Question- discuss

[Hero]

A 70 yr old man came to ER with palpitation. Symptoms started 45 mins prior to his arrival in ER. No dizzi, lightheadedness, or chest discomfort. Prev H/O MI 1 yr back, AFib, and CABG. On medications--aspirin, betaloc, warfarin, and ACE-I. An EKG was taken which showed wide complex tachy with a rate of 174 bpm. Which of the following confirms that this rhythm is VT?
(a) Syncope
(b) Cannon 'a' waves in JVP
(c) Hypotension
(d) An odd looking EKG with similar QRS complex pattern
(e) Irregular rhythm

Start discussing. Good luck!

[Vishal]

I feel lil bit tough solving this question. I go for 'D'.
Please let us know the exact answer with explanation, thank you for such an informative n interesting question. Keep it up.

[bharat]

Originally Posted by Hero

A 70 yr old man came to ER with palpitation. Symptoms started 45 mins prior to his arrival in ER. No dizzi, lightheadedness, or chest discomfort. Prev H/O MI 1 yr back, AFib, and CABG. On medications--aspirin, betaloc, warfarin, and ACE-I. An EKG was taken which showed wide complex tachy with a rate of 174 bpm. Which of the following confirms that this rhythm is VT?
(a) Syncope
(b) Cannon 'a' waves in JVP
(c) Hypotension
(d) An odd looking EKG with similar QRS complex pattern
(e) Irregular rhythm

Start discussing. Good luck!

hey hero here is my hunch.....well here is some thing important about VT before going to answer this question let me remind some things......
· The main symptoms of VT are palpitation, lightheadedness, and syncope. Because VT is often nonsustained, patients frequently present with recurrent syncopal episodes in the setting of underlying structural heart disease.
· Some patients describe a sensation of neck fullness, which may be related to increased central venous pressures and cannon A waves.
· Dyspnea may be related to increased pulmonary venous pressures and occasional left atrial contraction against a closed mitral valve.
· Faster VT rates are associated with lightheadedness or syncope related to diminished cerebral perfusion.
· Anxiety is often present, regardless of whether syncope occurs.
· Risk factors include prior myocardial infarction, other known structural heart disease, or a family history of premature sudden death. VT must be considered part of the differential diagnosis in any syncopal patient with such a history.
· Any patient with a strong family history of premature (<35 y) sudden death should be evaluated for long QT syndrome, short QT syndrome, Brugada syndrome, arrhythmogenic right ventricular dysplasia, and hypertrophic cardiomyopathy.

so option A and B can occur but i go for option A well correct me if i am wrong hero......see u

[nimsbdr]

sorry i meant D

[Hero]

Great thinking guys! Bharat--ur explanations are logical. All guys tried very well. In wide QRS tachycardia, we first think of VT or SVT with aberrant conduction. The question here was how to confirm this is VT. Well all options given may suggest VT, but syncope, hypotension and irregular rhythm are present in other types of tachycardia also. They are not specific for VT. Now remained option B and D. We usually say that concordant pattern of QRS in V1 to V6 suggest VT, but this one also not specific for VT coz in SVT also we may see this pattern of QRS. In VT, QRS may look alike--monomorphic or different--polymorphic. So, what remained? Option (B)--Cannon 'a' waves in JVP. Cannon a waves is seen in VT becoz of complete AV dissociation, which is the diagnostic feature for VT. In AV dissociation,the atria are contracting against a closed tricuspid valve producing cannon a waves in JVP. When you r confused with VT or SVT with aberrant conduction--look for cannon a waves, fusion beats, capture beats. Presence of any of these confirms VT.
Comments are welcomed!

[bharat]

opps i just missed it.thanks for the explaination

[Hero]

yesto ramro explanation diye yaar, bharat bahek kasaile pani thanks bhanena, so mean yaar