Arrhythmia - Ventricular Arrhythmia

Question 1

Differential Diagnosis with wide complex tachycardia

Answer 1

• WPW
• SVT with aberrancy
• VT
• artifact
  paced rhythm

Question 2

Approach to WCT

Answer 2

Question 2

most specific ecg findings for VT

Answer 2

VA dissociation

Question 3

diagnosis?

Answer 3

VT

Question 4

look ar AVR for axis. it is rare for normal physiologic activation to have right superior axis

Answer 4

think of VT

Question 5

Clues for VT: precordial transition

Answer 5

if the origin of VT came from the base, it will have positive QRS

if the origin of the VT came from the apex, will have a negative QRS

Question 6

RBB and LBB clues for VT

Answer 6

for RBB morphology, consider VT if
- there is q wave in V1 or small r in V6
- monomorphic QRS complex
- R is taller than r’

for LBB morphology, consider VT if
- (+) q wave in V6

Question 7

aVR criteria and brugada criteria for VT

Answer 7

Question 8

Clues for VT vs SVT in aberrancy

Answer 8



Question 9

novel simplified algorithm for WCT

Answer 9

Question 10

diagnosis?

Answer 10

Afib in WPW - procainamide drug of choice

Question 11

Diagnosis

Answer 11

artifact

Question 12

Origin of idiopathic VT

Answer 12

• outflow tracts
• papillary muscles
• perivenous area

Question 13

Diagnosis?

Answer 13

LBB morphology, RAD
- VT

Question 14

Triggers of Outflow tract tachycardia

Answer 14

men- Exercise
women - hormonal

Question 15

Mechanism of outflow tract VT

Answer 15

Delayed afterdepolarization

***papillary muscle VT - mechanism is abnormal automaticity

Question 16

Diagnosis?

Answer 16

Fascicular VT
- clues: RBB morphology+LAD

Question 17

Mechanism of Fascicular VT

Answer 17

ReEntry

***note that this is adenosine insensitive but VERAPAMIL sensitive

Question 18

Mechanism of Scar VT

Answer 18

• Reentry

Question 19

mutation in Arrhythmogenic RV Cardiomyopathy

Answer 19

Desmosome

Question 20

Diagnosis

Answer 20

T wave inversion in V1-3
Epsilon wave - terminal portion of the QRS complex is fractionated

Question 21

Mechanism in Bundle Branch VT

Answer 21

• Reentry

Question 22

Diagnosis?

Answer 22

top - sinus rhythm

bottom - BB reentry - common in non-ischemic DCM

Question 23

Mechanism of Polymorphic VT

Answer 23

Early afterdepolarization/ R on T phenomena

Question 24

diagnosis?

Answer 24

Polymorphic VT

Question 24

Mechanism of different types of VT. Idiopathic, fascicular, scar-based, polymorphic

Answer 24

Question 25

which type of VT where adenosine can be given

Answer 25

Idiopathic VT

Question 25

Approach to WCT: SVT in aberrancy vs VT

Answer 25

Question 26

Management for WCT

Answer 26

Question 27

Diagnosis?

Answer 27

Left fascicular reentrant ventricular tachycardias. This tachycardia is characterized by a right bundle branch block contour with relatively narrow QRS, typically less than 150 msec. In this instance the axis was superior rightward, consistent with exit from a reentry circuit involving the posterior fascicles of the left bundle branch.