ABC of clinical electrocardiography: Broad complex tachycardia---Part II

A case report reappraising the usefulness of Valsalva manoeuvre in drug-refractory ventricular tachycardia

“…Another method of identification of VT is based on certain features in the context of right bundle branch block (RBBB) and left bundle branch block (LBBB) morphologies ( Table 1 ). 5 , 8 , 9 Using these criteria, both BCTs in our patient fulfils the VT diagnosis for his LBBB tachycardia (VT-1) and RBBB tachycardia (VT-2).…”

“…VT is more likely in a patient aged >35 years old presenting as BCT. 5 A history of ischaemic heart disease in the form of a remote MI is 90% predictive of ventricular origin of a BCT. 5 …”

Years of palpitations and a heart rate of 213 beats per minute

“…Given this finding, this arrhythmia was likely due to an ectopic focus within the left ventricle causing a re‐entrant tachycardia arising from the posterior fascicle and extending apically along the inferoposterior septum in an anterograde fashion, Choice A 1. As the cardiac conduction system generates subsequent electrical impulses, standard ventricular activation from the Purkinje fibers to the ventricles is no longer preserved as a consequence of the aforementioned ectopic focus.…”

Ventricular tachycardia: a life-threatening dysrhythmia

“…Generally speaking, the wider the complex, the more convincing is the diagnosis. Indeed, some authorities would assert a QRS duration of >0.16 seconds is more conclusive (Garcia and Holtz, 2001;Edhouse and Morris, 2002). However, durations can be relatively short -as in fascicular tachycardia, where the QRS duration ranges from 0.11-0.14 seconds (Wagner, 1994).…”

“…Indeed, following an acute myocardial infarction (AMI), most sudden deaths that occur do so as a result of VT or ventricular fibrillation (VF). As a result of the increased awareness of the dangers of misdiagnosis, diagnostic strategies have been developed to promote VT as the default diagnosis of a regular broad complex tachycardia (Forsey and Griffith, 1996;Connaughton, 2001;Edhouse and Morris, 2002). The critical care nurse can apply a number of well-supported morphological criteria facilitating a confident diagnosis of VT in most cases from a standard 12-lead ECG recording.…”