Differential diagnosis in narrow QRS complex tachycardias Hosted

Differential diagnosis in narrow QRS complex tachycardias Hosted by DR Adrian Baranchuk MD FACC and DR Kevin Michael MBCB MPhil MD Presentation

Overview • A simple and useful algorithm to differentiate narrow complex tachycardias • Clinical applicability • Easy to remember • Real clinical cases • Some less frequent presentations “There is no algorithm that can cover ALL clinical scenarios”… 2 23, 2020 Differential diagnosis in narrow QRS complex tachycardias Presentation

Algorithm 3 Questions: 1. Narrow vs. Wide 2. Regular vs. Irregular 3. Where is the P-Wave 3 23, 2020 Differential diagnosis in narrow QRS complex tachycardias Presentation

Tachycardias VENTRICULAR SUPRAVENTRICULAR • • • SINUS TACHYCARDIA ATRIAL FIBRILLATION ATRIAL FLUTTER ATRIAL TACHYCARDIA AVNRT AVRT MONOMORPHIC VT POLYMORPHIC VT TORSADES POINTES VENTRICULAR FIBRILLATION • • 90% Narrow Complex Tachycardia 4 23, 2020 Wide Complex Tachycardia Differential diagnosis in narrow QRS complex tachycardias Presentation

Algorithm Narrow Complex Tachycardia Regular - P after QRS No P waves P before QRS + AVNRT ST Irregular Atrial Fibrillation RP<PR JT AVNRT - AVRT LAT Saw tooth RP>PR Atypical AVNRT A Flutter 5 23, 2020 A. Flutter w/variab. con. Differential diagnosis in narrow QRS complex tachycardias Presentation

Sinus tachycardia Electrical alternans Low qrs voltage CASE 1 Cardiac Tamponade • • • 6 23, 2020 Differential diagnosis in narrow QRS complex tachycardias Presentation

CASE 2 Low Atrial Tachycardia • - P-wave inf. Leads • - P-wave in lead I • Activation caudocranial left to right Negative P-waves in inferior leads 7 23, 2020 Differential diagnosis in narrow QRS complex tachycardias Presentation

CASE 3 Atrial Flutter • Saw tooth • Think in AFL if HR 150 bpm @ rest!!! • CSM: variable conduction 8 23, 2020 Differential diagnosis in narrow QRS complex tachycardias Workshop

CASE 4 Sinus Tachycardia 9 23, 2020 VAGAL MANEUVERS • SVT: “all or none” • A Flutter: ↑ degree of block • Sinus Tach: slow the rate Differential diagnosis in narrow QRS complex tachycardias Presentation

Regular, narrow complex - retrograde P-waves RP < PR RP < 80 ms CASE 5 Typical AVNRT • • 10 23, 2020 Differential diagnosis in narrow QRS complex tachycardias Presentation

CASE 6 Orthodromic AVRT 11 23, 2020 • • Regular, narrow complex - retrograde P-waves RP < PR RP < 80 ms Differential diagnosis in narrow QRS complex tachycardias Presentation

2: 1 AVNRT CASE 7 (Infrequent Presentations) • P-wave in the middle of RR • - retrograde P-waves • Pseudo ‘R-waves 12 23, 2020 Differential diagnosis in narrow QRS complex tachycardias Presentation

“ 2 x 1” Tachycardia • Narrow complex • Slightly irregular • 1 P-wave, 2 QRS CASE 8 P QRS Fast pathway Slow pathway 13 23, 2020 Differential diagnosis in narrow QRS complex tachycardias Presentation

Once Again… Narrow Complex Tachycardia Regular - P after QRS No P waves P before QRS + AVNRT ST Irregular Atrial Fibrillation RP<PR JT AVNRT - AVRT LAT Saw tooth RP>PR Atypical AVNRT A Flutter 14 23, 2020 A. Flutter w/variab. con. Differential diagnosis in narrow QRS complex tachycardias Presentation

www. HRMx. org www. doctorsfixinghearts. com 15 23, 2020 Differential diagnosis in narrow QRS complex tachycardias Presentation