Dr. Usman's Cardiology Notes

 A 40 year old man brought into the emergency room in a collapsed state with ECG given above. Carotid pulse was palpable (1+) and blood pressure was 80/45 mmHG. Thought 1: How to approach wide complex tachycardia? Thought 2: What is the first line drug in this case? This ECG has wide-complex tachycardia(QRS duration=120msec) at a rate of 180 bpm with a RBBB pattern, left superior axis deviation and R-S interval is hardly 80msec suggesting Idiopathic Fasicular Left Ventricular Tachycardia (ILVT) and due to left superior axis deviation its Posterior Fasicular VT . Right ventricular outflow tract tachycardia is also differential here but it is usually with LBBB morphology. During wide complex tachycardia the differentiation between supraventricular and ventricular origin of the arrhythmia is important to guide therapy. Several algorithms have been developed to aid in this differentiation which we will discuss in next sections. The patient was initially treated with success...