Tachyarrhythmia
Results:
UMEM Cases, Part 4: When the Computer Misses the Rhythm and Flutter Fakes a STEMI
A 44-year-old man with severe cardiomyopathy, an LVAD, chronic amiodarone therapy, and an AICD presents with palpitations. His ECG shows a regular wide-complex tachycardia, but the rate is only 135….
Junctional Tachycardia
Key Points: Junctional tachycardia is an uncommon supraventricular tachycardia arising from the AV junction, usually due to enhanced automaticity rather than reentry. It is usually a regular narrow-complex tachycardia, although…
Supraventricular Tachycardias (SVTs)
Key Points: SVT in bedside emergency medicine usually refers to a rapid regular tachycardia arising above the ventricles, most commonly AVNRT, AVRT, or atrial tachycardia. Most SVTs are regular narrow-complex…
Preexcitation Pitfalls (Part 4): Potpourri Cases & Final Teaching Points
A 49-year-old man arrives with palpitations and chest discomfort. The monitor shows an irregular, wide-complex tachycardia with varying morphology and rates nearing 250 to 300 bpm. The team debates polymorphic…
Atrial Flutter with Variable Conduction
Key Points: Mechanism: Typical atrial flutter arises from a large re-entry circuit in the right atrium. The atrial rate is usually near 300 beats per minute. ECG hallmark: Continuous “saw-tooth”…
Atrial Flutter 2:1 Conduction
Key Points: Atrial flutter is a macro-reentrant atrial tachycardia, most commonly typical cavotricuspid isthmus-dependent right atrial flutter, with an atrial rate usually near 300 bpm. With 2:1 AV conduction, the…
Atrial Flutter 1:1 Conduction
Key Points: Rare, high-risk rhythm. Atrial flutter with 1:1 conduction can produce ventricular rates of 240-320 bpm and may rapidly cause hypotension, ischemia, or collapse. Often mimics VT. The QRS…
Preexcitation Pitfalls (Part 3): Wide, Irregular, Fast…Avoid AV Nodal Blockers
A 53-year-old man presents with palpitations and lightheadedness. The following ECG is obtained on arrival and appears very rapid and irregular with changing QRS morphologies. He starts showing signs of…
Preexcitation Pitfalls (Part 2): Wide, Regular, Fast…Treat It Like VT
A young man with recurrent palpitations presents to the emergency department hemodynamically stable during an episode. The arrival ECG shows a wide complex, regular tachycardia and the computer interpretation calls…
WPW with Antidromic SVT (Antidromic AVRT)
Key Points: Antidromic AVRT is an AV re-entrant tachycardia that conducts antegrade down the accessory pathway and returns retrograde through the AV node (or another pathway), producing a regular wide-complex…
WPW with Orthodromic SVT (Orthodromic AVRT)
Key Points: Orthodromic AVRT is the most common tachyarrhythmia in WPW and presents as a regular narrow-complex SVT that is indistinguishable from AVNRT during the tachycardia. Mechanism: antegrade conduction down…
Baltimore City EMS ECGs: Pitfalls and Mimics (Part 1)
A 68-year-old man is brought to the emergency department by EMS with acute chest discomfort. The following prehospital ECG was obtained and shows concave ST elevation across multiple leads. The…
Three More ECG Pitfalls That Punish Anchoring Bias
A 51-year-old man with lung cancer presents with shortness of breath and tachycardia. The arrival ECG shows an S1Q3 pattern and seems to support a familiar diagnosis that would normally…
Bidirectional Ventricular Tachycardia (BiVT)
Key Points: BiVT is a regular wide-complex tachycardia with strict beat-to-beat alternation of QRS axis and/or bundle-branch pattern (often an approximately 180° frontal-plane axis flip). In adults, assume digoxin toxicity…
Torsade de Pointes (TdP)
Key Points Definition: TdP is a specific subtype of polymorphic ventricular tachycardia associated with a prolonged QTc interval. It often presents with a “twisting” pattern on ECG but can be…
Ventricular Tachycardia (VT): Core Overview
Key Points: VT is a ventricular-origin rhythm: ≥3 consecutive ventricular beats, QRS >120 ms, rate usually 120–250 bpm. Types include monomorphic VT, polymorphic VT, torsades (PMVT with long QT), ventricular…
Ventricular Tachycardia (VT) Mimics
Key Points: Initial Assumption: Any wide (QRS >120 ms), regular tachycardia should be considered ventricular tachycardia (VT) until clearly proven otherwise. VT Characteristics: VT generally has a ventricular rate of…
Pulseless Ventricular Tachycardia (pVT) Arrest
Key Points: Defibrillation First, Minimal Pauses: pVT is rapidly fatal without immediate shocks and high‑quality CPR. Charge defibrillator during compressions and resume compressions immediately after each shock. pVT is a…
Electrical Storm
Key Points: Definition: Electrical storm is defined as three or more episodes of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), or appropriate implantable cardioverter-defibrillator (ICD) shocks within 24 hours. Some…
Ventricular Fibrillation (VF) Arrest
Key Points: Defibrillation First, Minimal Pauses: VF is rapidly fatal without immediate shocks and high‑quality CPR. Charge during compressions and resume compressions immediately after each shock. Chaotic Electrical Activity: VF…
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