fcps new
fcps new
fcps new
Staphylococcus aureus
Staphylococcus epidermidis if < 2 months post valve surgery
AV dissociation
fusion or capture beats
positive QRS concordance in chest leads
marked left axis deviation
history of IHD
lack of response to adenosine or carotid sinus massage
QRS > 160 ms
Diltiazem3%Bisoprolol13%Amiodarone58%Magnesium14%Adenosine1
2%
The correct answer is amiodarone. This a haemodynamically stable
patient with irregular broad complex tachycardia. As the broad-
complex tachycardia is irregular it is most likely atrial fibrillation with
left bundle branch block or an alternative aberrant conduction pathway
such as Wolff-Parkinson-White syndrome. Diltiazem, bisoprolol and
adenosine are all contraindicated as they could enhance the aberrant
pathway leading to ventricular fibrillation. Magnesium would be
appropriate for torsades de pointes but is unlikely as the rhythm is
monomorphic.
The patient reports no chest pain or pre-syncope. The initial ECG shows a
regular broad complex tachycardia (QRS 152) with a rate of 110. P-waves are
visible and appear associated with QRS complexes. RS waves are seen in the
precordial leads. The RS duration is less than 100ms. There is an RSR'
pattern in V1 and V2.
Adenosine8%Amiodarone46%DC cardioversion6%Digoxin3%Vagal
manoeuvres36%
In the ECG presented there are RS waves in the precordial leads with AV
association. There is also an RSR' pattern seen. This is suggestive therefore
of an SVT with RBBB.
As per the ALS algorithm, the patient should therefore be treated as an SVT.
The first line for SVT would be vagal manoeuvres followed by adenosine. As
vagal manoeuvres have not yet been tried this would be the first treatment
option.
HOCM - poor prognostic factor on echo = septal wall thickness of > 3cm