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Journal Reading EMG

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  Introduction ã Broad QRS complex tachycardia (BCT):  – 12 lead ECG is a diagnostic challenge  – Differential Diagnosis: ã VT ã SVT with aberrant conduction ã Pre-existing bundle branch block (BBB) ã Intraventricular conduction disturbances, or pre-excitation. ã VT is the most important differential diagnosis:  – Least favourable prognostic value  – Accurate Dx/ + immediate Th/ is required.  – Delay or misdiagnosing: inappropriate of i.v drugs used for the treatment of SVT (verapamil and adenosine): VF and cardiac arrest.  ã Several criteria have been described for the differentiation between VT and SVT with a wide QRS complex. ã This paper will briefly review the most recognized criteria. Introduction  History and physical examination ã VT: most common cause of regular BCT (up to 80%) ã Positive predictive value:  – history of prior MCI (98%), CHF (100%), and recent angina (100%) ã Age > 35 years has a sensitivity of 92%. ã Mostly,  – VT does not respond to carotid sinus massage (CSM)  – Reentrant SVT usually slows down and may stop with CSM  – CAMP-related VT that terminates with CSM has also been reported
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