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    Make Up Pearl

    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

     

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