT:
1. + concordance in all precordial leads (90% specific)
2. Rsr’ in V1
My notes from Raashee’s lecture:
Wide Complex Tachycardia:
Regular:
Aflutter with BBB
Monomorphic VT- single focus, more likely ischemic
Polymorphic VT- multiple foci, more likely metabolic
Irregular:
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
