1
Q
Describe tools for differentiating between ventricular ttachycardia and SVT with aberrant conduction.
Do not include algorithms like the Brugada algorithm or Vereckei algorithm
A
- Factors suggesting VT
- Rsr’ in V1 (tall left rabbit ear)
- Most specific vinding for VT, nearly diagnostic
- Extreme axis deviation
- QRS duration >160ms
- absence of typical LBBB or RBBB morphology
- Fusion/capture beats/AV dissociation
- Positive or negative QRS concordance throughout the precordials
- Brugada sign
- onset of R wave to nadir of S wave >100ms (2.5 small squares)
- Josphson sign
- Notching/slurring at nadir of S-wave
- Rsr’ in V1 (tall left rabbit ear)
2
Q
Describe aVR findings which suggest VT over SVT with aberrancy (Vereckei Signs)
A
- Dominant INITIAL R wave in aVR suggests VT
- Dominant terminal R suggests SVT
3
Q
Does the attached ECG most likely show VT or SVT with aberrancy?
A
SVT with aberrancy
- AVNRT with typical LBBB appearance
- Negative Rsr’ in V1
- Negative Brugada, Josephson, and Vereckei sign
4
Q
Does the attached ECG most likely show VT or SVT with aberrancy?
A
VT
- Northwest axis
- Presence of fusion beats (V1)
- Otherwise borderline for SVT with RBBB
5
Q
Does the attached ECG most likely show VT or SVT with aberrancy?
A
SVT with aberrancy (TCA overdose)
- Lacks precordial concordance
- Negative Brugada sign (all widening is in terminal portion of S wave)
- Dominant TERMINAL R wave in aVR
- Vereckei sign
6
Q
Compare patient populations for whom SVT with aberrancy or VT is more likely in WCT
A
- VT
- age >35yrs.
- Hx of structural or ischemic heart disease or MI
- Hx of sudden cardiac death in family
- SVT with aberrancy
- pediatric patients
- Hx of baseline IVCD, RBBB or LBBB
- Hx of WPW or pSVT
7
Q
Describe the aVR STEMI pattern and explain it should and shouldn’t be considered a STEMI equivalent
A
- STE in aVR with diffuse ST depression
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