Wide Complex Tachycardia

Intro

There’s an old adage that wide complex tachycardia is VTach until proven otherwise. While this is true as do not want to miss any potentially lethal arrhythmia, it is also important to understand the differential for wide complex tachycardias so that we can tailor our potential treatments to the specific arrhythmia. It is also important to note that in any unstable patient with a wide complex tachycardia (or narrow complex tachycardia) that electricity is always safe.

Narrow Complex Tachycardias

Intro

The differential for narrow complex tachycardia is extremely important as it is the most commonly seen abnormal EKG in the emergency department. It includes rhythms such as sinus tachycardia, AVnRT, AVRT, atrial flutter, ectopic atrial tachycardia (EAT), atrial fibrillation, atrial flutter, and multifocal atrial tachycardia (MAT).

The goal of this blog is to run through this differential and give some methods to differentiate the rhythms. Although we will not delve too deep into antiarrhythmics, it is important to note that electricity is safe in all unstable rhythms no matter the etiology.

EKG: Pericarditis vs. STEMI

Dr. Patwari did a great review on differentiating ST elevations associated with pericarditis vs. acute MI. From medical school, I think we can recall many of the classic EKG findings that support pericarditis Diffuse ST elevations Concave upwards STE PR depressions in multiple leads (only reliable seen in viral pericarditis) PR elevation in aVR However,

EKG: Atrial Flutter

The 5-minute EKG was presented by our fan-favorite attending, Dr. Patwari. See EKG below (Answer to follow). You’re handed this EKG from triage. As always, it is important to approach an EKG in a systematic way including rate, rhythm, axis, intervals, and segments. However, the big takeaway from this EKG is that it is a

EKG of the Week

This week we have an EKG of a 65 year-old woman who presented with fatigue. She just didn’t seem to have the energy she normally has. No chest pain, shortness of breath, fever, cough or leg swelling. Her vital signs and exam were unremarkable.

Here is her EKG: EKG 2017-07-24

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