EKG of the Week 2016 8-7

This EKG comes courtesy of our Chief Resident from our first residency class - Dr. Ann Giovanni.

A 72 year old female, with a history of a-fib and SVT, presented to the ED complaining of lightheadedness. Vital signs: BP 140/90 pulse 220, Respirations 18, pulse ox 100%, afebrile. She was A&Ox3 with a normal mental status.

Her EKG is below:

1.    What is the rhythm?

2.    How would you manage this patient?

 

ANSWER:

The EKG demonstrates a regular wide complex tachycardia consistent with ventricular tachycardia.

The patient is hemodynamically stable so they can be managed with medications such as amiodarone or procainamide.

Tachyarrhythmias are divided into wide complex rhythms and narrow complex rhythms. Wide complex rhythms are assumed to be ventricular tachycardia. Although there are other things which can cause wide complex tachycardia (i.e. SVT with aberration, WPW), clinically in the emergency department we always treat it as if it is ventricular tachycardia.

V-tach presents as a wide complex rhythm, which is regular, usually with a rate >120, and often demonstrates AV dissociation.

If the patient is hemodynamically stable they can be treated medically. Options include amiodarone and procainamide. If the patient is unstable, they should be treated with synchronized cardioversion.

The following algorithm is useful in diagnosing tachyarrhythmias:

tachycardia algorithm.jpg