Wide Complex Tachycardia - Adult Pearls

What medication history should be asked about in wide complex tachycardia?

Aminophylline, diet pills, thyroid supplements, decongestants, digoxin

What dietary history should be asked about in wide complex tachycardia?

Caffeine, chocolate

What drug history should be asked about in wide complex tachycardia?

Nicotine, cocaine

What symptom history regarding heart racing should be asked in wide complex tachycardia?

History of palpitations/heart racing

What symptom history regarding fainting should be asked in wide complex tachycardia?

Syncope/near syncope

Why should a wide complex tachycardia always be assumed to be VT first?

Because VTach treatment works for the other diagnoses in the differential, but SVT-with-aberrancy treatment will kill a VTach patient

What medications should be avoided with WPW in wide complex tachycardia per the Pearls?

Adenosine, digoxin, diltiazem, verapamil

What is needed to diagnose and treat wide complex tachycardia?

A 12-lead ECG

What should be considered if a wide QRS is preceded by a P wave with a consistent PR interval?

It may be sinus tachycardia; refer to the appropriate protocol

What should you do when in doubt about a wide complex tachycardia diagnosis?

Continue with the wide complex tachycardia protocol

What is a variant of VTach with varying QRS morphologies?

Polymorphic VT

What causes Torsades de Pointes?

A long QTc (greater than 500 ms)

What is the treatment for Torsades de Pointes?

Magnesium or shock

What class of drugs should not be given for Torsades de Pointes?

AV nodal blockers like amiodarone, because they can prolong the QT further and lead to refractory VT