*Take home points: 1) Have a framework for approaching wide complex tachycardia 2) Treatment pearls: a) you’re almost never wrong to give amiodarone in the acute setting, b) push at least 2gm magnesium of any suspicion of polymorphic VT 3) Recognize mimics of ventricular tachycardia*
Stepwise framework for diagnosis wide complex tachycardia
1. Distinguish SVT w/ aberrancy from VT using Brugada criteria (when in doubt, treat as if VT)
2. If VT, monomorphic or polymorphic?
3. If polymorphic VT, long QT (i.e. torsades) or normal QT (i.e. almost certainly 2/2 ischemia)?
Ventricular Tachycardia Mimics
Other cardiac disease:
*Rate-related aberrancy (sinus tach or afib w/ bundle branch block)
*Rate-dependent interventricular conduction delay (benign)
Lytes and toxins (produce very wide, sinusoidal patterns):