宽QSS波心动过速的鉴别诊断

宽QRS波心动过速(wide QRS complex tachy-cardia)通常定义为QRS波时限≥0.12 s,频率大于每分钟100次.由于其包括多种不同类型,且不同类型心动过速的危害性及处理方法有很大不同,因此对宽QRS波心动过速的鉴别诊断有重要临床意义.     

The differential diagnosis of wide QRS complex tachycardia

Wide complex tachycardia is defined as a cardiac rhythm with a rate greater than 100 beats/min (bpm) and a QRS complex duration greater than 0.10 to 0.12 seconds (s) in the adult patient; wide complex tachycardia (WCT) in children is defined according to age-related metrics. The differential diagnosis of the WCT includes ventricular tachycardia and supraventricular tachycardia with aberrant intraventricular conduction, including both relatively benign and life-threatening dysrhythmias. This review focuses on the differential diagnosis of WCT with a discussion of strategies useful in making the appropriate diagnosis, when possible.     

Vereckei法新四步流程图对宽QRS心动过速鉴别诊断

目的了解宽QRS心动过速（WQRST）的鉴别诊断依据。方法选择在运动试验过程中诱发WQRST27例,根据Vereckei法新四步流程图,回顾性分析室性心动过速（VT）和室上性心动过速（SVT）的发病率。结果Vereckei法鉴别诊断WQRST符合率92．6％,误诊率7．4％。其中4例缺血性VT和1例缺血性sVT伴束支传导阻滞的高危患者,均经积极救治（急诊PCI）痊愈出院。结论Vereckei新四步法是WQRST鉴别诊断的重要手段之一,有助于及时正确识别VT和SVT,对疾病的治疗和预后有积极的作用。     

宽QRS波心动过速鉴别诊断的临床分析

目的分析和对比宽QRS波心动过速(WCT)的鉴别诊断流程图的应用价值。方法对就诊于我院急诊科及心内科并经食管心房调搏、心内电生理检查或射频消融治疗而明确诊断的WCT患者,回顾性分析其病史、心电图、食管调搏或电生理检查及射频消融治疗的结果,研究Brugada四步法、无人区电轴联合aVR导联四步法对WCT诊断的准确率。结果82例WCT患者中,63例为室性心动过速,15例为室上性心动过速伴差异传导,3例为室上性心动过速伴预激前传,1例为双旁道间折返性心动过速。应用Brugada四步法正确诊断71例,正确诊断率86.6%;联合应用无人区电轴及aVR导联四步法,正确诊断75例患者,正确诊断率91.5%。结论联合应用无人区电轴及aVR导联四步法,可使大部分WCT得以正确诊断,提高WCT鉴别诊断的准确率。     

Wide QRS complex tachycardia.

Electrocardiographic monitoring for dysrhythmias is a major responsibility of critical care nurses, and patients with wide QRS complex tachycardias present a challenge. Criteria for differentiating the impulse origin as ventricular or supraventricular are well documented: QRS duration, QRS morphology, QRS axis, and presence of atrioventricular dissociation. However, definitive diagnosis can only be made by invasive electrophysiologic studies. Knowledge of treatment protocols is important to prevent hemodynamic deterioration. Procainamide is effective for treating ventricular and supraventricular dysrhythmias and is the drug of choice unless certainty of impulse origin exists.     

Induction of wide QRS tachycardia during transthoracic echocardiography.

A wide QRS tachycardia was repeatedly triggered during transthoracic echocardiographic examination in a critically ill premature infant with bilateral chest tubes. The left-sided tube was anterior to the heart. The arrhythmia was not induced after removal of the chest tubes at the follow-up ultrasonographic evaluation. Compression of the thoracic wall and chest tube, and subsequently the heart, by the ultrasound transducer is postulated as the cause for this wide QRS tachycardia.     

Emergency management of wide complex tachycardia

Wide complex tachycardia (WCT) is a challenging clinical problem. Priorities in management are the rapid establishment of an appropriate diagnosis and the restoration of sinus rhythm with a minimum of discomfort or danger to the patient. Diagnosis is based upon clinical assessment and analysis of the 12-lead ECG. Pitfalls in the assessment of the 12-lead ECG are reviewed and a simple approach to 12-lead ECG assessment described. Adenosine may be used as a diagnostic test when the underlying rhythm is uncertain. Current recommendations for the treatment of WCT and the role of newer therapies, including trans-cutaneous pacing, are reviewed.     

Fulminant myocarditis presenting with wide complex tachycardia

Fulminant myocarditis is an uncommon diagnosis characterized by cardiac failure preceded by symptoms of a viral illness. Presentation can frequently mimic acute myocardial infarction. The electrocardiographic changes are frequently nonspecific, but include ST segment elevation and T wave changes, as well as conduction abnormalities. We report the case of a patient with fulminant myocarditis that presented with sinus rhythm, a conduction system abnormality, and severe ST segment elevation mimicking ventricular tachycardia. Myocarditis should be considered in young persons with unexplained heart failure and similar electrocardiographic abnormalities.     

Severe propranolol and ethanol overdose with wide complex tachycardia treated with intravenous lipid emulsion: A case report

Background. Propranolol is a highly lipid-soluble beta-blocker. We describe a case of severe propranolol overdose, with atypical dysrhythmia – wide complex tachycardia – which was successfully treated with lipid emulsion. Case report. A 31-year-old woman ingested approximately 3.6 g of propranolol along with ethanol. Clinical manifestations of poisoning included coma, seizures, respiratory failure, hypoglycaemia, circulatory shock, and dysrhythmias. An ECG revealed nonspecific intraventricular conduction delay, followed by wide complex supraventricular tachycardia. Toxicological analysis of blood showed ethanol 2.42 g/L and propranolol 4.21 mg/L. The patient responded poorly to conventional therapy, so intravenous lipid emulsion was used. Apart from IV dopamine, the only treatment after the onset of wide complex tachycardia was 20% Intralipid. Transient improvement was noticed after the initial dose of 500 mL; during the infusion of further Intralipid, blood pressure returned to normal and sinus rhythm was re-established. Conclusion. We believe that lipid emulsion had a beneficial effect in the treatment of propranolol toxicity.