Arrythmias- broad complex tachy

Question 1

What conditions cause broad complex tachys? Which is the most common?

Answer 1

Ventricular tachy (most common)
Wolff- Parkinson White
Torsades de Pointes
Antidromic AVRT

Question 2

What is torsades de pointes?

Answer 2

A form of VF, that self terminates

Question 3

What can cause Torsades de pointes?

Answer 3

Congenital Long QT syndromes
Medication (antiarrhythmics, antibiotics such as erythromycin, tricyclics, antipsychotics, ketoconazole)
Myocardial infarction
Renal/liver failure
Hypothyroidism
AV block
Toxins

Question 4

How is Torsades de Pointes managed?

Answer 4

Correct the cause (electrolyte disturbances or medications)
Magnesium infusion (even if they have a normal serum magnesium)
Defibrillation if VT occurs

Question 5

What is a type of pre excited AF?

Answer 5

WPW

Question 6

What is the pathophysiology of WPW?

Answer 6

Wolff-Parkinson White Syndrome is caused by an extra electrical pathway connecting the atria and ventricles.
The extra pathway that is present in Wolff-Parkinson White Syndrome is often called the Bundle of Kent.

Question 7

What is the definitive management of WPW?

Answer 7

Radiofrequency ablation of the accessory pathway

Question 8

What changes can be seen on ECG in WPW?

Answer 8

Short PR interval (< 0.12 seconds)
Wide QRS complex (> 0.12 seconds)
“Delta wave” which is a slurred upstroke on the QRS complex

Question 9

What are the ECG features for ventricular tachycardia?

Answer 9

Tachycardia (>100 beats per minute), plus
Absent P waves, plus
Monomorphic regular broad QRS complexes (>120 ms)