Wide complex tachycardia: diagnosis and treatment

A wide QRS complex tachycardia that cannot be immediately identified, and which on clinical grounds requires prompt treatment, should be converted electrically. Drug management can be time consuming, and agents that block AV transmission, that is, verapamil and propranolol, may be life-threatening.     

Wide complex tachycardia: misdiagnosis and outcome after emergent therapy

The extent and consequence of misdiagnosis of wide complex tachycardia (QRS, 120 ms or more; heart rate, 100 or more beats/min) presenting emergently were assessed. Forty-six consecutive episodes of wide complex tachycardia were reviewed and their tachycardia mechanisms subsequently established. All 8 episodes of supraventricular tachycardia with aberrant conduction were correctly diagnosed, whereas 15 of 38 episodes of ventricular tachycardia (39%) were misdiagnosed as supraventricular tachycardia at the time initial therapy was given. Ventriculoatrial dissociation was evident in 11 (73%) of the electrocardiograms of misdiagnosed ventricular tachycardia. Patients with misdiagnosed episodes had poorer outcomes than those with episodes correctly diagnosed (p = 0.0003). Verapamil was administered to patients in 13 of the 15 episodes of misdiagnosed ventricular tachycardia; hemodynamic deterioration occurred in all 13 episodes. Wide complex tachycardia is often incorrectly diagnosed as supraventricular tachycardia when, in fact, the 12-lead electrocardiogram strongly suggests ventricular tachycardia. Verapamil is commonly administered in these circumstances and is frequently associated with a poor outcome.     

Wide complex irregularly regular tachycardia with QRS alternation

A 44-year-old white man was referred to our service because of a history of symptomatic rapid palpitations that had begun on January 2007. He had no previous history of syncope or family history of sudden cardiac death. The patient was otherwise well and had not been taking any medications. The electrocardiogram (ECG) recorded during sinus rhythm was within normal limits. A 12-lead ECG was performed during the last episode on July 2007 while he was working at his office. An irregular wide complex tachycardia with varying QRS morphology (left bundle-branch block with an alternating pattern) was documented.The differential diagnoses based on the 12-lead electrocardiogram (ECG) were supraventricular tachycardia with aberrant conduction and QRS alternans, atrial tachycardia with anterograde conduction over an accessory pathway, or ventricular tachycardia. An electrophysiology study was performed and the results are discussed.     

Wide complex tachycardia and congenital heart disease.

We present a patient with congenital heart disease and haemodynamically poorly tolerated wide QRS tachycardia. Differential diagnosis and therapy are discussed. After the patient underwent heart transplantation, and the substrates for ECG abnormalities and arrhythmias were demonstrated in the explanted heart.     

Pasteurella multocida osteomyelitis: An unusual case presentation

A healthy male farm employee developed an unusual infection caused by Pasteurella multocida. Atypical features included the chronic nature of the infection, the development of osteomyelitis of the tibia without direct animal inoculation, and lack of fever and leukocytosis. Radiographic appearance of P multocida osteomyelitis may be the result of osteoclast activation and can be confused with musculoskeletal tumour. P multocida infection requires a high degree of suspicion, and should be considered in cases of farm- or animal-related injuries even if there is no history of direct animal contact.     

Covid-19 pneumonia: An unusual radiological presentation

A 26 year old female presented with complaints of high grade fever and cough for 10 days. Nasopharyngeal swab tested for COVID-19 RT-PCR at admission was negative. Clinical examination suggested a patch of bronchial breathing in left infrascapular region and bilateral diffuse rhonchi. Chest X-ray was suggestive of left lower zone consolidation. HRCT showed a large patch of consolidation with GGO along with a cavitary lesion involving left lower lobe. Sputum for RT-PCR COVID 19 was positive. Patient was managed as per covid-19 protocol, subsequently showing clinical and radiological improvement.