tag:blogger.com,1999:blog-549949223388475481.post6319789796246619744..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: A 12 year old with Wide Complex TachycardiaUnknownnoreply@blogger.comBlogger9125tag:blogger.com,1999:blog-549949223388475481.post-4862055321654401452018-03-05T06:27:58.092-06:002018-03-05T06:27:58.092-06:00Thanks, Tom!Thanks, Tom!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-36274668942134837702018-03-04T22:30:13.079-06:002018-03-04T22:30:13.079-06:00extraordinary case. thank you, Steveextraordinary case. thank you, Stevetom fieronoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-27332786539950674242016-07-24T11:10:16.531-05:002016-07-24T11:10:16.531-05:00they are simply unlikely to work. If you don't...they are simply unlikely to work. If you don't know what a regular wide complex tachycardia is, you can shock it. You don't need to avoid AV nodal blockers unless there is BOTH WPW and atrial fib. Adenosine won't work for this, though it will work for a regular tachycardia due to WPW. Amio and Procaine won't work. Verapamil only dangerous if there is poor LV fct.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-39160603307668679412016-07-24T11:08:03.401-05:002016-07-24T11:08:03.401-05:00Bashar,
Verapamil will only work for this particul...Bashar,<br />Verapamil will only work for this particular kind of VT. So only use it for this, not for electrolyte-induced VT.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-43235315158484076232016-07-24T11:07:07.688-05:002016-07-24T11:07:07.688-05:00Possibly, but not as reliably. Electricity would ...Possibly, but not as reliably. Electricity would work.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-47578781205039202022016-07-22T14:13:00.039-05:002016-07-22T14:13:00.039-05:00Great case. I'm a fairly junior doctor, so I t...Great case. I'm a fairly junior doctor, so I try to keep things simple in difficult cases such as this. I was always taught, if it's wide, treat it wide. Even though there is no sign of delta wave, or irregularity (afib with wpw), my general inclination would be to avoid av nodal blocking agents or ccb's. Perhaps just go straight to procainamide? That said faced with this case in front of me, I could see myself convincing myself it's probably just svt with abberancy and giving adenosine x 2. I think my personal preference would have been amiodarone or procainamide, any reason NOT to use those?...verapamil would have made me nervous, as I have not typically used it, and know all too well it's negative inotropic effects (saw 2-3 serious ped's verapamil OD's with small doses). Lgaardhttps://www.blogger.com/profile/17398341796922616660noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-81561116103134504662016-07-22T12:13:31.093-05:002016-07-22T12:13:31.093-05:00so is the problem with verapamil the systolic func...so is the problem with verapamil the systolic function only without being sure about the diagnosis ( sure not suggested ) ?<br /><br />I don' t know if this is a smart question but could we use verapamil if the systolic function is good and the vt is caused by electrolyte problems<br /><br />Thanks <br />Nice caseAnonymoushttps://www.blogger.com/profile/08488975105375814621noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-9658619764967895792016-07-22T09:42:23.477-05:002016-07-22T09:42:23.477-05:00If Verapamil is not available, would Amiodarone be...If Verapamil is not available, would Amiodarone be safe/effective??Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-70996248189660547552016-07-21T02:59:15.711-05:002016-07-21T02:59:15.711-05:00The rhythm is a regular WCT ( = Wide-Complex Tachy...The rhythm is a regular WCT ( = Wide-Complex Tachycardia) at ~ 210/minute without sign of atrial activity. Dr. Smith has reviewed the principal differential diagnosis. I don’t think QRS duration is particularly helpful here, given that the patient is a 12-year old child (for whom normal QRS duration is a bit less than in adults). So the QRS is definitely wide, though not excessively so — but probably overlaps most entities to be considered. What strikes me — is the obvious suggestion of bifascicular block (RBBB/LAHB), though of atypical morphology. In an otherwise healthy child (who does not have congenital heart disease or other structural heart abnormality) — one would expect a more typical RBBB morphology with a clear triphasic appearance with taller right-rabbit ear in lead V1, instead of the atypical picture we see here in V1,V2,V3. Considering this and integrating it with the important Learning Points Dr. Smith emphasizes (ie, that fascicular VT often occurs in otherwise normal hearts) — places Fascicular VT high in the differential. Against WPW here is the lack of a delta wave in a tracing in which at least 9 leads manifest a clearly defined and narrow initial deflection. While professing no expertise in pediatric arrhythmias — my approach would have been identical to that attempted = initial administration of Adenosine (which shouldn’t be harmful, and which may convert some of the entities being considered) — followed by cautious trial of Verapamil (which often works amazingly well to convert fascicular VT). GREAT case with happy ending!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.com