1/11. Wide QRS complex tachycardia: ECG differential diagnosis.Wide QRS complex tachycardias (WCT) present significant diagnostic and therapeutic challenges to the emergency physician. WCT may represent a supraventricular tachycardia with aberrant ventricular conduction; alternatively, such a rhythm presentation may be caused by ventricular tachycardia. Other clinical syndromes may also demonstrate WCT, such as tricyclic antidepressant toxicity and hyperkalemia. Patient age and history may assist in rhythm diagnosis, especially when coupled with electrocardiographic (ECG) evidence. Numerous ECG features have been suggested as potential clues to origin of the WCT, including ventricular rate, frontal axis, QRS complex width, and QRS morphology, as well as the presence of other characteristics such as atrioventricular dissociation and fusion/capture beats. Differentiation between ventricular tachycardia and supraventricular tachycardia with aberrant conduction frequently is difficult despite this clinical and electrocardiographic information, particularly in the early stages of evaluation with an unstable patient. When the rhythm diagnosis is in question, resuscitative therapy should be directed toward ventricular tachycardia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. Non-pharmacological termination of a supraventricular tachycardia.patients with re-entrant supraventricular tachycardias frequently attend casualty departments for termination of their rhythm. With the advent of adenosine in the physician's pharmaceutical armoury, the ease and effectiveness of vagal stimulation is being forgotten.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/11. hypersensitivity reaction associated with acute hepatic dysfunction following a single intravenous dose of procainamide.Rare cases of hepatotoxicity have been attributed to the antiarrhythmic agent procainamide. We here describe the case of a patient who had a hypersensitivity reaction to procainamide with fever, chills, arthralgia, abdominal pain and acute elevations of serum aminotransferase activities and bilirubin concentration. The reaction occurred after the patient had received a large intravenous dose during cardiac electrophysiological testing. This case should alert physicians to potential hepatotoxic reactions to procainamide, particularly with the increasing popularity of cardiac electrophysiological testing, during which this drug is commonly used.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/11. A case of a borderline-broad complex tachycardia.Prompt and correct treatment of broad complex tachycardias in the emergency department can often be life-saving to the patient and satisfying for the emergency physician. They, however, are often a diagnostic challenge. Here, we present a case of posterior fascicular ventricular tachycardia, an idiopathic form of ventricular tachycardia that occurs in patients without coronary artery disease and verapamil sensitive. The differential diagnoses of posterior fascicular ventricular tachycardia and supraventricular tachycardia with aberrancy will also be discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/11. adenosine use during pregnancy.adenosine is a naturally occurring endogenous nucleoside that suppresses atrioventricular nodal conduction time, terminates supraventricular tachycardia, and restores sinus rhythm. Its use has been reported in children and adults but not in pregnant patients. This case documents the successful termination of a supraventricular tachycardia in a 39-week pregnant hypotensive patient. Emergency physicians may wish to consider adenosine use in pregnant patients needing emergency therapy or when conventional therapy fails.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/11. Untoward reaction to adenosine therapy for supraventricular tachycardia.adenosine, a naturally occurring nucleoside that slows conduction through the atrioventricular node, has recently been approved for the treatment of supraventricular tachycardia. It has been shown to convert patients with supraventricular tachycardia to sinus rhythm in up to 92% of cases. Its intravascular half-life of only 10 seconds and absence of reported serious side effects have made adenosine an attractive antiarrhythmic agent. This report describes two cases in which significant side effects from the administration of adenosine were encountered including: (1) prolonged sinus arrest with syncope, and (2) syncope with prolonged bradycardia and hypotension. Emergency physicians should be cognizant of the potential complications resulting from adenosine administration, and should be prepared to deal with them when using this newly available agent.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/11. Evaluation and management of supraventricular tachycardia in children.Emergency physicians may be called on to resuscitate acute complications in pediatric patients with congenital heart disease. Supraventricular tachycardia, with or without hemodynamic decompensation, is one of the most serious complications. We present the case of a 22-month-old boy with a history of single ventricle who presented to our institution with a history of syncope and hemodynamically stable supraventricular tachycardia. Initial attempts at pharmacologic conversion with propranolol and verapamil failed. The arrhythmia was terminated in response to an IV fluid bolus and dopamine infusion and probably resulted from a combination of anemia, hypovolemia, and impaired contractility. Appropriate evaluation and management relating to the cre of acute supraventricular tachycardia in children are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/11. Polymorphic ventricular tachycardia.The case of a patient with torsade de pointes in the setting of congenital complete heart block is described. Lack of recognition of this polymorphic ventricular tachycardia resulted in therapy that potentiated the dysrhythmia. After correct recognition, and directed therapy, the patient responded appropriately. The clinical settings, recognition, and management options available for torsade de pointes are discussed to familiarize the emergency physician with this important and unique dysrhythmia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/11. Cardiotoxicity related to 5-fluorouracil chemotherapy: a report of two cases.5-fluorouracil (5-FU) is a chemotherapeutic agent which has been used to treat many solid tumors including cancers of the breast, ovary, cervix, bladder, prostate gland and gastrointestinal tract. Side effects related to the drug include bone marrow suppression, stomatitis, nausea, vomiting and diarrhea. However another less frequent but lethal event cardiotoxicity--appears to have been ignored by physicians. Recently, two cases of cardiac toxicity induced by 5-FU have been encountered here. One patient developed supraventricular tachycardia and the other illustrated silent myocardial infarction with congestive heart failure. Since these side effects may result in death when 5-FU is prescribed to those patients who have had previous heart disease or are concomitantly receiving inevitable radiotherapy over the cardiac region, it should be recommended with extreme caution.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/11. Development of ventricular fibrillation after intravenous calcium chloride administration in a patient with supraventricular tachycardia.The i.v. administration of calcium before or shortly after treatment of supraventricular tachycardia with verapamil has been suggested to counteract a hypotensive response to verapamil. We discuss the case of a patient who presented to the emergency department with an accelerated wide-complex tachycardia and minimal symptoms. Immediately after i.v. administration, of 1 g calcium chloride as pretreatment for verapamil administration, ventricular fibrillation developed. Emergency physicians should be aware of potential dangers after the administration of i.v. calcium preparations when trying to prevent known hypotensive side effects of i.v. verapamil administration.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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